AMA House Calls for Continued Flexibility of Telehealth Regulations Beyond the Pandemic
Abstract
APA leaders testified during the virtual meeting of the House of Delegates in support of making permanent the flexibilities that have been adopted around telehealth during the pandemic.
At its virtual meeting last month, the AMA House of Delegates approved policy advocating for widespread adoption of telehealth services by physicians and physician-led teams beyond the COVID-19 pandemic.
The resolution was one of dozens of new policies on public health, physician practice and payment, and medical education adopted by the House. Among those was a resolution outlining principles for protecting residents when the institution where they are training closes (see box below).
The resolution on telehealth calls for the Centers for Medicare and Medicaid Services (CMS), other federal and state agencies, and the health insurance industry to provide equitable coverage that allows patients to access telehealth services whether at home or elsewhere.
“APA supports permanently maintaining a number of the telehealth flexibilities that have been implemented.” — Theresa Miskimen, M.D.
Testifying on the telehealth resolution, Theresa Miskimen, M.D., an APA delegate to the Section Council on Psychiatry, cited a recent APA poll showing that 62% of Americans are experiencing more anxiety now compared with this time last year (see Psychiatric News).
“We know that we need mental health and substance use treatment more than ever,” she said. “APA supports permanently maintaining a number of the telehealth flexibilities that have been implemented. We also support Congressional action to remove the geographic restrictions.”
Maintaining telehealth flexibilities beyond the pandemic will “ensure a smooth transition to in-person care and increase telehealth access.” Such access, she said, “is especially important for mental health and substance use treatment, where the ability to establish and maintain a strong, uninterrupted therapeutic alliance with patients is critical to ensure effective interventions for all payors.”
AMA Seeks to Protect Residents Whose Training Institutions Close
The AMA House of Delegates last month approved a resolution outlining the AMA’s principles for protecting residents when their training institution closes. The resolution was a response to last year’s abrupt closing of Hahnemann University Hospital in Philadelphia, resulting in more than 500 residents having to relocate to other institutions. Hahnemann was the primary academic partner for Drexel University College of Medicine.
The new policy calls for the Centers for Medicare and Medicaid Services to stipulate in its regulations that residency slots are not assets that belong to the teaching institution. It also encourages the Association of American Medical Colleges (AAMC), American Association of Colleges of Osteopathic Medicine, and the National Resident Matching Program to develop a process similar to the Supplemental Offer and Acceptance Program that could be used when a teaching institution or program is suddenly closed.
Under the new policy, the AMA will also take the following steps:
Encourage the Accreditation Council on Graduate Medical Education (ACGME) to specify that sponsoring institutions are to provide residents and residency applicants information regarding the financial health of the institution, such as its credit rating, or if it has recently been part of an acquisition or merger.
Work with the AAMC, ACGME, and relevant state and specialty societies to collaborate on the communication with sponsoring institutions, residency programs, and resident physicians in the event of a sudden institution or program closure.
Encourage the ACGME to revise its Institutional Requirements to state that sponsoring institutions must maintain a fund to ensure professional liability coverage for residents in the event of an institution or program closure.
Continue to work with the ACGME to monitor issues related to training programs run by corporate entities and the effects on medical education.
Ken Certa, M.D., APA’s senior delegate to the Section Council on Psychiatry and former psychiatry residency training director at Thomas Jefferson University in Philadelphia, was familiar with the tumultuous events surrounding Hahnemann’s closing.
“Graduate medical education funding for teaching hospitals will continue to be an issue, as many hospitals are bleeding money because of the pandemic, and it is likely that more hospitals will be in a precarious position,” he told Psychiatric News. “The AMA has now outlined some guideposts for making sure people in training will not be left in the lurch as they were when Hahnemann went under.”
Certa said that the AMA was active in advocating for trainees at the time of Hahnemann’s closing. “The only ones looking out for residents were the AMA and the medical specialty societies.”
Delegates also approved a report by the AMA’s Council on Science and Public Health calling cannabis “a dangerous drug and … a serious public health concern” that should not be legalized. The report says that states that have already legalized cannabis (for medical or adult use or both) should be required to take steps to regulate the product effectively to protect public health and safety.
“There is no current scientific evidence that cannabis is in any way beneficial for the treatment of any psychiatric disorder,” testified APA President-elect Vivian Pender, M.D. “In contrast, current evidence supports, at minimum, a strong association of cannabis use with the onset of psychiatric disorders. Adolescents are particularly vulnerable to harm, given the effects of cannabis on neurological development.
“Further research on the use of cannabis-derived substances as medicine should be encouraged and facilitated by the federal government,” Pender said. “The adverse effects of cannabis, including, but not limited to, the likelihood of addiction, must be simultaneously studied.”
The possibility of enactment of a “public option” in the next administration was the source of vigorous debate. Delegates adopted a report of the Council on Medical Service stating that the “primary goals of establishing a public option are to maximize patient choice of health plan and maximize health plan marketplace competition.”
The report delineates these other AMA priorities for any public health option:
Eligibility for premium tax credit and cost-sharing assistance to purchase the public option should be restricted to individuals without access to affordable employer-sponsored coverage.
Physician payments under the public option should be established through meaningful negotiations and contracts and not be tied to Medicare and/or Medicaid rates.
Physicians should have the freedom to choose whether to participate in the public option.
There should not be subsidies for public option that give it an advantage over other health plans.
Six months after the killing of George Floyd at the hands of Minneapolis police, Delegates debated several resolutions around racial bias and adopted new policy calling racism “a threat to public health.” The policy requests the AMA to identify a set of best practices for health care institutions, physician practices, and academic medical centers to address and mitigate the effects of racism on patients, international medical graduates, and other health care professionals.
Dionne Hart, M.D., an alternate APA delegate to the House of Delegates, spoke to the House about the effect of police brutality on public health. “According to a 2019 report from the U.S. Department of Justice Bureau of Justice Statistics, Black residents are more likely to experience both street and traffic stops,” said Hart. “The presumption of threats by officers increases levels of chronic stress among minority populations who are impacted by these volatile police interactions. Black Americans are three times more likely than White Americans to be killed by police and account for over 40% of victims of police killings nationwide. In this past year alone, 1,020 Black people have been shot and killed by police. Black men are especially likely to be imprisoned. Black Americans have lived with these risks that were largely ignored while community leaders with the power to make a change, including members of law enforcement, have dismissed or ignored these real concerns.”
Hart is a member of the APA Council on Government Relations and AMA representative to the National Commission on Correctional Healthcare. ■
Resolutions and reports approved by the AMA House of Delegates are posted here.
