HOD 2013: CMA delegates set policy at annual meeting

More than 500 California physicians convened in Anaheim Oct. 11-13 for the 2013 House of Delegates (HOD), the annual meeting of the California Medical Association (CMA). Each year, physicians from all 53 California counties, representing all modes of practice, meet to discuss issues related to healthcare policy, medicine and patient care, and to elect CMA officers.

Over 90 resolutions were introduced and debated in reference committees on Friday, Oct. 11. Over the next two days, the complete HOD met again to debate and vote on reference committee recommendations. Sixty-three resolutions were adopted.

As a first step toward a “virtual” reference committee process that will enable a shorter, two-day meeting in future years, Reference Committee A (Science and Public Health) conducted all testimony online in advance of the meeting. All CMA members were invited to participate in the debate, and nearly 300 online comments were recorded. The committee members then met via web conference in advance of the meeting to develop their recommendations, which were presented to the HOD for floor debate on Saturday afternoon.

The HOD also elected a new president, Paradise internist Richard Thorp, MD. Humboldt surgeon Luther Cobb, MD, was tapped as president-elect.

Summaries of some of the resolutions that were adopted as policy appear below. The full actions of the HOD are available to members at www.cmanet.org/hod , under the Documents tab.

Increased reporting of immunizations

Resolution 104-13

The delegates approved a resolution that encourages increased reporting of patient immunizations to the California Department of Public Health for purposes of vaccination, disease control and prevention.

HIV and STDs: Consent requirements for testing

Resolution 109-13

The delegates voted to support revision of HIV consent requirements to allow all healthcare providers to order a test for HIV when appropriate and to encourage routine HIV testing for all patients who are evaluated for other sexually transmitted diseases.

Graphic health warnings on tobacco products

Resolution 115-13

Delegates called on CMA to support the use of graphic image labeling on cigarette and other tobacco packaging that warns of the health impact of smoking.

Legal blood alcohol limit for drivers

Resolution 118-13

Delegates endorsed the National Transportation Safety Board’s 2013 recommendation that the legal blood alcohol limit for operating a motor vehicle be decreased from .08% to .05% or lower.

Food insecurity screening

Resolution 122-13

The delegates directed CMA to promote that providers need to identify children and adults who are food insecure to avoid detrimental development and comorbidities and to refer them to appropriate programs and services.

Elimination of CMS outpatient observation status

Resolution 211-13

The delegates directed CMA to request that the Centers for Medicare and Medicaid Services (CMS) eliminate its “outpatient patient observation” status, which is placed upon patients whose anticipated hospital stay is 48 hours or less. Delegates noted that this practice places undue financial burden on patients and creates administrative hassles for physicians.

Health exchange benefit designs and tax deductibility of out-of-pocket expenses

Resolution 401-13

The delegates called on CMA to support efforts to develop benefit designs in the health benefit exchange that appeal to the young and healthy to boost the risk pool; and to support legislation allowing federal and state income tax deductibility of all out-of-pocket healthcare expenses.

Reimbursement for telephone/electronic patient management

Resolution 407-13

The delegates asked that CMA support legislation requiring health insurance companies to pay physicians for telephone or other electronic patient management services.

National health information exchange

Resolution 501-13

The delegates called on CMA to support the development of a secure, interoperable, nationwide health information exchange network.

Deatiled descriptions of selected resolutions:

Delegates push for increased reporting of immunizations

The CMA House of Delegates passed a resolution directing the association to encourage and promote the reporting of immunizations to the California Department of Public Health for purposes of vaccination, disease control and prevention (Res. 104-13).

“More accurate tracking of immunizations would lead to improved vaccination rates, reduce duplicative health services and improve the health of all Californians,” wrote one delegate in online testimony.

Nearly one in four children sees more than one immunization provider by age two. In fact, the chart in the child’s most recent medical home is accurate only 62 percent of the time.

With increased reporting, public health departments can better identify people who are at risk in the event of a disease outbreak or other emergency such as hurricanes, earthquakes, floods or man-made disasters. They can also help locate communities with low coverage rates so that they can provide targeted interventions to increase coverage rates and protect more people from disease.

CMA supports reduced blood alcohol limit for drivers

The CMA House of Delegates voted to endorse the National Transportation Safety Board’s 2013 recommendation that the legal blood alcohol limit for operating a motor vehicle be decreased from .08% to .05% or lower (Res. 118-13).

According to the National Transportation Safety Board (NTSB), each year in the United States, nearly 10,000 people are killed in crashes involving alcohol-impaired drivers and more than 173,000 are injured, with 27,000 suffering incapacitating injuries. Since the mid-1990s, even as total highway fatalities have fallen, the proportion of deaths from accidents involving an alcohol-impaired driver has remained constant at around 30%.

Research shows that although impairment begins with the first drink, by .05% blood alcohol content most drivers experience a decline in both cognitive and visual functions, which significantly increases the risk of a serious crash. Currently, over 100 countries on six continents have limits set at .05% or lower. The NTSB has asked all 50 states to do the same.

CMA supports graphic image labeling on cigarettes

The CMA House of Delegates overwhelmingly voted to support graphic image warning labels on tobacco packaging that depict the very real health impact of smoking (Res. 115-13).

The U.S. Centers for Disease Control and Prevention rolled out a series of graphic advertisements in 2012, which featured startling photos of the health consequences of smoking. National smoking cessation hotlines and websites saw a doubling of calls and a fivefold increase in web visits while the ads were running.

The United States Food and Drug Administration has also proposed placing such images on cigarette packaging as a deterrent to smoking and a stimulus to cessation, but was stopped by legal challenges from the tobacco industry.

The resolution also directs CMA to urge courts to also support such labeling.

“Family physicians support the required use of graphic warnings and statements on cigarette packages and advertisements as an important step toward reducing the existing and future use of tobacco products,” wrote one delegate in online testimony. “Warnings help counter the $12.5 billion cigarette manufacturers spend marketing their products each year. More than two dozen countries already require similar packaging for cigarettes.”

CMA has been a tireless advocate for stronger restrictions on the tobacco industry for decades. In 1970, 1978 and 1980, CMA supported ballot initiatives that would have banned smoking in many public places. In 1987, CMA took on its biggest tobacco-related challenge and won, with the passage of Proposition 99, which established a 25-cents-per-pack tax on cigarettes and a tax hike for other tobacco-related products.

Delegates weigh in on exchange grace period

Members of the CMA House of Delegates took a stance on the 90-day grace period provision called for in the Affordable Care Act (ACA), an issue that has been rapidly evolving in response to CMA’s continued advocacy.

The resolution (Res. 402-13) was amended by delegates during floor debate to reflect recent state and federal actions regarding the grace period provision. The resolution, as adopted by the House, calls for heightened standards for information provided to physicians regarding enrollees in the state’s health benefit exchange, as well as a provision emphasizing CMA’s position that physicians should not be compelled by payors to participate in exchange products.

As initially proposed, the ACA’s grace period posed considerable risk to physicians participating in exchange products, potentially exposing them to two months of suspended and/or denied claims if a patient is delinquent on their insurance premiums. Recently, however, California’s Department of Managed Health Care has asserted that patients falling under the grace period provision would have coverage suspended after the first 30 days, and that insurance companies could not represent this coverage as active to the participating physician. The patient would then have the second and third months to pay the premium balance and have coverage reinstated.

Given that the grace-period provision has been a concern to physicians across the country and California is the only state thus far to move forward on the suspension of coverage issue, the matter was also referred to the American Medical Association for national action.