ASE and the AMA House of Delegates (HOD)

By Michael Main posted 12-20-2016 11:18


The AMA House of Delegates (HOD) is the principal policy-making body of the AMA and sets the legislative and regulatory priorities for the AMA. Through Dr. Peter Rahko’s leadership, ASE was able to obtain full delegate status in 2013 and he continues to ensure echo has a voice in this process.

The AMA House of Delegates Interim Meeting was held on November 12-15, 2016 and several topics of concern to ASE were addressed. Dr. Rahko reported that there were several resolutions regarding studying the Affordable Care Act, all written before the election. Considering the election results, it is now uncertain how these resolutions will be incorporated into the AMA’s legislative and regulatory agenda. However, it is clear that the AMA will be actively pursuing and looking for input about implications of the new administration’s stance on the Affordable Care Act and/or its successor. Several resolutions regarding MACRA and MIPS were also introduced; most focused on small practices and were generally in concert with CMS’ more liberal interpretation of low-volume practices based upon numbers of patients and dollar thresholds.

There was also some discussion regarding Recovery Audit Contractor (RAC) audits. There are some indications that RAC audits may increase in number/frequency in the near future, and specifically there is concern that RAC audits frequently do not abstract information from the full report text but only form major headings. This may have implications, for instance, for echo reports, where the abstractors may only look at the final conclusions or summary and not the body of the report

ASE joined ACC and HRS in introducing Resolution 925. This resolution mandates graphic warning labels on cigarette packages.  It was adopted by the HOD on the last day of the meeting.

Board Report 6 changes the designation of specialty society representation and seeks to establish parity between States and Specialties.  Dr. Rahko mentioned that the HOD adopted the report after several years of discussion and debate.  This report recommends adoption of a new methodology for determining specialty society delegate allocation.  Under these new requirements, states get one delegate for every 1000 AMA members and this determines the total number of delegates.  Specialties will also get one delegate for every 1000 AMA members.  The total number of specialty society delegates would be adjusted up or down annually to equal the number of delegates allocated to state societies.  However, specialty societies will continue to be reviewed every five years and must meet specific requirements to remain in the HOD.  Most specialty societies will only be allocated one delegate.  If ASE numbers hold, under these new requirements the society will qualify for two delegates when this policy goes into effect.  Please note, specialty societies must also maintain greater than a 50% physician membership to qualify for HOD membership.

With full delegate status ASE is updated and included in the AMA’s efforts. We are offered the opportunity to sign on to legislative and regulatory communications from the AMA and briefed on legislative and regulatory developments by AMA staff, invited to participate in AMA sponsored workshops and workgroups, and  encouraged to share resources.

Delegate status also provides ASE with full representation before CPT/RUC. This has contributed to some of ASE’s more recent substantial advocacy successes. Since achieving full delegate status ASE has worked to create three new CPT™ codes for echocardiography: interventional TEE, myocardial strain, and myocardial perfusion. ASE has also had the opportunity to deliver well-received presentations when the transthoracic echo and stress echo codes were reviewed by RUC this year. RUC recommendations are not final, but ASE is cautiously optimistic. A final decision from CMS is expected in November 2018.