AMA | Plastic surgery societies come together at AMA House of Delegates

In November, the AMA House of Delegates (HOD) conducted its interim meeting (I-17) in Honolulu, Hawaii. HOD meetings provide an opportunity for the Plastic Surgery Caucus to gather, strategize and work in unison to monitor and impact AMA policy that matters to the specialty. Seventeen members attended the Plastic Surgery Caucus, which is comprised of representatives from the American Association for Hand Surgery, American Association of Plastic Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, and the American Society of Maxillofacial Surgeons.

While the interim meeting is generally focused on advocacy issues, in preparation for the event, the ASPS delegation reviewed 30 Council reports and more than 90 resolutions divided among five reference committees. Resolutions of interest to the Caucus included:

• a request for the AMA to aggressively and immediately advocate to ensure that both the procedure and evaluation and management codes are paid at the full allowable payment rate when appropriately reported with a modifier -25. This resolution had broad support at the meeting, with delegates ranging from primary care physicians to surgeons who testified about their experiences with payers. The specialty is highly concerned with the little to no transparency on how the adjusted rates are determined, by 50 percent or more, for services billed correctly per current CPT Coding Guidelines
• a request for the AMA to proactively engage and advocate with any commercial insurance company that proposes to or actually discontinues payment for consultation codes (CPT codes 99241-99245). The AMA was also charged with requesting the company carry out coding education and outreach rather than discontinuing payment for codes they purport are routinely billed in error or abused.
• a request for the AMA to convene an in-person meeting of relevant stakeholders to initiate the creation of a consistent national strategy to oppose the independent practice of non-physicians, including APRNs, physician assistants, and Doctors of Medical Science. This easily gained the support of the House. The AMA was also asked to create public education materials on this issue and work to oppose state and national legislative efforts aimed at inappropriate scope of practice expansion of non-physician practitioners

In addition to these adopted resolutions, steps forward were taken at I-17 on other important issues, including patient notification. While existing AMA policy addresses network adequacy, HOD attendees felt strongly that health insurers who terminate in-network providers should be required to give notice to both the provider and the patient before any action is be taken. Testimony during reference committee meetings as well as at the House included anecdotal reports of payers notifying patients that their provider had been dropped, without ever removing the provider form the network. Providers also shared stories of instances in which they were dropped from a network as a maneuver by the payer to allow payment at the usual and customary dollar amount, rather than reimburse at contracted rates. Regardless of the reason for the change in a provider's network status, all delegates agreed patients need time to arrange for appropriate follow-up care. Ultimately, the House finalized new policy to hold payers to a 90-day notice prior to removal, with 60-day notice prior to distribution of updated lists by payers and 30 days for a physician to respond.

A new Rural Medicine Caucus was unveiled at I-17 to ensure the AMA can better serve the needs of rural physicians and patients in rural or other low-resource settings. HOD attendees were offered learning sessions, ranging from promoting a culture of safety, to addressing physician wellness. The AMA also presented information on its new Leadership Development Institute and opportunities for mentoring final year medical students.

We can expect the 2018 Annual Meeting in June to focus on elections and the inauguration of the incoming president. The Plastic Surgery Caucus expects to receive requests from several candidates, including lending our support to ASPS member Bob Basu, MD as chair-elect of the Surgical Caucus of the AMA.