Special Meeting of the AMA House of Delegates

Delegates Address COVID-19 Pandemic on Multiple Fronts

November 25, 2020, 10:54 am David Mitchell -- As the nation’s number of COVID-19 cases topped 12 million and the death toll surpassed 250,000, U.S. physicians took steps to address the pandemic during a recent Special Meeting of the AMA House of Delegates.

“I compare this with what we do in the Army – AAR, or after action review – where we prepare a structured review analyzing what happened, why it happened and how it can be done better,” she said. “We must not let this crisis go to waste. We must learn from this and use the lessons learned to make sure that we move past this and ensure that we are prepared for any future pandemics.”

COVID-19 Vaccines

The AAFP delegation offered an amendment, which was accepted, to a resolution that was adopted regarding COVID-19 vaccination programs. The resolution called for the AMA to “institute a program to safeguard the integrity” of a COVID-19 vaccination program by countering misinformation and addressing public anxiety through patient education materials and educating physicians about speaking with patients regarding the vaccine.

The resolution also called for the formation of a coalition of medical organizations committed to developing and implementing a joint public education program.

The Academy’s amended language noted that patient education materials should be created with “the historical context of ‘experimentation’ with vaccines and other medications” on minorities.

“It was important for us to propose that language because there is lingering mistrust due to the history of medical mistreatment and experimentation in people of color,” Stewart said. “Our Academy recognizes the importance, now more than ever, that we must provide evidence-based, culturally appropriate education to our diverse patient population, which looks to us for guidance.”

The resolution also called for the AMA to support monitoring of COVID-19 vaccines to ensure that evidence continues to support their safe and effective use.

Financial Relief

Stewart said many Academy members, especially those in solo and independent practices, have seen their practice suffer substantial financial difficulties during the pandemic. Thus, the AAFP delegation supported a resolution adopted by delegates that called on the AMA to work to “improve and expand various federal stimulus programs,” such as the Coronavirus Aid, Relief and Economic Security Act and the Medicaid Purchase Plan. The resolution called for the AMA to advocate for

• restarting the Medicare Advance payment program, including reducing the interest rate and lengthening its repayment period;
• expanding the CARES Act Provider Relief Fund and working to ensure that a significant share of funding is made available to physicians regardless of the type of patients they treat; and
• reforming the Paycheck Protection Program to ensure flexibility in how such funds are spent and lengthening the repayment period.

The resolution also called on the AMA to advocate for loan forgiveness for medical school debt in light of the financial strain on physicians during the pandemic.

Telehealth

Delegates adopted an alternate resolution that called on the AMA to continue to advocate for the widespread adoption of telehealth services “for physicians and physician-led teams post-SARS-CoV-2.”

The resolution also called for the AMA to advocate for state and federal governments and private payers to adopt clear and uniform standards relating to telehealth services that permanently

• provide equitable coverage that allows patients to access telehealth services wherever they are located;
• provide for the use of accessible devices and technologies, with appropriate privacy and security protections, for connecting physicians and patients; and
• promote continuity of care by preventing payers from using cost-sharing or other policies to prevent or disincentivize patients from receiving care via telehealth from the physician of their choice.

However, delegates referred multiple resolutions and amendments related to the much-debated resolutions for further study, including a resolve regarding “equitable payment for telehealth services that are comparable to in-person services.”

According to an AAFP survey, more than 80% of family physicians started providing virtual visits for the first time during the pandemic, and nearly 70% expressed interest in continuing to provide virtual care when the crisis ends.

“Telehealth is here to stay, and we must address issues surrounding the use of telehealth now,” Stewart said.

Racism

Delegates also took action on numerous issues not specifically related to COVID-19, including adopting new policy that directs the AMA to recognize racism as a serious threat to both public health and the advancement of health equity, and a barrier to appropriate medical care. They also directed the AMA to acknowledge that “racism and unconscious bias within medical research and health care delivery have caused and continue to cause harm to marginalized communities and society as a whole.”

Furthermore, delegates directed the AMA to

• support the development of policy to combat racism and its effects;
• encourage governmental agencies and nongovernmental organizations to increase research funding related to racism;
• encourage the development, implementation and evaluation of undergraduate, graduate and CME programs and curricula that engender greater understanding of the causes, influences and effects of racism; and
• identify a set of best practices for health care institutions and practices to recognize, address and mitigate the effects of racism.

The AAFP already has adopted policies related to race-based medicine and institutional racism.