The 2017 American Medical Association (AMA) House of Delegates meeting
took place in June, under the shadow
of the impending release of the Senate
Republican health care bill. Of prime
interest to pediatricians and the AAP
delegation is the fate of Medicaid.
After a spirited debate and discussion
led by the AAP delegation’s Melissa
Garretson, M.D., FAAP, the House of
Delegates adopted new policy stating
that the AMA “oppose caps on federal
Medicaid funding” and “advocate that
Congress and the Department of Health
and Human Services seek and take into
consideration input from our AMA and
interested state medical associations, na-
tional medical specialty societies, gov-
ernors, Medicaid directors, mayors and
other stakeholders during the process
of developing federal legislation, reg-
ulations, and guidelines on Medicaid
The initial AMA report had discussed
principles to guide negotiations for proposed chang-
es to the program, which would have put children
covered by Medicaid at risk. The Academy submit-
ted five resolutions for AMA consideration that were
1. “Coverage for Preventive Care and Immunizations” states that the AMA advocate that all
public and private payers be required to provide first dollar coverage of routine preventive
pediatric care, as recommended by the Academy and the American Academy of Family Physicians (AAFP), and immunizations, as recommended by the Centers for Disease Control
and Prevention (CDC), the AAP and AAFP.
2. The AMA reaffirmed its support of payment
parity for all Medicaid services at Medicare
3. In response to the opioid epidemic, and specifically addressing adolescent access to these
drugs of abuse, the AAP resolution titled “Safe
Use, Storage, and Disposal of Leftover Opioids and other Controlled Substances” was
4. A resolution was adopted calling for the AMA
to advocate that the Centers for Medicare &
Medicaid Services (CMS) publish relative
value units (RVUs) for all covered and non-covered and bundled services. CMS does not
list associated RVUs for about 20 services that
it defines with a Current Procedural Terminology code. These services include common
pediatric procedures such as instrument-based
ocular screening and application of topical fluoride varnish. If RVUs are not listed, health
plans often choose to not pay for the service.
5. The AMA adopted a resolution that advocates
for the inclusion of developmental disabilities
curriculum in undergraduate, graduate and
continuing medical education of physicians.
Additional AMA resolutions of interest to pediatricians that were adopted include the following:
In response to concerns that the federal administration may propose new vaccine policy based on
unfounded information, the AMA adopted new
policy that supports the rigorous scientific review
process of the CDC’s Advisory Committee on Immunization Practices, recognizes the substantial
body of scientific evidence that has disproved a link
between vaccines and autism, and opposes creation
of a federal commission that would study an association between autism and vaccines.
AMA policy was adopted that acknowledges the
adverse effects of sugar-sweetened beverages and
supports evidence-based strategies to reduce their
consumption. Strategies include excise taxes, removing options to purchase in schools, restrictions
on marketing to children and informing consumers
about the adverse health effects of sugar-sweetened
There were multiple resolutions related to concerns about President Trump’s proposed travel ban
and the potential impact on international medical
students and graduates. The House of Delegates accepted a multiple-part resolution that affirmed the
contributions and value of international medical
graduates and opposes laws and regulations denying
entry or re-entry to these individuals.
The Council on Medical Education
submitted four reports, including
the annual update on Maintenance
of Certification (MOC) and Osteopathic Continuous Certification. A
resolution was adopted that updated
the AMA policy on MOC stating that
lifelong learning for a physician is a
fundamental obligation of the profession and is best achieved by ongoing
participation in a high-quality continuing medical education program
appropriate to that physician’s medical practice as determined by the relevant specialty society.
Additional language that asked the
AMA to work with state medical associations and specialty societies to bar
health plans and hospital associations
from utilizing the American Board of
Medical Specialties-sponsored MOC
process for credentialing was referred
to the AMA Board of Trustees for a future report. MOC programs continue
to evolve in a positive way based on
physician feedback, and some specialties are satisfied
with their MOC program, most often where the
high stakes, proctored exams were discontinued.
The AMA adopted resolutions on the role physicians can play in combating the commercial sexual
exploitation and human trafficking of minors, consideration of the health and welfare of U.S. minor
children in deportation proceedings against their undocumented parents, and providing care to women
and children in family immigration
detention and opposing expansion of
Dr. Barone is chair of the AAP delegation to the AMA House of Delegates.
Members of the AAP delegation include (from left to right): Carol D. Berkowitz, M.D.,
FAAP; Matthew E. Lecuyer, M.D., FAAP; Ajanta Patel, M.D., FAAP; Charles Barone
II, M.D., FAAP; David T. Tayloe Jr., M.D., FAAP; Melissa J. Garretson, M.D, FAAP;
Samantha L. Rosman, M.D., FAAP; and Toluwalase Ajayi, M.D., FAAP. Not pictured are: Zarah Iqbal, M.D., FAAP, medical student delegate; AAP President-elect
Colleen Kraft, M.D., FAAP; CEO/Executive Vice President Karen Remley, M.D.,
M.B.A., M.P.H., FAAP; and Mark Del Monte, J.D., chief deputy, senior vice
president, Advocacy and External Affairs.
Celiac disease clinical guide
A new clinical guide, https://clinical.celiac.
org/, provides sequential management decisions and interventions to diagnose and treat
pediatric celiac disease.
Pediatricians can follow evidence-based
step-by-step questions to assess whether a
patient’s symptoms and test results point to
the disease. People with a parent, child or
sibling with celiac disease have a one in 10
risk of developing the disease.
The online guide was developed by the
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
and the Celiac Disease Foundation.