The 2012 SFMS delegation to the California Medical Association’s (CMA) annual House of Delegates meeting took a wide range of proposed resolutions for consideration by the statewide gathering. Each resolution, some with modification, moved important health care issues forward in the areas of health care delivery, health care mandates, and pharmaceutical industry issues, including medication disposal and insurance coverage.
Our roster of policy proposals this year, with outcomes, included:
Tracking Prescriptions to Curtail Medication Abuse (Rokeach, Loring, Turner): CMA supports the development of a fully functional, Web-based prescription drug monitoring program (PDMP), whether it be an improved CURES (Controlled Substances Review and Evaluation System) program or a new one that should be fully funded, including through a fee-per-prescription paid by manufacturers and suppliers of drugs monitored.
Reducing Overutilization: Physician Leadership (Denys, Fung, Eng): CMA supports physician-led, evidence-based efforts to improve appropriate use of medical services and will educate physicians, hospitals, health care leaders, and patients about the need for physician-led, evidence-based efforts to improve appropriate use of medical services. This resolution originally referred to the “Choosing Wisely” effort that will be the topic of the January/February 2013 edition of San Francisco Medicine.
"Pay for Delay" Practices on Generic Medications (Susens): CMA will ask AMA to support federal legislation that makes tactics delaying conversion of medications to generic status, also known as “pay for delay,” illegal in the United States. As noted in a recent NEJM piece, that might already be the case!
Increasing Utilization of POLST Orders (Newman, Schickedanz, Lopato): CMA encourages physicians to become educated about all aspects of the POLST form and to integrate discussions about, and use, POLST in all appropriate instances where medical services are provided to patients at the end of life. Surprisingly to many, this was perhaps the most hotly debated resolution of the year, as our original allowed for nurse practitioners to fill out POLST forms for physician confirmation, as is done in some other states.
Medical Mandates for Insurance Coverage and Medi-Cal (Chan): CMA supports the principle that mandated coverage for private insurers should also apply to publicly financed entities, when appropriate; and will advocate that the state legislature must budget for the increased cost to Medi-Cal and enrollees of the California Health Benefit Exchange when passing mandated coverage.
Promoting Quality and Transparency in Graduate Medical Education (Schickedanz): CMA supports efforts to urgently address the anticipated imbalance between the number of medical school graduates and available residency training positions; and greater transparency at all levels in the calculation, distribution, and tracking of graduate medical education (GME) funding; and will petition the Centers for Medicare and Medicaid Services to address perceived disparities in the distribution of GME funding.
Cell Phone Use in Cars (Udovic-Constant, Fouras): CMA will support public education efforts regarding the dangers of distracted driving, particularly activities that take drivers’ eyes off the road, and will ask the AMA to do likewise. Our original was more forceful, asking for more severe penalties and even bans.
There was much more, with something of interest to every specialty, practice setting, and personality.
Interested in submitting a resolution or suggesting a resolution idea for 2013 HOD? Please contact SFMS at email@example.com.
Frustrated with the vagaries of today's health care system? Would you like to see something done to fix it? Do you have some new and/or innovative policy ideas you would like to share? The SFMS delegation to the CMA House of Delegates (HOD) would like your input about issues and concerns you have as a San Francisco physician.
The SFMS delegation has long had a significant impact on CMA policy, which can have a real world influence on state and national policy. We develop resolutions on any issue related to medicine and public health, and welcome ideas from any SFMS member.
The CMA House of Delegates is the CMA policy-making body that represents physicians statewide. The delegates meet once a year to establish CMA policies on key issues that affect the practice of medicine, from medical ethics to critical matters of public health. SFMS will once again send a full delegation to this year’s meeting. Our delegates share the responsibility of representing the voices of San Francisco family physicians, their patients, and the communities in which they live.
Resolutions adopted at past HODs include banning sugar drinks in schools, establishing regulation of e-cigarettes, granting minor access to obtain preventative treatment for STIs without parental consent, and assisting students and residents with medical education debt.
By Steve Heilig, MPH
Contraception exploded onto the front pages this month. That might seem strange to most people—what is controversial about contraception at this late date? One headline read “Changes to Contraceptive Coverage Rules Draw Mixed Reaction” and that one wins the ‘understatement’ award on this topic.
“Conservatives” seized on the issue as a potentially good wedge issue to attack President Obama on various fronts, and hoped that it would somehow awaken some version of the good old moral majority to political action. Yet almost all women, including Catholics, ignore their putative religious leaders on this issue, and always have—when they have a choice. And most men support that practice. In letters and online comments, the most incisive perspectives seem to come mostly from women—political leaders, doctors, nurses, social workers, and just plain folks.
The New York Times editors noted that Catholic authorities were trying to have it both ways, claiming all the special financial privileges of a church but wanting to ignore any strings that might be attached, however compassionate those might be. Others observed that behind this debate was specter of abortion politics—even though the one proven way to reduce abortions is to make contraception as easily available as possible.
Amongst politicos, the gender split seemed to hold true as well. Three female senators wrote to the Wall Street Journal defending the contraceptive mandate. Some female politicians even felt compelled to boycott the male-dominated House hearing on the topic.
In the GOP candidate’s race, Romney sought whatever position he could sell to the most people; Santorum, consistent at least, already opposes contraception, perhaps not surprising for a guy who thinks women working is a “radical feminist” plot. Irrelevant cranks Ron Paul and Newt Gingrich made statements that were aptly ignored.
Kris Long, a nurse writing in the New York Times likely had it best: “As a former employee of a Catholic-run hospital, I find it appalling that the party of ‘individual rights’ would stand up for a religious bias rather than for the non-Catholic employees who are deprived of the right to choose health insurance commensurate with the private needs and beliefs. Why should I not be allowed birth control through my insurance because my boss has a problem with it?”
Strangely enough, organized medical voices have been muted in this heated debate. But the contraceptive mandated did not spring anew out of the White House health reform plan. It is an old idea, long supported among healthcare policy wonks and, last summer, given strong endorsement by perhaps the highest medical authority in the land, the Institute of Medicine (IOM) of the National Academy of Sciences. Their report “Clinical Preventive Services for Women: Closing the Gaps” focuses on preventive care for women, including but not limited to contraception. In medical circles it was hardly controversial and seemed to be greeted in the clinical trenches with an “OK, now make it happen” sentiment, as is often the case with rational, evidence-based medical recommendations.
Given that, and sensing that the IOM recommendations might be more controversial in non-scientific arenas, I thought it might be good to have a strong statement of support from the medical organizations I work with, and drafted the statement below for the San Francisco Medical Society’s policy-making body:
Contraception as a Fully-Covered Health Insurance Benefit
Whereas, the United States Institute of Medicine in July 2011 strongly recommended that “the full range of FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity” be a fully covered benefit of all health insurance plans; and
Whereas, the costs of contraception have long been identified as a barrier to many women’s optimal use of contraception, with negative impacts on their health and in terms of unwanted pregnancies, as well as discriminatory implications; and
Whereas, The Federal administration has just mandated that contraception be a covered benefit, but health insurance industry representatives have voiced their opposition to this measure and might try to repeal it; now be it
RESOLVED: That the California Medical Association supports the coverage, without co-payments, of all FDA-approved contraception methods as a mandated health benefit of all health plans.
True to form, this statement was noncontroversial among the 20+ physicians of various specialties who reviewed it and three physicians signed on as co-authors—all of them women (I am omitting their names here to protect them from the scary minority), but we could have added men as well. The statement then went to the annual policy-making meeting of the California Medical Association (CMA)—a much larger and often more conservative bunch, made up of hundreds of doctors from all over the state.
We thought there might be some opposition there, but in the open debate, the CMA physicians even strengthened the final statement to include voluntary sterilization. Thus, here is one of the nation’s largest state medical association’s concise position on this matter:
RESOLVED: That the California Medical Association supports the coverage, without co-payments, of all FDA-approved contraception methods and sterilization as a mandated health benefit of all health plans.
Simple, direct, and medically correct, regarding a private medical matter between women and their physicians.
As for the rest of those pundits weighing in, mostly male and including religious figures and politicians, I can’t help but be again reminded of what pioneering lawyer and yes, feminist Florynce Kennedy once quipped, “If men could get pregnant, abortion would be a sacrament.”
The importance of this mandate is highlighted in The New York Times report this week showing that Catholic control of hospitals in some areas is growing, with resultant restrictions on some services.
I also can’t help but note that a recent report from the widely-respected group Save the Children confirmed what has long been known—one out of four children already here on this planet are malnourished, and many of them are starving to death around the world, at a rate of one every five minutes.
Some would say these issues are related. The Catholic church does much good in the world; some of my best friends are Catholic (seriously). But on this topic, pundits have pointed out that for all the fire and brimstone directed by church leaders against the contraceptive mandate, they tend to be much less vehement when politicians propose policies that seemingly violate other teachings about war, inequality, compassion and empathy for the poor. I respectfully wonder if Catholic and political leaders opposed to contraception could meditate on that for a moment, and instead of fulminating against one of the only solutions we have for helping women live better lives—and to prevent abortions—they might devote their time and energy towards alleviating this ongoing tragedy of suffering in the world. And—a novel idea—perhaps they could listen to what doctors think as well. Once can hope so, but I will not hold my breath.
Originally published on sfgate.com/San Francisco Chronicle blog on February 21, 2012.
The SFMS Delegation, along with hundreds of California physicians, convened in Anaheim this past weekend for the 2011 CMA House of Delegates. The CMA HOD is an annual conference where all 53 California counties, representing all modes of practice, meet to discuss issues related to health care policy, medicine and patient care, and to elect CMA officers. A shortlist of the newly approved policies are posted below, all of which stemmed from SFMS submitted resolutions.