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Health Care Policy Analysis derived from the Farewell remarks from AMA President Jack Resneck Jr., MD | AMA 2023 Annual Meeting

Curators: Aviva Lev-Ari, PhD, RN, Stephen J. Williams, PhD and Prof. Marcus W. Feldman

Article ID #301: Health Care Policy Analysis derived from the Farewell remarks from AMA President Jack Resneck Jr., MD | AMA 2023 Annual Meeting. Published on 6/10/23

WordCloud Image Produced by Adam Tubman

Bot Name: ChatGPT, GPT-4

Date of Update: 07/03/2023
Programmer’s Name: Frason K.
Human Verifier: Aviva Lev-Ari & Dr. Stephen J. Williams

On June 10, 2023, I watched the video, below which represents the delivery of the Farewell remarks from AMA by the AMA President, Jack Resneck Jr., MD at the AMA 2023 Annual Meeting on 6/10/2023.

Watch the Video

https://www.youtube.com/watch?v=dGEGH5IwOaE

Download PDF Transcript

https://www.ama-assn.org/system/files/a23-resneck-speech.pdf

Upon completion of watching this video, I concluded that I should include it as an embedded video in this article as a new Audio Podcast in our Library of 300 “Interviews with Scientific Leaders” same title of a research category in the ontology of LPBI Group’s PharmaceuticalIntelligence.com Journal.

The context for the decision made in favor of embedding the video of AMA President, Jack Resneck Jr., MD, Farewell remarks from AMA at the AMA 2023 Annual Meeting on 6/10/2023 is one of Policy Analysis of the Health Care system in the US in 2023.

Aligned with this decision was to qualify Dr. Resneck Jr, MD speech to be an equivalent to an “Interview with a Scientific Leader in the domain of Health Policy” to be included in LPBI Group’s Library of 300 audio podcast Interviews planned to be published in July 2023.

Key points made by Dr. Resneck Jr, MD in the video

>> Dangerous external attacks engulfing our profession

  • anti-science aggression,
  • disinformation,
  • payment cuts,
  • many practice burdens driving burnout
  • growing number of states and courts forcing themselves into the most intimate and difficult conversations patients and physicians

The challenges facing the medical profession and delivery of care by Providers:

  • A dysfunctional health care environment, and
  • The climate of anti-science aggression

 

In his own words: Dr. Resneck Jr, MD

We need to fix what’s broken in health care, and it’s NOT the doctor.

The Wisconsin Supreme Court agreed with us that patients and judges can’t force physicians to administer substandard care.

Courts have invalidated parts of No Surprises Act rules that plainly ignored Congressional intent and put a thumb on the scale to favor insurance companies… thank you Texas Medical Association and AMA!

The 5th Circuit Court is staying- for now – an egregious ruling that would have stripped patients of the right to access preventive care service with no out-of-pocket costs, a key piece of the Affordable Care Act.

The U.S. Supreme Court is delaying attempts by a single district judge with no scientific or medical training to take mifepristone off the market nationally and upend our entire FDA drug regulatory process.

We’ve helped shift the national conversation about protecting patient data and making sure digital health and AI tools are proven BEFORE being deployed.

We’ve broadened and intensified our work to embed equity and racial justice, and to push upstream to affect structural and social drivers of health inequities.

The AMA doesn’t win every battle. But we are more resolute in our work because of the threats to our profession and our patients.

I’m still appalled by the Medicare cuts. What on earth was Congress thinking? Practices are on the brink. Our workforce is at risk. Access to care stands in the balance

  • Physician burnout

One in five physicians plans to leave their practice within two years, while one in three is reducing hours.

Only 57 percent of doctors today would choose medicine again if they were just starting their careers.

two in five physicians go beyond mere daydreams of another career to wishing they had never chosen this path in the first place

And shame on political leaders, fueling fear and sowing division by making enemies of public health officials, of transgender adolescents, of physicians doing anti-racism work, and of women making personal decisions about their pregnancies.

The burnout and the moral injury are real … I’ve felt it myself. I hear this concern in the voices of medical students, residents, and even young physicians when they ask me … “Am I going to be okay?” “Have I made the right career choice?”

  • Medicare payment reform for “a dilapidated Medicare payment system”

fighting for long overdue fixes to a broken Medicare payment system, and obnoxious prior auth abuses, even when policymakers have neglected the problems for decades.

We absolutely must tie future Medicare payments to inflation, and we’re readying a major national campaign to finally achieve Congressional action.

Linking physician payment to inflation is an absolute top priority, an existential must to keep practices afloat, and pillar #1 of our plan. An important step on that path was the recent introduction of a bipartisan bill to finally align the Medicare fee schedule with MEI.

key role in legislation to extend Medicare Telehealth coverage.

State after state is making progress to constrain prior authorization, and CMS issued rules to do the same in Medicare Advantage plans.

Medicaid work requirements that conflict with AMA policy were kept out of the debt ceiling bill.

  • Scope of practice expansions

In partnership with states and specialties, our advocacy has helped protect patients from outrageous and broad scope expansions more than 50 times so far this year.

defending against broad scope expansions that put patients at risk, even when it requires gearing up again and again, in state after state.

When politicians force their way into our exam rooms Interfering with the sacred patient-doctor relationship is about CONTROL. : battling in state legislatures and courthouses for the very soul of our nation and our profession – to protect patients from those outside influences wanting to dictate the terms of their care … …telling them what medical treatments their physicians can provide … …what FDA-approved medicines we can prescribe…. …even what words we can use …

I loved traveling to Mississippi and witnessing their progress from startling COVID inequities to achieving one of the nation’s top vaccination rates among Black residents.

And we have been instrumental in helping create confidential wellness programs for physicians and removing outdated questions from past impairment from licensing and credentialing forms.

  • Gun Violence Victims – Preventable and needless homicides and suicides continue, and the political inaction is atrocious.

But solid majorities of Americans believe in commonsense gun reforms in line with our AMA recommendations.

You wouldn’t know it from 20 state legislatures racing to criminalize abortion and rob women of access to reproductive health care… But most people in this country support our policies and the fundamental rights of patients to make their own decisions about their health.

>> AMA Recovery Plan for America’s Physicians: https://bit.ly/AMA_RecoveryPlan

 

>> Insurance impact on delivery of care by providers

m health insurers still bullying us with prior auth delays and denying care …

We’ve joined others in suing Cigna for shortchanging doctors and patients.

The Voice of Dr. Stephen J. Williams

     The outgoing president of the AMA, Dr. Jack Resneck, gives an impassioned speech about his concerns for the present and future of medicine, his profession, and the issues which will face future physicians, and all involved in healthcare.  These issues have been building up for decades now in the U.S. and his remarks hopefully will be taken more to heart by those who can enact change, instead of wafting in the ongoing partisan debates in Washington.  He eventually outlines the actions which could be taken but ultimately laments the inaction of many parties involved, including business, the political class, and his own physician profession.  Dr. Resneck rightly states that the AMA must carry the burden of equitable and sustainable healthcare into the future and must continue the fight in this regard.  He likens this fight for equitable and sustainable medicine like a marathon, where there is no defined end, no finish tape for medical professionals except to persevere in their task.

However, there are more extraneous issues to the profession where the physician has to

get back up, shake the dust off, and keep running

He notes some of the problems occurring not in direct control of the profession are

  • the constant onslaught and tiresome battle against disinformation
  • large insurers
  • a political class that has jeapardized the physician/patient relationship with either their action and inaction
  • the financial burdens placed on the small physician practice of rising third party “inflators” like higher rents, increased drug prices, higher operating costs

These laments have been felt by many parallel professions where the standards and practice to the profession have been subjugated and hijacked by other outside interests (middle men).  And when the ultimate decisions of conduct are not governed by the constituents or stakeholders of the profession but by a cadre of business people, profiteers or social engineers problems like this result.  As such, Dr. Resneck sees the draconian Medicare cuts as such an onslaught.  This has been voiced in an earlier posting describing how these problems have crept in the biomedicine and biotech field as well as in medical care in Can the Public Benefit Company Structure Save US Healthcare?

One must consider then, as Dr. Resneck had, is it time to reinvent the healthcare structure in this country to allow more equitable, sustainable delivery of healthcare and to stave off a potential crisis in the number of physicians staying in the profession?  As such he had suggested the AMA move forward with their “revival plan” in order to force legislation to reform Medicare as well as individual regulatory reform.  To date there has been some success by the AMA to this effect, but as he eluded to, these efforts have been rather piecemeal instead of an overall reform.

The Voice of Aviva Lev-Ari, PhD, RN

Gun Violence, all should not have to happen and burden the care delivery system designed to deal with chronic and acute diagnoses.

As Supervisor of a Long Term Acute Hospital in Waltham, MA in 2010:

  • I became familiar with care plans of patients victims of gun violence and the life long disabilities cause by ONE gun shot to the brain or to the spine. Accidents that are preventable and needless.

I found Dr. Resneck’s  address to be a call for continuation of a long term fight the AMA is involved in, with all the constituents of the Medical profession. They are very many and very powerful:

  • Big Pharma,
  • FDA,
  • State and Federal legislators,
  • HMOs,
  • Health Insurers,
  • For-profit, and
  • not-for-profit institutions

all having interests that are private and public and often conflicting ones, chiefly are the following:

  • Gun reforms made impossible by The National Rifle Association (NRA)’s supporters linking the defense to bear arms with the Constitution
  • 20 state legislatures racing to criminalize abortion and rob women of access to reproductive health care…
  • Drug pricing and Insurance denying coverage
  • Need for redesign of the Curriculum of in Medical School to include the rapid change in technology, medical devices, knowledge base in life sciences and more

 

The Voice of Prof. Marcus W. Feldman

mfeldman@stanford.edu

Dr Resneck’s talk has three components: two are rather pessimistic and concern Medicine as a profession and Health-care as a goal of medicine. The positive part, which was quite brief, concerned the continuing work of the AMA in its advocacy for better conditions for physicians and for a more equitable distribution of health care.

Medicine as a part of science continues to be assailed by anti-science political groups. 57% of doctors surveyed said they would not choose Medicine as a profession if given the chance to relive their lives. Part of this is the failure of Medicare and other insurance mechanisms to properly compensate physicians. Part is due to attacks on the profession by anti-science anti education social media and state legislatures. Whereas Medicine was once the profession of choice for the best students, universities are seeing the premed majors overtaken by computer-related fields. Dr. Resneck also referred to the importance of maintaining high standards of medical ethics, which is increasingly difficult in today’s political and economic climate.

With respect to the specifics of health care, Dr. Resneck stressed the attack on the medical professions by laws and regulations that outlaw people rights to their own bodies, manifest in anti-abortion and anti-gender affirming procedures, anti-education book banning, political opposition to measures, supported by the majority of Americans, that would reduce gun violence, and the difficulty of achieving improvements in government procedures for reimbursement of health care services. The AMA is involved in trying to elicit medically sound decisions on these.

Dr Resneck was positive, if not very optimistic about the AMA’s important role in advocacy for reform of Medicare and the Health-Care system, reform that is essential for the sustainability of Medicine as a profession.

 

We recommend AMA to add to their Library resources from LPBI Group:

A. PharmaceuticalIntelligence.com Journal, 6,170 articles

B. BioMed e-Series in Five specialties of Medicine in English and Spanish – 37 books

https://pharmaceuticalintelligence.com/five-bilingual-biomed-e-series/

C. e-Proceedings and Tweet Collection of top 100 Conferences in Medicine and Biotech

https://pharmaceuticalintelligence.com/press-coverage/part-two-list-of-biotech-conferences-2013-to-present/

D. Gallery of Images, N = +6600

E. Library of 300 Audio Podcasts

https://pharmaceuticalintelligence.com/audio-podcasts/

 

SOURCES from AMA

In his outgoing remarks to the AMA House of Delegates, AMA President Jack Resneck Jr., M.D., acknowledged the challenges facing the medical profession, including burnout, Medicare payment reform, and scope of practice expansions. He highlighted the importance of unity and perseverance in advancing the profession’s goals and how the AMA is aligned in the fight with the AMA Recovery Plan for America’s Physicians. Learn more about the AMA Recovery Plan for America’s Physicians: https://bit.ly/AMA_RecoveryPlan Get exclusive updates on the AMA Annual meeting: https://bit.ly/AMA_Meeting2023 The AMA is your powerful ally in patient care. Join now. https://bit.ly/AMAJoinRenew — Follow the AMA on YouTube: @americanmedicalassociation 🎥 Watch AMA Update for the latest in health care news for physicians: https://bit.ly/AMA_Update ✉️ Subscribe to AMA Morning Rounds newsletter, with the news you need every morning delivered to your inbox: https://bit.ly/AMA-MorningRounds 🎧 Listen to our latest podcast episodes now: https://bit.ly/AMA_Podcasts 📱 Download AMA Connect for news, podcasts, video updates and learning in one place: https://apple.co/3URzNES #physicianadvocacy #futureofhealthcare #medicine #amarecoveryplan #scopeofpractice #physicianburnout #telehealth #telemedicine #fightingfordocs

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Live Conference Coverage Medcity Converge 2018 Philadelphia: Clinical Trials and Mega Health Mergers

Reporter: Stephen J. Williams, PhD

1:30 – 2:15 PM Clinical Trials 2.0

The randomized, controlled clinical trial is the gold standard, but it may be time for a new model. How can patient networks and new technology be leveraged to boost clinical trial recruitment and manage clinical trials more efficiently?

Moderator: John Reites, Chief Product Officer, Thread @johnreites
Speakers:
Andrew Chapman M.D., Chief of Cancer Services , Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital
Michelle Longmire, M.D., Founder, Medable @LongmireMD
Sameek Roychowdhury MD, PhD, Medical Oncologist and Researcher, Ohio State University Comprehensive Cancer Center @OSUCCC_James

 

Michele: Medable is creating a digital surrogate biomarker for short term end result for cardiology clinical trials as well as creating a virtual site clinical trial design (independent of geography)

Sameek:  OSU is developing RNASeq tests for oncogenic fusions that are actionable

John: ability to use various technologies to conduct telehealth and tele-trials.  So why are we talking about Clinical Trials 2.0?

Andrew: We are not meeting many patients needs.  The provider also have a workload that prevents from the efficient running of a clinical trial.

Michele:  Personalized medicine: what is the framework how we conduct clinical trials in this new paradigm?

Sameek: How do we find those rare patients outside of a health network?  A fragmented health system is hurting patient recruitment efforts.

Wout: The Christmas Tree paradigm: collecting data points based on previous studies may lead to unnecessary criteria for patient recruitment

Sameek:  OSU has a cancer network (Orion) that has 95% success rate of recruitment.  Over Orion network sequencing performed at $10,000 per patient, cost reimbursed through network.  Network helps pharma companies find patients and patients to find drugs

Wout: reaching out to different stakeholders

John: what he sees in 2.0 is use of tech.  They took 12 clinic business but they integrated these sites and was able to benefit patient experience… this helped in recruitment into trials.  Now after a patient is recruited, how 2.0 model works?

Sameek:  since we work with pharma companies, what if we bring in patients from all over the US.  how do we continue to take care of them?

Andrew: utilizing a technology is critically important for tele-health to work and for tele-clinical trials to work

Michele:  the utilization of tele-health by patients is rather low.

Wout:  We are looking for insights into the data.  So we are concentrated on collecting the data and not decision trees.

John: What is a barrier to driving Clinical Trial 2.0?

Andrew: The complexity is a barrier to the patient.  Need to show the simplicity of this.  Need to match trials within a system.

Saleem: Data sharing incentives might not be there or the value not recognized by all players.  And it is hard to figure out how to share the data in the most efficient way.

Wout: Key issue when think locally and act globally but healthcare is the inverse of this as there are so many stakeholders but that adoption by all stakeholders take time

Michele: accessibility of healthcare data by patients is revolutionary.  The medical training in US does not train doctors in communicating a value of a trial

John: we are in a value-driven economy.  You have to give alot to get something in this economy. Final comments?

Saleem: we need fundamental research on the validity of clinical trials 2.0.

Wout:  Use tools to mine manually but don’t do everything manually, not underlying tasks

Andrew: Show value to patient

2:20-3:00 PM CONVERGEnce on Steroids: Why Comcast and Independence Blue Cross?

This year has seen a great deal of convergence in health care.  One of the most innovative collaborations announced was that of Cable and Media giant Comcast Corporation and health plan Independence Blue Cross.  This fireside chat will explore what the joint venture is all about, the backstory of how this unlikely partnership came to be, and what it might mean for our industry.

sponsored by Independence Blue Cross @IBX 

Moderator: Tom Olenzak, Managing Director Strategic Innovation Portfolio, Independence Blue Cross @IBX
Speakers:
Marc Siry, VP, Strategic Development, Comcast
Michael Vennera, SVP, Chief Information Officer, Independence Blue Cross

Comcast and Independence Blue Cross Blue Shield are teaming together to form an independent health firm to bring various players in healthcare onto a platform to give people a clear path to manage their healthcare.  Its not just about a payer and information system but an ecosystem within Philadelphia and over the nation.

Michael:  About 2015 at a health innovation conference they came together to produce a demo on how they envision the future of healthcare.

Marc: When we think of a customer we think of the household. So we thought about aggregating services to people in health.  How do people interact with their healthcare system?

What are the risks for bringing this vision to reality?

Michael: Key to experience is how to connect consumer to caregiver.

How do we aggregate the data, and present it in a way to consumer where it is actionable?

How do we help the patient to know where to go next?

Marc: Concept of ubiquity, not just the app, nor asking the provider to ask patient to download the app and use it but use our platform to expand it over all forms of media. They did a study with an insurer with metabolic syndrome and people’s viewing habits.  So when you can combine the expertise of IBX and the scale of a Comcast platform you can provide great amount of usable data.

Michael: Analytics will be a prime importance of the venture.

Tom:  We look at lots of companies that try to pitch technologies but they dont understand healthcare is a human problem not a tech problem.  What have you learned?

Marc: Adoption rate of new tech by doctors is very low as they are very busy.  Understanding the clinicians workflow is important and how to not disrupt their workflow was humbling for us.

Michael:  The speed at which big tech companies can integrate and innovate new technologies is very rapid, something we did not understand.  We want to get this off the ground locally but want to take this solution national and globally.

Marc:  We are not in competition with local startups but we are looking to work with them to build scale and operability so startups need to show how they can scale up.  This joint venture is designed to look at these ideas.  However this will take a while before we open up the ecosystem until we can see how they would add value. There are also challenges with small companies working with large organizations.

 

Please follow on Twitter using the following #hashtags and @pharma_BI

#MCConverge

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