Jan. 10, 2020 (ACP) – The abrupt closure of Philadelphia's Hahnemann University Hospital and its displaced residents and fellows, e-cigarettes, gun violence, and LGBTQ inclusivity all took center stage at the annual American Medical Association (AMA) delegates meeting in Chicago.
The Philadelphia Academic Health System, LLC, the parent company of Hahnemann University Hospital, filed for Chapter 11 bankruptcy in June 2019, and as a direct result, 570 doctors-in-training must now scurry to find new placements. “This has never happened before and serves as a cautionary tale,” said Dr. William Golden, who chairs the American College of Physician's delegation to the AMA House of Delegates. “There are lots of concerns about private equity-bought practices and hospitals and what this means to patients and physicians.”
To help financially and professionally protect residents and fellows who were displaced by Hahnemann's closure as well as those who may be impacted by future teaching hospital closures, the AMA adopted a new policy calling for secure medical liability insurance “tail coverage.” “The bankrupt company wasn't going to buy malpractice insurance for the house staff so they could be stuck with all sorts of legal issues, and if they don't buy a ‘tail’ on their own, they may not get appropriate licensure or work in their new locations,” Golden said.
The AMA is also working with the Centers for Medicare & Medicaid Services to establish regulations that will help protect residents and fellows affected by training program closures. Moreover, the international medical residents at Hahnemann are at risk for being deported. J-1 cultural exchange visas require active contracts with a hospital, so if international residents and fellows can't find new placements within 30 days of losing their jobs at Hahnemann, they'll have to leave the country, Golden said. The AMA is asking the U.S. Department of State and U.S. Citizenship and Immigration Services to waive the grace-period requirement.
Vaping Ban, LGBTQ Issues
The AMA House of Delegates also voted to ban the sale and distribution of all e-cigarette and vaping products except those approved by the U.S. Food and Drug Administration for smoking cessation and made available by prescription only. The group also called for more undergraduate and graduate training on how to care for populations from diverse sexual orientations and gender identities such as the LGBTQ community.
There was a push for research on gun violence, Golden said. “In the past, the AMA would duck and cover from gun violence and now they are embracing the need for the medical profession to be out in front of this issue,” he said. “There is greater interest on the health impact of global warming too.”
“The bigger picture is that the AMA and ACP are becoming more aligned with their beliefs and goals than in the past,” Golden added. “The AMA is increasingly becoming more moderate in its policies and adopting many items consistent with ACP policy.”
Dr. Doug DeLong, chair of the ACP Board of Regents, addressed the AMA Internal Medicine Caucus and Section Council during the meeting. Calling the 2020 Medicare Fee Schedule “a historic win for internal medicine,” he said that the increased payments for Evaluation and Management (E/M) Services and decreased documentation requirements underscore the value of primary care doctors and the services they provide. He highlighted the role that ACP played in advocating for these changes.
But, he cautioned, there may still be some pushback from other physician groups. ACP is asking members to let their representatives in Congress know that the E/M changes are vital and should be supported.