Overview

The American Medical Association (AMA) is the largest association of physicians and medical students in the United States. Made up of physicians from all different specialties and subspecialties, the AMA sets standards for the medical profession and advocates on policy issues on behalf of physicians and patients.

The AMA has recognized ASCO as a national specialty society, offering ASCO the ability to advocate on behalf of the oncology community. ASCO has the opportunity to participate in a number of important AMA activities that set policy priorities, coding and billing practices, and recommendations for physician reimbursement, including:

• AMA House of Delegates (HOD)
• AMA’s Current Procedural Terminology (CPT®) Editorial Panel and the CPT® Advisory Committee
• AMA’s Relative Value Scale (RVS) Update Committee (RUC)

This ASCO in Action brief is the first of a series that explores ASCO’s work with the AMA on behalf of the oncology community. This brief will provide a high-level overview of ASCO’s participation in the AMA; future briefs will dive deeper into key AMA activities that directly impact ASCO members and their patients.

AMA House of Delegates

The House of Delegates (HOD) is the principal policy-making body of the AMA, and meets twice each year (June and November) to establish the Association’s policy priorities. During each meeting, the HOD considers the most pressing policy issues related to the practice of medicine. National and state medical societies, as well as national specialty societies, introduce resolutions to address particular policy issues. After reference committees review each resolution, delegates have the opportunity to deliver testimony in support or opposition to each resolution. The HOD amends or votes on each resolution, and if accepted, the resolution becomes part of the AMA’s policy platform.

ASCO sends appointed delegates to each HOD meeting to:

• Ensure that the needs of the oncology community are heard by colleagues from across the wider medical community
• Learn about issues that are affecting those colleagues
• Help to shape a broad and influential advocacy platform

The AMA HOD is comprised of more than 500 voting delegates from all 50 states and U.S. territories. AMA delegates represent federal service organizations (U.S. Air Force, U.S. Army, U.S. Navy, U.S. Department of Veterans Affairs, and U.S. Public Health Service), professional interest associations (such as the Resident and Fellow Section, Women Physicians Section, and International Medical Student Section), and more than 170 national medical specialty societies, including ASCO. Each member organization receives a number of delegates based on an organization’s AMA membership. Currently ASCO has two AMA delegates that attend HOD meetings to represent ASCO members. A third delegate represents ASCO in the Resident and Fellow Section. ASCO also has two alternate delegates that regularly attend the AMA HOD meetings to help cover the significant amount of work at the meetings.

ASCO, through its delegates and staff, has played an active role in shaping AMA policy. In 2016, for example, five resolutions submitted or supported by ASCO were incorporated into the AMA’s policy platform:

• Medicare Part B Demonstration: Directed AMA to oppose the Part B Model and work with Congress to block the demonstration from moving forward.
• United States Pharmacopeia Convention’s (USP) 800: Directed AMA to advocate against certain sections of USP General Chapter 800.
• Clinical Pathways: Required AMA to support the development of transparent, collaboratively constructed clinical pathways that: (a) are implemented in ways that promote administrative efficiencies for both providers and payers; (b) promote access to evidence-based care for patients; (c) recognize medical variability among patients and individual patient autonomy; (d) promote access to clinical trials; and (e) are continuously updated to reflect the rapid development of new scientific knowledge. 
• MACRA and High-Cost Drugs: Directed AMA to work with Congress and the Centers for Medicare & Medicaid Services (CMS) to exempt all Medicare Part B and Part D drug costs from resource use measurement mechanisms, including Merit-based Incentive Programs (MIPS) and Alternative Payment Models (APMs).
• Opioids: Directed AMA to advocate against arbitrary prescription limits that restrict access to medically necessary pain treatment for patients with cancer or a terminal diagnosis. The resolution also required AMA to work with the Centers for Disease Control and Prevention (CDC) to provide leeway in the interpretation of new guidelines for prescribing opioids when treating patients with cancer-related pain.

In addition to its work with the full HOD, ASCO leads the AMA Cancer Caucus, which provides an important forum for delegates to address ongoing cancer-specific issues and to discuss ASCO’s position on key resolutions.

ASCO also supports candidates for key AMA positions, including the Board of Trustees and important councils. Recently, ASCO endorsed Dr. Barbara McAneny for 2017 AMA President-elect. If elected, Dr. McAneny would be the first oncologist to serve as President of the organization.

By participating in the House of Delegates, ASCO ensures that the entire medical community hears the oncology perspective and that AMA advocates on behalf of oncologists and patients with cancer.

AMA Current Procedural Terminology (CPT®) Editorial Panel and the CPT® Advisory Committee

Current Procedural Terminology codes (CPT® codes) are used to report outpatient and office procedures. The CPT® data set was originally developed over 50 years ago “to provide health care professionals with a uniform language for medical coding and medical billing.” The AMA CPT® Editorial Panel is responsible for ensuring codes are up-to-date and reflect the latest medical care provided to patients. The panel meets three times each year to review the CPT® code set, make additions and modifications, and delete certain codes that are no longer relevant to patient care. Members of the panel are appointed by the AMA and nominated by national specialty societies. ASCO periodically has a member on the CPT® Editorial Panel.

The CPT® Panel asks for direct input from practicing physicians, medical device manufacturers, developers of diagnostic tests, and the CPT® Advisory Committee. ASCO also participates in the CPT® Advisory Committee, whose members are nominated by national medical specialty societies. ASCO’s CPT® advisor has three primary responsibilities in the CPT® Editorial Process:

1. Prepare and present CPT® code applications and revisions applicable to ASCO members and the oncology community.
2. Review and comment on other applications before the Panel meetings.
3. Assist with the ASCO Relative Value System (RVS) Updated Committee (RUC) advisor activities.

AMA Relative Value Scale (RVS) Update Committee (RUC)

The AMA RUC Committee is a group of 31 multi-specialty physicians that reviews the resources (practice expense and physician work) necessary to provide medical services. The RUC makes recommendations to CMS as it considers the relative value units (RVUs) for each CPT® code. Although the process is complex and nuanced, it directly impacts the reimbursement from Medicare and other insurers for services physicians provide.

The above diagram illustrates the RUC process and the events that trigger a review of the CPT® codes. To trigger a review of the CPT®, either CMS requests a review of the codes or the CPT® Editorial Panel makes changes to a code (or codes).

When appropriate, ASCO participates in this process by conducting a survey of its members on behalf of the RUC to understand the resources needed to perform the specific service. Using the results of the survey, ASCO’s advisors develop recommendations and present those recommendations to the RUC. For example, ASCO recently presented recommendations on 10 drug administration codes (including the new pegfilgastrim on-body injector) to the RUC for consideration.

After the RUC determines the appropriate values of each CPT® code, their recommendations are forwarded to CMS for review. CMS reviews the RUC’s recommendations and makes the final determination about the RVUs.

ASCO’s Current AMA Representatives

ASCO currently sends two delegates to the AMA House of Delegates: Edward P. Balaban, DO, FACP, FASCO, and Thomas Marsland, MD, FASCO. The society also has two HOD alternate delegates: Ray Page, DO, PhD, FACOI and Kristina Novick, MD. The society’s Resident and Fellow Section Delegate is Steve Y. Lee, MD.

ASCO’s RUC advisor is David Regan, MD, FASCO, who has served as the primary RUC advisor for 13 years. Elizabeth Blanchard, MD was appointed as alternate RUC advisor for ASCO in 2015. ASCO’s CPT® Advisor is Christian Thomas, MD. The CPT® and RUC advisors and delegates for HOD are appointed by ASCO and also serve on ASCO’s Clinical Practice Committee.

To learn more about ASCO’s work with the House of Delegates, please read Dr. Balaban’s blog on ASCO Connection.