Posts tagged AGS

“Size Matters Not:” More Progress by AAHPM in the AMA House

The AAHPM Delegation to the American Medical Association (AMA) House of Delegates welcomed back a good friend and effective representative at the AMA’s 2010 Annual Meeting in Chicago, held June 12-15. Dennis S. Pacl, MD FACP – who was instrumental in the securing the Academy’s seat in the House and once served as its delegate – rejoined the team as Alternate Delegate, replacing Ron Crossno, MD CMD FAAFP FAAHPM, who is now focused on serving the Academy as its President Elect. I was pleased to accept the appointment to fulfill Dr. Crossno’s term on the AMA Pain and Palliative Medicine Specialty Section Council (PPMSSC) and will serve as Acting Vice-Chair through November 2010. Aided by key AAHPM staff – including CEO Steve Smith, Jackie Kocinski and Laura Davis – the Academy’s small, but effective delegation enjoyed another active and successful meeting.

Protecting and Expanding Past Achievements

The AMA periodically reviews established policies to ensure their relevance over time. After acceptance of its report on the ethics of palliative sedation to unconsciousness (AAHPM Bulletin, Summer 2008), the AMA’s Council on Ethical and Judicial Affairs (CEJA) planned to “sunset” an older policy that addressed decisions at the end of life. This older policy included concise definitions of key terms used in palliative care and clear statements about the ethics of withholding and withdrawing care outside of the realm of palliative sedation to unconsciousness. The AAHPM Delegation testified about the older policy’s enduring relevance, and the House of Delegates retained it as AMA policy in deference to the Academy’s continuing interest.

The AAHPM Delegation and PPMSSC also offered support to a passed resolution that asked the AMA to recognize, yet again, the benefit of hospice at the end of life and to encourage attending physician collaboration with hospice staff who are caring for their patients. This resolution will result in an AMA study of the Medicare Hospice Benefit and issues related to access issues for eligible patients. Your delegation expects the Academy will be involved in the development of this AMA report.

VA Physicians’ Access to Prescription Drug Monitoring Programs (PDMPs)

In April 2010, a member of the AAHPM Public Policy Committee brought forward for discussion a directive from the U.S. Department of Veterans Affairs (VA) Office of General Counsel (OGC) that restricted VA physicians from participating in state Prescription Drug Monitoring Programs (PDMPs). The OGC directive is based on concerns about patient privacy and informed consent issues inherent to PDMPs. At the AMA meeting, the Kentucky delegation introduced a resolution that opposed the OGC directive, which afforded a welcome opportunity for the AAHPM Delegation to advocate aggressively for Academy members who practice in VA hospitals.

In reference committee hearings, AAHPM testified in favor of Kentucky’s resolution based on three principles. First, the Academy argued that VA physicians should have access to the same prescription data as non-VA physicians as a matter of fairness and equity. Secondly, as evidenced by recent U.S. Food and Drug Administration (FDA) efforts to create a Risk Evaluation and Mitigation Strategy (REMS) for long-acting opioids, all physicians share a role in creating a balance between protecting patients’ legitimate access to controlled medications and assuring the public’s safety; PDMPs represent useful tools for achieving that balance. Finally, the AAHPM noted that while the OCG’s concerns about privacy and consent issues are prudent, they do not automatically trump issues of public safety, civil justice and professional autonomy from an ethical or legal standpoint.

Other Achievements in the AMA House

AAHPM co-sponsored a resolution with the American Geriatrics Society (AGS) and other specialty allies, urging the AMA to recognize an ongoing need for physicians who care for older adults to be competent in geriatric care and encouraging adequate geriatrics training in medical school and graduate education. This resolution passed with broad support, and it parallels Academy efforts to incorporate palliative care education into medical school and graduate curricula.

Lastly, through its involvement in the PPMSSC, AAHPM supported the acceptance of a report by the AMA Council on Science and Public Health (CSAPH) that addressed recent scientific findings on the pathogenesis of neuropathic pain. This included a recommendation for increasing the use of the term “maldynia” and integrating the objective concept of neural injury into the subjective experience of chronic neuropathic pain, a practice that would potentially benefit patients who suffer from disability related to neuropathic pain.

(Any AAHPM members interested in learning more about the work of AMA or joining the AMA should contact Chad Kollas, AMA Delegate, at or Dennis Pacl, AMA Alternate Delegate at

Hospice & Palliative Care at the American Geriatrics Society Meeting

What, if anything, is the relationship between geriatrics and palliative medicine? They are clearly separate fields, each with their own distinct areas of competence and interests. There is though an area of overlap that holds the power to transform the way we care for patients with advanced illness. We saw a preview of this at the American Geriatrics Society annual meeting at Walt Disney World. Here are some highlights:

• Christine Ritchie gave a powerful talk at the fellowship director’s forum on bridging the divide between geriatrics and palliative care. She notes that collaboration makes sense in 2010 as unprecedented gains in life expectancy are leading to an exponential rise in the number of old frail patients with multiple chronic complex diseases. There is high symptom burden and care needs of these patents and their caregivers, and yet they are pitted against a fragmented health care system that is facing enormous financial pressures. Each field has areas of strength that the other can learn from, however this will require mutual respect and, per Dr. Ritchie, a clear recognition of the areas of non-overlap and distinctiveness.

• VJ Periyakoil’s pre-conference workshop on “Updates in Hospice and Palliative Medicine, was not only co-sponsored by AAHPM and AGS, but also used the GeriPal, a geriatrics and palliative care community [], to solicit input prior to her workshop. Are you sad that you missed it? Don’t worry – VJ will also be leading a similar collaborative pre-conference session at the upcoming AAHPM/HPNA meeting in Vancouver.

• Sandra Sanchez-Reilly and Jennifer Kappo led the palliative care SIG. Attendees received an overview of the where the two fields are collaborating from Greg Sachs. We also discussed new possible avenues for collaboration (combined fellowship anyone???)

• Jane Givens won the award for best scientific abstract in the ethics and health disparities section. Look for interesting new findings about the impact of antimicrobial treatment of pneumonia in nursing home patients with advanced dementia – is it associated with longer life? Are there tradeoffs in terms of quality of life? We’ll await the final paper

• Interesting findings from an MSTAR student at Mt. Sinai Tony Vullo suggesting two previously underappreciated barriers to hospice: (1) patients don’t want to give up their current home-care providers, with whom they have established relationships; and (2) patients would receive fewer hours of in-home support than they currently receive if they switch to hospice.

What were your highlights? Leave them as comments below.

by Alex Smith, MD and Eric Widera, MD