More than 500 California physicians convened in San Diego for the 2014 House of
Delegates (HOD), the annual meeting of the California Medical Association (CMA).
Each year, physicians from all 53 California counties, representing all specialties
and modes of practice, meet to discuss issues related to medical practice, public
health, health economics and finance – and much more.
Physician delegates to the CMA are elected by each county medical association,
the number based upon the number of members. We strive to have our twenty-person
delegation reflect SFMS with respect to specialty, practice setting, demographics,
and so forth. Any SFMS member can run for the delegation, and any member at
all can draft a resolution for consideration. The SFMS delegation has a long
history of being disproportionately influential; our proposals have become CMA
and AMA policy on many issues, including AIDS, reproductive health, antibiotic
use, drug policy, environmental health, and much more. The import of this is
that these policies guide CMA and AMA lobbying—and those are powerful
presences in Sacramento and Washington. Our efforts have positively impacted
countless patients and physician practices, and that’s why we persist.
Some of the issues and new policies SFMS spearheaded include:
Electronic Cigarettes: CMA now supports a ban on the advertising
of electronic cigarettes and other nicotine delivery devices not approved by
the FDA as smoking cessation aids; believes that e-cigarettes should be regulated,
at the state and local level, consistent with tobacco products until such time
that they are approved by the FDA as smoking cessation aids; supports education
of the public on the known and potential health impacts of electronic cigarettes
and other nicotine delivery devices; and proposes that electronic cigarettes
be taxed to generate funds, which could be used for, but not be limited to,
1) support for research into their efficacy as smoking cessation aids and their
health impacts and 2) education on their known and potential health impacts.
Vaccination: To increase child vaccination rates, CMA supports the
development and evaluation of educational efforts, based on scientific evidence
and in collaboration with health care providers, to support parents who want
to help educate and encourage reluctant parents to vaccinate their children.
This is, alas, timely given the recent identification of clusters of unvaccinated
kids and the increase in parents opting out of vaccination for unsupportable
reasons. CMA also adopted policy to discontinue allowing such personal exemptions.
Contraception as a Mandated Health Benefit: CMA supports state
and federal efforts to require the inclusion, without copayments, of all FDA-approved
contraception methods and sterilization as a mandated health benefit in all
Regulation of Commercial Genetic Testing: CMA supports the
Food and Drug Administration’s regulation of commercialized genetic testing
services as medical services and devices and urges that the highest standards
of accuracy, risk versus benefit, patient informed consent, privacy, and marketing
be applied in reviewing, approving, and regulating such testing technology and
services, to minimize misleading genetic information and waste of clinical time
to interpret it.
POLST Orders and Nurse Practitioners: To improve use of Physician
Orders for Life-Sustaining Treatment (POLST) forms, CMA will advocate for the
policy used in other states, that appropriately trained nurse practitioners/advance
practice nurses and physician assistants be authorized to complete and sign
POLST orders, with review by the patient’s supervising physician as appropriate,
for any patients unless otherwise specified by physicians or medical staff policies.
This was a “third-time’s a charm” success for us as fears
about “scope of practice” issues had to be addressed.
Reimbursement for End-of-Life Counseling: CMA urges that all
public and private health care insurers be required to cover, at a reasonable
reimbursement rate, counseling for end- of-life care planning as an accepted
and integral part of good medical care. This is in response to the specious “death
panel” charge that removed such reimbursement from the ACA; Medicare is
now implementing such codes, but private insurers should also.