Health Policy Report: Medical Policy-Making 2014

House of Delegates

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.

HOD RogerChild 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 health plans.

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.

Click here to view the full list of the new policies adopted at the 2014 CMA House of Delegates.