The American Medical Association (AMA) gathered physician and medical student leaders at its Annual Meeting on June 9-13, emerging with new policies and guidance on a wide range of pressing healthcare topics.
The new policies adopted on the final day of voting included advocating for new policies on firearm violence, children’s mental health, more oversight of AI in prior authorization, and clarifying the role of BMI as a medical measurement.
The policies adopted by the House of Delegates to address firearm violence include:
Strengthening Background Checks and Preventing Sales of Multiple Firearms to Same Purchaser Within Five Days
Supporting Medical Professionals in Utilizing Extreme Risk Protection Orders to Prevent Firearm Violence Among High-risk Patients
Calling on Social Media Companies to Remove Posts Glorifying Firearm Violence
Under the new policy, the AMA will advocate for federal and state policies that prevent inheriting, gifting, or transferring ownership of firearms without adhering to all federal and state requirements for background checks, waiting periods, and licensure requirements.
Additionally, the AMA adopted policy aimed at including medical professionals as parties who are able to ask a court to prevent someone at imminent risk of harm to themselves or others from purchasing or possessing firearms when there is a high or imminent risk for violence, building on AMA’s policy adopted in 2022 which called for AMA to develop a toolkit to improve physician use of extreme risk protection orders (ERPO).
“Physicians are encouraged to ask patients at risk of firearm injury about access to firearms during routine patient visits. Allowing physicians to petition the courts when they encounter a patient at risk of firearm violence is necessary and could help prevent further firearm-related tragedies,” said AMA Immediate Past President Jack Resneck Jr., M.D.
To help end the ongoing and devastating effects of firearm violence in the U.S., the AMA also strongly recommends that social media sites continuously update and monitor their algorithms to detect and eliminate any information that discusses and displays firearms and firearm violence in a way that encourages viewers to act violently.
“Misinformation and disinformation continue to spread through social media largely unchecked. With more than 48,000 Americans dying and tens of thousands more seriously injured from firearms every year, we can’t sit by while firearm violence is glorified through social media sites. We implore social media sites to take immediate action to limit these dangerous posts, people’s lives depend on it,” said Resneck Jr., M.D.
An estimated one in five children in the U.S. experience a mental health disorder each year and as of 2021 suicide was the second leading cause of death among children aged 10-14, according to the Centers for Disease Control and Prevention. And, while many mental health disorders can be treated, nearly half of young adults do not receive the mental health services they need, according to the Substance Abuse and Mental Health Services Administration. Given these startling statistics, delegates adopted policy to advocate that children’s mental health and barriers to mental health care access for children represent a national emergency that requires urgent attention.
The new policy also calls on the AMA to join with other interested parties to advocate for efforts to increase the mental health workforce to address the increasing shortfall in access to appropriate mental health care for children.
AI Prior Authorization Oversight
The newly adopted policy calls for health insurers utilizing AI technology to implement a thorough and fair process that is based on clinical criteria and includes reviews by physicians and other health care professionals with expertise for the service under review and no incentive to deny care. ProPublica revealed that over a period of two months in 2022, Cigna doctors denied more than 300,000 claims as part of a review process that used artificial intelligence, with Cigna doctors spending an average of 1.2 seconds on each case. The new AMA policy calls for insurers to require a human examination of patient records prior to a care denial.
"The use of AI in prior authorization can be a positive step toward reducing the use of valuable practice resources to conduct these manual, time-consuming processes. But AI is not a silver bullet,” said AMA Board Member Marilyn Heine, MD. “As health insurance companies increasingly rely on AI as a more economical way to conduct prior authorization reviews, the sheer volume of prior authorization requirements continues to be a massive burden for physicians and creates significant barriers to care for patients. The bottom line remains the same: we must reduce the number of things that are subject to prior authorization.”
The AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations. Due to significant limitations associated with the widespread use of BMI in clinical settings, the AMA suggests that it be used in conjunction with other valid measures of risk such as, but not limited to, measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference, and genetic/metabolic factors. The policy noted that BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level. The AMA also recognizes that relative body shape and composition differences across race/ethnic groups, sexes, genders, and age span is essential to consider when applying BMI as a measure of adiposity and that BMI should not be used as a sole criterion to deny appropriate insurance reimbursement.
“There are numerous concerns with the way BMI has been used to measure body fat and diagnose obesity, yet some physicians find it to be a helpful measure in certain scenarios,” said AMA Immediate Past President Jack Resneck, Jr. M.D. “It is important for physicians to understand the benefits and limitations of using BMI in clinical settings to determine the best care for their patients.”