News Items

ASCRS participation at the AMA House of Delegates (HOD)November 2022 Interim Meeting
 
ASCRS  Delegates: Anne Mongiu M.D. and Lucas Poggio M.D.
ASCRS Alternate Delegates: Paul Johnson M.D., Sachin Vaid M.D.
 
House of Delegates Facts:

• The HOD is the legislative body of the American Medical Association (AMA)
• Delegates represent state medical societies, various subspecialty societies and government
• Delegate count is based upon the number of AMA members within each state/society – ASCRS has 2 Delegates and 2 Alternate Delegates
• ASCRS Delegates are part of the Digestive Disease Section Council (DDSC)¹
• The House of Delegates (HOD) meets twice a year to introduce and debate new resolutions which can become AMA advocacy policy, as well as modify and (re)affirm existing AMA policy
• Resolutions are grouped into “reference committees”² by subject matter to facilitate further review and deliberation
• Resolutions for new advocacy and modifications to existing AMA policy are introduced a few weeks in advance of each meeting to a public website where it can be reviewed and commented on in an open forum by AMA members and member societies 
• Prior to the start of business of the annual meeting, the reference committees summarize all the testimony offered in the open forum
• The first portion of the meeting itself, then involves labor-intensive review of each resolution line by line with open testimony on the floor of the HOD
• The reference committees carefully summarize all the testimony given and adjust/amend the resolutions to match the will of the house as testified
• The entire house meets as a whole after review the reference committees work, and vote either to accept the judgement the reference committee or to bring individual items are parts of items to the floor of the house for open to be voting
• At the end of the meeting all proffered resolutions are accepted, amended, overruled, or referred for further study/decision

November 2022 Meeting Update:
 
Prior to the meeting, ASCRS delegates and alternate delegates vet all proffered resolutions and identified 20 (of > 100 proffered) that would be most relevant to Colorectal surgeons and their patients.

 
Day 1: Activities at the Digestive Disease Section Council (DDSC):
 
The ASCRS received DDSC support for:

• Resolution 819: advocating for the implementation of updated US preventative services task force recommendations for colorectal cancer screening among primary care physicians in major payers by the AMA
• Resolution 817: promoting oral anticancer drug parity
• Resolution 808: Reinstatement of consultation codes
• Resolution B201: Physician reimbursement for interpreter services

 
The ASCRS received partial support from some DDSC members but not the full backing of the Council:

• Resolutions 310 and 316: AMA backing of certifying/recertifying organizations

 
 
Day 2:  Reference committees systematically review resolutions and hear oral testimony³
 
Dr. Poggio: gave oral testimony on items J817, J819, C31
Dr. Mongiu: served as a member of Reference Committee J hearing all resolutions


 
 
Day 3 and 4: Debate on the resolutions proffered by the Reference Committees¹:
 
The Caucasus, Councils, and subspecialty societies subsequently meet on Monday morning to review the final resolutions proffered by the reference committees, identifying those with which they agreed, and those on which they would elect to call out for further debate on the floor.
 


Reference Committee J:
Resolution 816: Supporting coverage of continuous glucose monitoring devices for patients with diabetes - Adopted
Resolutions 817: Promoting oral anti-cancer drug coverage parity – Adopted after testimony and amendment
Resolution 819: Advocating implementation, education, and coverage of USPSTF colorectal cancer screening guidelines - Adopted after testimony and reference committee amendment reaffirmed Resolution  808: Reinstatement consultation codes – Reaffirmed with stronger language
Resolution 810: Concerning transparent negotiations for Medicare drug pricing, patent evergreening, and blocking direct to consumer advertising – Reaffirmed with stronger language
 
Reference Committee B:
Resolution 201: Reimbursement for interpreter services, expanded to include ASL -Adopted and amended
Resolution 205: Supporting elimination of waiver of due process clause is from physician contracts – Adopted and amended
Resolution 223: Broadening the AMA stance against criminalization a pregnancy loss as a result of medical treatment (such as treatment for colon cancer) – Adopted and amended
Resolution 224:  Providing insurance coverage for fertility treatment, especially in the case of iatrogenic infertility (such as IPAA) -Adopted and amended
 
Reference Committee C:
CME 1: Impact of private equity

• Recommended for adoption and supported by the ASCRS delegates
• This is very important for our society. Investment by PE (private equity) in health care is increasing and can affect training programs
• Example: The closed Philadelphia Hahnemann University Training Program in 2019 required significant efforts from ACGME and AMA to ensure trainees were able to continue with their training despite needing to change institutions

 
CME 2: Mitigating demographic and socioeconomic inequities in the Residency and Fellowship selection process

• Recommended for adoption and supported by the ASCRS delegates

 
Resolution C302/303 and 308: Address employee leave to include miscarriage and stillbirth along with medical student leave and paid family/medical leave in medicine

• Amended and significant changes were implemented and adopted
• Asking for a study of the feasibility of incorporating into their parental leave policies for a 12-week minimum leave allowance
• Supported by the ASCRS: it addresses parental, family and medical necessity leave for medical students and physicians

 
Resolution C305: Addresses the need to encourage medical schools to sponsor pipeline programs to Medicine for underrepresented groups had significant changes but essentially encouraged in resolution that medical schools recommend pathways programs for underrepresented students free of charge for example. And it was supported by us.
 
Resolution C316: Modifying existing AMA policy to have stronger language supporting specialty certification to include boards which both certify and recertify, rather than those who offer to recertify physician previously certified elsewhere

• Spirited debate on the floor with a split result 
• A portion of the amended language was accepted and the stronger verbiage was moved for referral back to the reference committee for further review
• Some Societies voiced resistance to current ABMS recertification citing physician "burn out" and "cost"
• The specialty certification issue will likely continue to arise at future meetings with need for continued work on the part of the ABMS and Specialty Societies/ASCRS to advocate for

 
Reference Committee K:
Resolution K902: Addresses recommendations to reduce the burden of incarceration on Public Health

• Supported by ASCRS delegates and recommended for adoption with amendments
• These amendments include but are not limited to address the need for a livable wage and access to affordable housing opportunities - these issues often impact successfully returning into society.

 
Resolution K916: ASCRS provided oral testimony for expanding HPV associated cancer prevention from cervical cancer to include specific language which relates to our work in screening patients for HPV-related anal cancer including but not limited to patients with anal dysplasia and anal cancer secondary to HPV infection
 
NOTES:
1. The DDSC is comprised of delegates from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, Society of American Gastrointestinal Endoscopic Surgeons, ASCRS, and American Society for Metabolic and Bariatric Surgery, and comprises ~20 delegates. The Chair of the DDSC is rotated between the medical and surgical societies. ASCRS will be chair during the 2025/26 meeting season. The benefit of DDSC backing on resolutions means the voice of our two-delegate society is amplified to include the entire membership of the DDSC when giving oral testimony in the HOD. Testimony delivered on behalf of section counsel carries more weight than an individual or small society in the ultimate decision making performed by the reference committee.
 
2. The subject matter referred to each reference committee is as follows:
● Reference Committee on Amendments to Constitution and Bylaws (Constitution;
Bylaws; Ethics)
● Reference Committee A: Medical Service (Annual Meeting only)
● Reference Committee B: Legislation
● Reference Committee C: Medical Education (Annual Meeting only)
● Reference Committee D: Public Health (Annual Meeting only)
● Reference Committee E: Science and Technology (Annual Meeting only)
● Reference Committee F: AMA Finance and Governance
● Reference Committee G: Medical Practice (Annual Meeting only)
● Reference Committee J: Advocacy related to medical service, medical practice, insurance
and related topics (Interim Meeting only)
● Reference Committee K: Advocacy related to medical education, science and public
health and related topics (Interim Meeting only)
 
3. At the end of the day, the delegates are dismissed, and the reference committee members spend the evening reviewing the testimony and writing/rewriting the resolutions to match the spoken testimony and submit

As the American Society of Colon and Rectal Surgeons, it is our mission to advance the understanding, prevention and treatment of colorectal cancer.  Colorectal surgeons are uniquely involved in every aspect of colon cancer care including prevention, diagnosis, treatment, and surveillance.  
The findings of the recent NordICC study, published in the New England Journal of Medicine, have generated significant media attention, calling into question the benefit of screening colonoscopy in preventing colorectal cancer.  It is vitally important to us to clarify the findings of the study to avoid misinterpretation.

The NordICC study enrolled over 84,000 patients in Poland, Norway, and Sweden, and randomized them to either receive an invitation to undergo screening colonoscopy, or to follow usual care.  Strikingly, only 42% of the invited patients actually underwent colonoscopy, and this significantly diluted the benefits of colonoscopy in the study.  While the group invited to undergo colonoscopy had an 18% reduction in the risk of colorectal cancer after a decade of follow-up, there was no difference in the two groups with regard to risk of death from colorectal cancer (0.25% vs. 0.31%).  Importantly, the investigators calculated that, had all invited patients undergone the screening colonoscopy, they would have had a 30% reduction in the risk of colorectal cancer and 50% reduction in the risk of death due to colorectal cancer. 

Therefore, based on the findings of this study and many others, the ASCRS still recommends screening colonoscopy beginning at age 45 for average risk patients, in accordance with the American Cancer Society guidelines.  Colonoscopy is the most effective test to prevent, diagnose and reduce the incidence of colorectal cancer.  Patients may also consider alternatives to screening colonoscopy after discussing with their primary care physician.  Options include flexible sigmoidoscopy, CT colonography (“virtual colonoscopy”), as well as stool-based tests such as the fecal immunochemical test (FIT), fecal occult blood test, and fecal DNA tests.  The ASCRS is committed to improving access to colonoscopy and awareness of alternative screening options in order to have the greatest impact on prevention of colorectal cancer.

Dear ASCRS Committee Members,

At our recent meeting, the Executive Council approved reducing terms of office from three years to two years for committee leaders and members on most committees. The rationale for reducing term lengths by one year is to reduce the number of unmatched committee applicants that ASCRS has each year, while also ensuring that committees continue to have the number of members with the right experience needed to accomplish the important work of our committees. It’s our goal to offer as many members as possible the opportunity to participate on ASCRS committees. The proposal that was offered by the members of the Committee Term Task Force will create 20% more turnover and therefore more opportunity for member engagement.

At present, a member could serve up to two contiguous three-year terms or six years in total. A member who continues to a committee leadership position would serve an additional three years as vice chair, then three years as chair for a total of 12 years. Under the new model approved by the Executive Council, the total potential commitment is reduced to eight years for a member in the chair position. A very small number of committees with multi-year work products, and or as necessitated by the learning curve, will continue with three-year terms.

Implementation of the New Committee Terms
The implementation process will extend over several years, and include the following guidelines applicable to all committees migrating to two-year terms:

• All members who have served at least five years on the committee as of June 2023 will be removed from the committee.
• Starting with appointments effective June 2024, consistent with the table below, nearly all committee members will have two-year terms (i.e., two-year first term and a two-year second term).
• Committee chairs will be given the opportunity to request, subject to approval of the Committee on Committees Chair and the President, the opportunity to extend the term of one or more committee members beyond the typical end date, to complete an existing project/initiative.
• Committee members will have the opportunity to reapply to their committee, following four years of service (two terms), after a two-year break. Committee members who are ending their service as the result of the term reduction can apply for consideration for appointment to other committees in the next appointment cycle- no waiting.
• Committee term length will be incorporated in the descriptions of each committee and included on the website and communicated during the call for committee volunteers.

The following table displays the new terms.


 






























 

The Healthcare Economics Committee and ASCRS Leadership are happy to announce the appointment of new AMA House of Delegates (HOD) representatives for the upcoming 3 year cycle.
 
Dr. Juan "Lucas" Poggio will serve as incoming Delegate and Drs. Paul Johnson and Sachin Vaid will serve as Alternate Delegates joining Dr. Anne Mongiu in her role as a current Delegate. The ASCRS had traditionally had one Delegate and Alternate Delegate spot at the AMA HOD but has been afforded an additional Delegate and Alternate spot starting this year. 
 
We would like to express our sincere thanks to Dr. Ron Gagliano and Dr. Harry Papaconstantinou for their many years of service to the ASCRS as AMA HOD delegates. We appreciate their dedication, representation, and willingness to pass on their valuable knowledge to our incoming delegates. 
 
Members of the AMA House of Delegates (HOD) serve as an important communications, policy and membership link between the AMA and grassroots physicians. The delegates and alternate delegates are a key source of information on activities, programs and policies of the AMA. The delegates and alternate delegates are also a direct contact for the individual member to communicate with and contribute to the formulation of AMA policy positions, the identification of situations that might be addressed through policy implementation efforts and the implementation of AMA policies. Members of ASCRS AMA HOD delegation automatically become members of the ASCRS Healthcare Economics Committee.
 

On behalf of the Executive Council, The American Society of Colon & Rectal Surgeons supports the joint statement by the American College of Obstetrics and Gynecologists (ACOG) and the American Medical Association (AMA) in response to the recent Supreme Court’s decision to overturn Roe v. Wade. The statement can be found below.
 
In arriving at the decision to endorse the statement, the ASCRS Executive Council discussed and carefully considered the broad implications of the Supreme Court decision on our fellow society members and patients. As Council members, we reflected on the diversity of our membership, practices, and the regions of the country where our members live and work. We are unified by the overriding principles that the integrity of the physician-patient relationship must be protected, that the freedom to safely practice and access evidence-based medicine is a fundamental right, and that each of us must have the right to make autonomous reproductive health decisions.
 
We welcome open dialogue and value tolerance and inclusivity as our society and the nation navigates these challenging times.
 
Respectfully,  The ASCRS Executive Council


The following is a statement from the American College of Obstetricians and Gynecologists and the American Medical Association, joined by the Alliance for Academic Internal Medicine; American Academy of Family Physicians; American Academy of Nursing; American Academy of Pediatrics; American Association of Child and Adolescent Psychiatry; American Association of Public Health Physicians; American Board of Anesthesiology; American Board of Internal Medicine; American Board of Internal Medicine Foundation; American Board of Medical Genetics and Genomics; American Board of Medical Specialties; American Board of Obstetrics and Gynecology; American Board of Plastic Surgery; American Board of Psychiatry and Neurology; American Board of Surgery; American College of Correctional Physicians; American College of Medical Genetics and Genomics; American College of Nurse-Midwives; American College of Osteopathic Obstetricians and Gynecologists; American College of Physicians; American College of Preventive Medicine; American Epilepsy Society; American Geriatrics Society; American Gynecological and Obstetrical Society; American Medical Student Association; American Medical Women's Association; American Muslim Health Professionals; American Psychiatric Association; American Public Health Association; American Society for Clinical Pathology; American Society for Reproductive Medicine; American Society of Addiction Medicine; American Society of Colon & Rectal Surgeons; American Society of Hematology; American Thoracic Society; American Urogynecologic Society; Association for Clinical Oncology; Association of American Indian Physicians; Association of American Medical Colleges; Association of Professors of Gynecology and Obstetrics; Association of Women's Health, Obstetric and Neonatal Nurses; Black Mamas Matter Alliance, Inc.; Council of Medical Specialty Societies; Council of University Chairs of Obstetrics and Gynecology; Endocrine Society; GLMA: Health Professionals Advancing LGBTQ Equality; Infectious Diseases Society for Obstetrics and Gynecology; International Society for the Study of Women's Sexual Health; March for Moms; Massachusetts Medical Society; Medical Students for Choice; National Abortion Federation; National Association of Nurse Practitioners in Women's Health; National Birth Equity Collaborative; National Hispanic Medical Association; National Medical Association; New York Academy of Medicine; North American Society for Pediatric and Adolescent Gynecology; North American Society for Psychosocial Obstetrics & Gynecology; Physicians for Reproductive Health; Ryan Residency Training Program in Abortion and Family Planning; Society for Academic Specialists in General Obstetrics and Gynecology; Society for Adolescent Health and Medicine; Society for Maternal-Fetal Medicine; Society for Obstetric Anesthesia and Perinatology; Society for Reproductive Endocrinology and Infertility; Society for Reproductive Investigation; Society of Family Planning; Society of General Internal Medicine; Society of Gynecologic Oncology; Society of Gynecologic Surgeons; Society of Hospital Medicine; Society of OB/GYN Hospitalists; Student Osteopathic Medical Association; and Womxn's Health Collaborative:

“As the U.S. health care system enters a post-Roe era, we, representing dozens of major organizations of health care professionals, oppose all legislative interference in the patient–clinician relationship. Our patients need to be able to access—and our clinicians need to be able to provide—the evidence-based care that is right for them, including abortion, without arbitrary limitations, without threats, and without harm.

“The wave of abortion bans going into effect in states across the country will harm patients, impair the
integrity of the medical profession, and have a devastating and unquantifiable impact on the patients and clinicians it affects. People in at least half the states will now face a cruel choice between traveling hundreds of miles to receive abortion care (which is simply impossible for those who lack the resources, means, and opportunity) or being forced to continue with a pregnancy that may threaten their health, well-being, and future.

“Clinicians who practice in good faith in these states will be subject to a similarly untenable decision: risk criminal prosecution or other civil sanctions by providing appropriate, evidence-based care in accordance with their patients’ needs and wishes or withhold safe and effective reproductive health care from patients in need.

“Banning abortion care is a decision not founded in science or based on evidence. In all facets of medicine, clinicians train for years—some for decades—to learn how to provide the best evidence-based care possible to their patients. Patients form trusting relationships with their health care professionals, but when health care professionals are prevented from providing the full spectrum of care by threat of legal action, the quality and scope of care they can provide is limited, endangering both patient care and the patient–clinician relationship. Just as patients should not be forced to leave their communities to access abortion care, clinicians should not be forced to uproot their lives and leave their homes in order to practice in safe, supportive environments. Restricting access to care and eroding the trust between patients and health care professionals will worsen existing gaps in health disparities and outcomes, compounding the harm that underresourced communities already experience.

“Abortion care is safe and essential reproductive health care. Keeping the patient–clinician relationship safe and private is essential not only to quality individualized care but also to the fabric of our communities and the integrity of our health care infrastructure. As leading medical and health care organizations dedicated to patient care and public health, we condemn this and all interference in the patient–clinician relationship.”