As we emerge from the shadows of the COVID-19 pandemic, it has become clear that Plato’s paraphrased maxim that necessity is the mother of invention was proven many times over during its course.
At CMA, as in society, we were forced to develop adaptations that would otherwise have come to fruition much more slowly, including the ability to rapidly develop and implement virtual approaches to teamwork when unanticipated events prevented us from physically standing shoulder to shoulder. As it turned out for the 2023 CMA House of Delegates, that pivot once again proved itself invaluable in overcoming adverse circumstances: as a result of an unforeseeable wave of labor unrest in Southern California, meeting face-to-face in Los Angeles to conduct the business of the House became untenable.
As a result, the full House of Delegates was able to meet virtually on February 10, 2024 to address several major issues facing the House of Medicine.
The CMA House of Delegates is a body of nearly 500 physicians elected by members of component medical societies including SSVMS, specialty societies, and CMA sections and forums. The body is structured to ensure representation of virtually every mode of practice and region in California. The House of Delegates meets every year to discuss some of the most important matters facing the practice of medicine and to form the CMA policy that guides its legislative and regulatory advocacy.
The three major issues chosen for policy debate in 2023 at the HOD included the Office of Healthcare Affordability (OHCA), the rise of artificial intelligence, and climate change.
On June 30, 2022, after a two-year delay following the initial proposal as a result of the pandemic, California created a new government agency, the Department of Healthcare Access and Information (DHAI), and under it, OHCA. The office has wide-ranging powers including the creation, imposition, and enforcement of cost targets on health care entities, development of payment models, and creation of such additional regulatory bodies as an affordability advisory committee.
With wide-ranging powers, of course, comes the risk of similarly wide-ranging unintended adverse consequences in the absence of sufficient institutional knowledge and expert input. That created a need for clear CMA policy with respect to OHCA initiatives. The House of Delegates crafted that policy on February 10, calling for DHAI and OHCA to focus on the most consistent drivers, take inflation and medical indices into consideration when setting statewide spending growth targets, and to protect medical providers from being held accountable for costs outside their control.
The second major topic was artificial intelligence and its implications in health care. Much of the discussion was focused on the importance of applying artificial intelligence and ways that enhance, rather than degrade, the physician-patient relationship. Recommendations included ensuring that the input of physicians with firsthand knowledge of practice at the bedside is an integral part of the design, creation, and implementation of artificial intelligence applications. There was extensive discussion about the risk of using artificial intelligence applications to provide direct medical care by its substituting, rather than supplementing, direct physician oversight of patient care.
Significant concerns were also raised with respect to patient privacy and the risk of data collection and use for commercial purposes. Data source transparency was emphasized, as was discussion of data source adequacy and mitigation of the risk of introduction of bias into artificial intelligence algorithms. Critically, CMA moved to clarify and identify any potential medical legal liability that might arise for a physician using — or not using — augmented intelligence, especially for technologies that operate more autonomously and that an individual provider may have little control over.
The third major topic addressed was climate change. Policy was made that emphasized the need to develop resilient health care systems capable of delivering effective and equitable care in the face of challenges associated with climate change. There was fairly lively debate on topics such as the degree to which solo and small group practices, as opposed to large hospital systems, should be burdened with requirements such as purchasing and maintaining off-grid battery backups and publicly reporting greenhouse gas emissions associated with practice activities. Some physicians pointed out the difficulties of such measures in a solo practice, while other physicians commented with viewpoints aligned with the idea that the responsibility to address climate change extends to all citizens and businesses, regardless of size.
To be certain, it was a day full of discussion, opinion, and in the end, invaluable expert policy consensus that will allow CMA to move forward in helping our legislators protect the health and wellbeing of the patients in our state and nation. To learn more about the House of Delegates, or if you are interested in joining the District XI delegation as a delegate or alternate delegate, contact Chris Stincelli at cstincelli@ssvms.org
Sean Deane, MD is chair of the District XI delegation to the CMA House of Delegates.
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