AMA seeks to expand telehealth, reform payment system and prior authorization

During his presidential address at the AMA House of Delegates meeting, Gerald E. Harmon, MD, outlined five actions that he said policymakers must take to better support physicians.

These actions are part of the AMA’s Recovery Plan for Physicians, an “ambitious” but “doable” roadmap that will help physicians move forward after 2 years of sacrifices during the COVID-19 pandemic, Harmon said.

“You’ve taken care of our nation at great personal sacrifice ... and it’s time our nation renews its commitment to you,” he said.

The five actions that AMA is advocating for are to:

• expand telehealth;
• reform the Medicare payment system;
• stop the “unsafe scope of practice expansions;”
• fix prior authorization; and
• increase efforts to reduce physician burnout, retain the workforce and address stigma surrounding mental health.

Telehealth

During the pandemic, 90% of physicians opted to deliver care through telehealth, about half of whom had never used it before, Harmon said. CMS introduced flexibilities so that physicians could be reimbursed the same amount when delivering care through telehealth, including audio-only visits, as they would for in-person services, he added.

To ensure these changes continue after the public health emergency is over, Harmon said that the AMA is “fighting to update our laws and regulations.”

“While it’s not appropriate for suturing a wound or setting a broken bone, telehealth can be hugely beneficial for chronic disease management, care coordination, and especially for tele-psychiatry for a community like mine with a shortage of behavioral health resources,” he said.

Medicare payment reform

The second component of the recovery plan is Medicare payment reform.

“Medicare physician payments are the only component of health care delivery subject to budget neutrality and have fallen 20%, adjusted for inflation, since 2001— an average of about 1% a year,” Harmon said. “As a result of various legislative and regulatory provisions implemented prior to and during the COVID pandemic, we were threatened with a 10% cut in Medicare payments this past January. Thanks to the pressure of the AMA and others in organized medicine, Congress acted at the last minute to avert the cuts.”

Although Harmon said this was “a major victory,” a permanent solution is needed “to predict financial returns with some reliability in order to invest in costly infrastructure like new technologies and treatments.”

“In short — we’re done with short-term patches and looming cuts,” he said.

Unsafe practice expansions

The third component of the plan aims to keep nurse practitioners and other nonphysician professionals from expanding the scope of their practice.

“Quality, affordable health care is only possible with teamwork. We rely on nurses, physician assistants, and office workers to do the invaluable work they are trained to do,” Harmon said. “But patients need to trust that a physician is leading their care and leading the team. We have years’ more education, and thousands of hours’ more clinical training than other members of the team, and we’re better prepared to treat complex cases, and complications.”

Practice scope expansions are “primarily a state issue,” Harmon said. The AMA is working with federation partners through the Scope of Practice Partnership to defeat “unsafe scope expansion bills that are proposed during each state legislative session,” he added.

Prior authorization

The fourth component aims to fix “one of the burdens physicians find most frustrating: prior authorization,” Harmon said.

In a recent survey conducted by the AMA, 93% of physicians said that obstacles imposed by prior authorization for tests, medications and procedures have delayed care for their patients.

“Four out of five doctors said these processes have led patients to abandon their treatment,” Harmon said. “Can you believe it?”

These obstacles are also time consuming for physicians and medical staff to navigate, he added.

In 2018, the AMA released a consensus statement with other stakeholders — including the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, the Blue Cross Blue Shield Association and the Medical Group Management Association — to improve the prior authorization process. Since then, however, Harmon said that insurers “have done precious little to implement agreed-upon improvements.”

“It’s time to hold them accountable,” he said. “And that’s exactly what we are doing by pushing for legislative and regulatory remedies at the federal and state levels. About a dozen states now have comprehensive reforms in place, many based on the AMA’s model legislation.”

Physician burnout

The final component of the recovery plan — “and potentially the most important,” Harmon said — is to develop a health care system that attracts new physicians, retains existing physicians and reduces burnout.

“For over a decade, the AMA has worked to remove administrative barriers like prior authorization to care that can lead to burnout,” Harmon said. “But we know solutions must go even further. We must find ways for physicians to address their mental health needs without fear of negative repercussions.”

In 2019, health organizations in the United States declared physician burnout a public health crisis. According to The Physicians Foundation, 61% of physicians in the U.S. reported burnout in 2021, “an incredible increase” from the 40% who reported it in 2018, Healio previously reported.

Amid this increase in burnout, the Association of American Medical Colleges predicted that in 2034, there would be a shortage of between 17,800 and 48,000 primary care physicians and a shortage of between 21,000 and 77,100 physicians from nonprimary care specialties.

To address these issues, Harmon said the AMA has supported efforts to address physician burnout and stigma around mental health, such as the passage of the Dr. Lorna Breen Health Care Provider Protection Act. The association is also working to update outdated language on medical licensing and credentialing applications, which often discourage physicians from seeking mental health treatment, and is supporting legislation for the creation of confidential physician wellness programs.

To help recruit new physicians, the AMA is calling for efforts to:

• reduce the amount of debt that medical students accumulate, which is now more than $200,000;
• increase residency training slots and remove caps on Medicare-funded positions; and
• increase funding for new medical schools and residency programs at historically Black colleges and universities, as well as Hispanic- and tribal-serving institutions.

“Providing pathways for more people from underrepresented communities to enter the medical profession is a key component of the AMA’s health equity work that has been such a major focus of the past 2 years,” Harmon said. “I am proud to have been able to play a role in advancing racial justice and health equity in medicine during my presidency. This work is long overdue and must continue.”

References:

AAMC report reinforces mounting physician shortage. https://www.aamc.org/news-insights/press-releases/aamc-report-reinforces-mounting-physician-shortage. Published June 11, 2021. Accessed June 13, 2022.

AMA and national stakeholders release consensus statement on prior authorization. https://aasm.org/ama-national-stakeholders-release-consensus-statement-prior-authorization/. Published Jan. 19, 2018. Accessed June 13, 2022.

AMA unveils Recovery Plan for America’s Physicians. https://www.ama-assn.org/press-center/press-releases/ama-unveils-recovery-plan-america-s-physicians. Published June 10, 2022. Accessed June 13, 2022.

President Gerald E. Harmon, MD, address at the 2022 Annual Meeting of the HOD. https://www.ama-assn.org/press-center/speeches/president-gerald-e-harmon-md-address-2022-annual-meeting-hod. Published June 10, 2022. Accessed June 13, 2022.