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Featured topic and speakers
What is the CMS rule for prior authorizations? How is AI changing health care? Why is there a shortage of primary care physicians? What are the telehealth billing rules?
Our guest is outgoing AMA President Jesse Ehrenfeld, MD, MPH. AMA Chief Experience Officer Todd Unger hosts.
- The AMA is your powerful ally in patient care. Join now.
- CMS billing guidelines and telehealth CPT codes.
- See how the AMA fights for physicians.
Speaker
- Jesse Ehrenfeld, MD, MPH, president, AMA
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, I'm joined by outgoing AMA President Dr. Jesse Ehrenfeld in Milwaukee. We're going to discuss the highlights of his presidency and what it was like to lead the AMA over the last year. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Ehrenfeld, thanks so much for joining us today.
Dr. Ehrenfeld: Thanks for having me, Todd. Good to talk to you.
Unger: Well, we've had a chance to talk numerous times over the last year about all the work that the AMA is doing. I'm curious, as you look back, what were some of the major accomplishments that you're most proud of during your presidency?
Dr. Ehrenfeld: There's so much. It's hard to encapsulate it. But there are three huge wins that I think are worth highlighting, one on prior authorization. As you know, CMS finalized a rule in January that's going to require any plan regulated by CMS, that's Medicare, any of the plans on the exchanges to support electronic prior authorization embedded into our electronic health records. This is going to bring needed automation, efficiency, save tremendous amount of times, and also plans are going to have to publish publicly how often they deny things, how long it takes them to make a decision.
So we're going to get some needed transparency about the shady practices that so many third-party payers are engaged in. And all together, CMS estimates that's going to be a $15 billion cost saving to physician practices over 10 years. On telehealth, we've achieved passage of legislation to extend the telehealth flexibilities through Medicare, including audio only and hospital home services through the end of this calendar year. And we're on track to make these changes permanent. And we're anticipating any day now a really important final rule that's finally going to put some teeth into a law that's languished for 15.5 years, the Mental Health Parity law. That law was enacted in 2008.
Final regulations came out in 2013. But we know that today you're nine times more likely to have to go out of network for mental health, behavioral health, substance use treatment services than medical or surgical services. And despite this administration and previous administration's efforts, the health plans have flouted the rules, flouted compliance for more than 15 years, complying with mental health parity is not complicated, but enforcement has been challenging. And so the Department of Labor, Health and Human Services, and the Treasury are working on a final rule that's going to make this all much, much better for patients and physicians. And that's going to be a huge win when it comes out.
Unger: Gosh, talk about physicians' powerful ally in patient care. Those are huge achievements, very tangible in terms of priorities for the year. Of course, we know there are still challenges. Talk to us a little bit, Dr. Ehrenfeld, about some of the barriers that physicians face right now. And where do you see the greatest opportunities to address them?
Dr. Ehrenfeld: Well, the pace of change in medicine is having an enormous impact on physicians, and frankly, all of health care. There's so much pressure on the system, labor shortages contributing to greater inefficiencies and jeopardizing the care that we can provide to our patients. So as we think about how we work to achieve lower costs, improve patient outcomes, deliver better patient care, all important goals in our health care system, we've also got to recognize how burnout among physicians and our health care team colleagues imperils each and every one of those goals.
So you've got to recognize how everything's interconnected and held in place by a broken, bloated, wildly inefficient system that has just put too many barriers in front of patients and too many barriers in front of physicians who are trying to deliver the care. So the AMA's mission is pretty simple, improving the art and science of medicine and a better public health. We do that by getting rid of these obstacles, improving the health of the nation and driving the future of medicine. We're going to continue to do all of those things.
Unger: Well, one really important area about achieving what you just talked about is in the arena of technology. And I think this is one of the areas you've been so passionate about over the last year, technology, and in particular, of course, the topic we can't not talk about, which is AI. You've talked extensively about this issue. You've been at the forefront of the national dialogue on AI in medicine. What impact do you hope that your advocacy in this arena has had?
Dr. Ehrenfeld: We've shaped the conversation. We've changed the conversation. Sometimes I just felt like I was banging my head against a wall when I would make an important differentiation between augmented intelligence and artificial intelligence. When the AMA talks about AI, we think it's so critical to refer to it as augmented intelligence to emphasize that human beings have to be at the center of patient care.
Clinical decisions made by AI have to allow humans to intervene during the decision-making process so that if there's potential for harm, we can step in. We can use our clinical judgment. We can interpret. We can act on the AI, and we can make sure that there's not a problem. And the way to think here is not about us versus the computers or the AI or the machine, but to ask about how we can bring everything together to elevate our practice of humane care in medicine.
And when I started sort of talking about this important distinction about augmented versus artificial five, eight years ago, I got a lot of blank looks. And I cannot tell you the number of meetings with lawmakers and regulators, and other industry stakeholders I've been in where they're starting to talk about augmented intelligence in health care, not artificial intelligence in health care. And so that gives me some hope that we've actually made a difference.
Unger: Absolutely. Just the fact that physician voices channeled through the AMA, through you are at the center of these conversations about technology, digital health, that's a big change from the past. And we know these conversations aren't slowing down. How do you think these conversations are going to evolve in the year ahead?
Dr. Ehrenfeld: Well, it's funny. When I would go to the big tech meetings, HIMSS and HLTH, and South by Southwest, and all these places, for years, it would be entrepreneurs. It would be companies. It would be data scientists. And there weren't physicians. That has changed markedly.
Now when I go to these big meetings, there are dozens of physicians, many members, some who are not, who are deeply engaged in the process of developing this technology. And that is so exciting and so important for me because we've got to make sure that the physician voice is at the center of the design cycle and present throughout design, development and deployment if we're going to have tools that actually work for our practices and are not a burden but an asset.
Unger: Absolutely. Now, on the human side of this issue, one of the things that you've talked a lot about during your presidency is the attention around the physician shortage. And you gave a speech to the National Press Club about it. What impact will that shortage have? And do you feel that policymakers are finally starting to see how urgent this issue is?
Dr. Ehrenfeld: The issue is urgent. The projections about the shortfall in 10 years are real, maybe well over 100,000 positions short. But the crisis is now. 83 million Americans do not have access to primary care physicians. And so we know that we have to do more.
When I'm on the Hill, when I talk with colleagues across the country, people get it. They understand that we have to expand GME. We have to make it easier for international physicians to come and practice in the U.S. And we have to make sure that for the physicians that we have already working, we reduce the burdens that are driving burnout and causing people to reduce their hours or in some cases leave the practice entirely.
Unger: When we spoke at the start of your presidency, I asked you what words of encouragement that you had for America's physicians, and as we wrap up today's conversation, I'd like to ask that question again. What words of encouragement do you have to share with them one year later?
Dr. Ehrenfeld: Well, there was a wonderful article in The Atlantic in 2021 that kind of summed up the state of our health care workforce. And the person wrote that health care workers aren't quitting their jobs because they can't handle them. They're quitting because they can't handle being unable to do their jobs.
And so as I think about the work of the AMA, the challenges that physicians face, people continue to persevere because we know what we do matters. And I'm so proud to have been at the helm of the AMA this past year as we continue to make it easier and easier for people to show up and do what they do, which is look patients in the eye and take care of them. And so no matter what challenges lie ahead, I hope folks know that the AMA will always be there to stand beside you and be your powerful ally in patient care.
Unger: Dr. Ehrenfeld, it's been a pleasure and an honor to be able to talk with you and work with you over the past year. I just want to say thank you for your leadership over the past year and being such a vocal advocate for physicians and patients. To support the work of the AMA on the issues that we discussed today and more, I encourage you to become an AMA member at ama-assn.org/join. That wraps up today's episode, and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today, and please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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