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What does the AMA fight for? Why is prior authorization taking so long? What is the scope of practice for the American Medical Association?
Our guest is the new president of the AMA, Bruce Scott, MD. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Bruce Scott, MD, president, AMA
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, I've got the honor of speaking with the new president of the AMA, Dr. Bruce Scott, in Louisville, Kentucky. We'll get his perspective on what's next for medicine and the challenges that lie ahead. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Scott, welcome and congratulations on your new role as AMA president.
Dr. Scott: Thank you, Todd. It is an incredible honor to be elected to be the president of the American Medical Association by my fellow physicians. And I'm delighted to be here with you.
Unger: Well, this is no doubt a defining moment for you and your career. And you're also stepping into this position at a defining time for medicine. How are you feeling about it?
Dr. Scott: I'm extremely excited to lead the AMA to help improve health care in America. I think the medicine is on the cutting edge of some really important and big changes that we're going to believe be able to tackle chronic disease and maybe even cancer in my lifetime. The opportunity is now. With digital medicine, it almost seems like the frontier is unimaginable and unlimited. So there's lots of great opportunities.
At the same time, there's a lot of problems in health care as it exists right now, and we have a lot of work to be done. Admittedly, we've made a lot of advances, but there's still plenty of work to be done. And I'm excited about going forward and leading the way. I'm ready to fight for our patients and for our profession. I believe that we're set to win.
Unger: Well, that is great. And what an exciting time post pandemic to take the reins here. And you're also starting your presidency with really strong momentum. The AMA's work has resulted in some major wins over the last year, particularly with the CMS final rule on prior authorization. Dr. Scott, what progress are you hoping to see in the year ahead?
Dr. Scott: Well, prior authorization is overused and overly burdensome to physicians. And working directly with the Center for Medicare and Medicaid Services, the American Medical Association was able to secure significant reforms for federally funded patient care, including Medicare, Medicaid and Medicare Advantage plans. This is a significant group of people.
By CMS's own estimates, these changes will result in $15 billion of savings for physicians over the next 10 years. That gives you an idea of just how much of an impact prior authorization has on physician practices. But the real winners in this victory tide are the patients, who have federally funded health care, because now their health plans will not be able to deny and delay the care that their physicians order for them.
You see, prior authorization harms patients. Let me tell you about a patient in my office just recently. A young lady came to see me with a tumor growing in her face and her sinuses right next to her eye. We met together and decided that the best course was surgery to remove the tumor. We scheduled the surgery. And a few days later, her health plan notified the patient and me that the surgery was not medically necessary because the patient had not been on two rounds of antibiotics and a steroid nasal spray.
Now, any physician and most laypeople would know that antibiotics and a nasal spray is not going to cure a tumor. So I had to pick up the phone and talk to their medical director. And sure enough, the surgery was ultimately approved, the patient is recovering nicely from the surgery. And it looks like the tumor may be cured. But imagine for a moment, the stress and anxiety on this woman when she's notified that the surgery that she had agreed to was not medically necessary. That's simply wrong, and it needs to stop.
So now we need to take those prior authorization reforms to the private payers and make sure we can protect our patients.
Unger: Absolutely. And what a harrowing story. You can only imagine how she felt like that. And I'm glad to hear about the outcome. That's great. You mentioned earlier in your comments the magic word of collaboration, and that's been a driving force behind many of the wins this last year. We're supporting prior authorization reform also at the state level and pushing back against a record number of scope of practice bills.
Again, many of those occurring at the state level. Where do you see more opportunities for medicine to come together this year?
Dr. Scott: The AMA is a powerful ally and very influential with patients and physicians, particularly when we team with our federation partners of the state medical associations and the specialty associations. We all agree that patients deserve good medical care, and that our health care system should help physicians provide that care, not get in the way. The patient-physician relationship is the foundation of good medical care. And yet sometimes it seems that legislatures and courts get in the way.
I've seen firsthand the power of patient stories, like here in Kentucky, when we were fighting for prior authorization reform, and the young mother talked about her daughter, who had suffered permanent brain damage because of the health insurance company's delay in approving her seizure medicine. We need to work with the states and the specialty societies to work with our patients to tell those stories to the legislators. Those are the stories that will motivate change.
Together, we can also continue to fight against the continued scope of practice expansion. Patients have made it clear that they want a physician involved in their care, and we need to make sure that the physician-led team remains the standard of care in our country.
Unger: Absolutely. One of the other issues that I've had a chance to talk to you about before is around Medicare payment, and Medicare payment reform being, of course, a huge focus of the AMA right now. You've got kind of a unique perspective, of course, because you're running a private practice. And I'm curious how your experience as an independent physician shapes your perspective as president of the AMA.
Dr. Scott: Yeah. You know, after 30 years of frontline clinical experience, I have a vivid firsthand perspective of the mounting challenges facing physicians and patients today, from the financial stresses, from the decades of shrinking Medicare reimbursement, to the growing list of administrative burdens that are imposed upon us seemingly more and more every year.
I fear for the continuation of access for patient care. Adjusted for inflation, Medicare reimbursement to physicians has actually declined 30% over the last 20 years. In my practice alone, we've seen considerable increases in the rent, the cost of medical equipment, and of course, my staff have all needed raises because of the inflation that they face at the grocery store and the gas station. And yet last year, with record inflation, Medicare cut, once again, what they paid us as physicians. And what makes it worse is that the health plans have all linked their contracts to the Medicare rates.
So it's a spiraling down process. And I don't know how much longer physician practices, particularly independent private practices like mine, are going to be able to sustain this. At the same time, we face continuing burdens from administrative challenges.
Right now, it's estimated that physicians spend two hours in administrative time for every one hour we spend taking care of patients. No wonder physicians are getting burned out. We need to fix the system, and we need to fix it now.
Unger: Absolutely. And that's a lot of challenges that you've outlined right there, especially those that are in independent practice are facing. I mean, just the numbers that you cited up front in terms of the increasing costs laid out against the decreasing reimbursement rates creates a really untenable situation.
Besides Medicare payment reform, of course, you talked about physician well-being, about really making sure that all the technology that's coming out right now works for physicians and not vice versa. What are some of the challenges that we face in making progress on these and other issues this year?
Dr. Scott: Well first, physicians, our priority has always been and always will be taking care of our patients. And that's why all of us became physicians in the first place. But frankly, it's getting harder and harder to provide that care to the patients. It's no surprise that physicians are getting burned out and looking to retire early or to reduce their hours.
I see my fellow colleagues struggling to survive. I'm concerned that unless something is done to change the course, that patient access, particularly access for the most vulnerable patients, including the senior citizens, is going to suffer. In regards to technology, the challenges that we have to move forward into this exciting new future, making sure that as augmented intelligence enters the clinical realm, that we make sure that it is patient-centric, that it is ethical, that it is transparent, and that the technology works in a physician's practice and perhaps, most importantly, that physicians are involved in the development and the implementation of the new technology. The opportunity is great, but the challenge is also large.
Unger: Dr. Scott, that's quite a number of challenges. What can we do to overcome them?
Dr. Scott: Physicians need to unite. There is so much more that binds us together than what divides us. This work, the work I'm talking about, to answer these challenges that we've detailed, to advocate, to stand up for patients, to fight for our profession, that charge belongs to all of us. Our profession needs to speak with a unified voice. And the AMA is that voice.
If not the AMA, then who will respond to the challenges and the obstacles that undoubtedly lie ahead, the continued financial assault on physician practices, the impediments that payers continuously place between patients and their physician, the next pandemic? The next cyber attack on health care giant? Are we going to let the pharmaceutical companies handle it? What about the health insurance? Or maybe just allow the legislators to fix it on their own? I think not.
We need to come together because the consensus between us is much stronger than the opposition against us. We are positioned to win if we pull together and speak as a unified voice. Join me in this fight. Join the AMA now.
Unger: Dr. Scott, what a great message and platform for your upcoming presidency. I'm really looking forward to many discussions with you in the coming year. Thanks so much for joining us today and congratulations again. Like Dr. Scott said, it's so important that we speak with a unified voice and to support the work of the AMA. In the year ahead, 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. 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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