Todd Askew on AMA’s advocacy efforts for physician and patient protections

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In the first of a two-part series, AMA Chief Experience Officer Todd Unger speaks with AMA Senior Vice President of advocacy Todd Askew on AMA's latest advocacy efforts, including protections for physicians and patients during the COVID-19 pandemic.

Learn more at the AMA COVID-19 resource center.

Speakers

• Todd Askew, senior vice president, AMA

Unger: Hello, this is the American Medical Association's COVID-19 update. This is part one of a two part series on AMA's latest advocacy efforts. I'm joined today by Todd Askew, AMA's senior vice president of advocacy in Washington, DC. I'm Todd Unger, AMA's chief experience officer in Chicago. The AMA's advocacy has led to significant protections for physicians and patients throughout this pandemic. Mr. Askew, I'd like you to start by telling us more about this week's Supreme Court ruling on the Title VII cases, and what role AMA advocacy played in this decision?

Askew: Well, thanks Todd. Yes, it is a very important ruling with significant implications for health care. The court this week affirmed that the protections against workplace discrimination under Title VII of the Civil Rights Act do apply to LGBTQ individuals. And this is an effort that the AMA had supported, along with a long list of other organizations with an interest in the case. We know that discrimination can have significant impacts on mental health as well as physical health, and we've seen obviously the disproportionate impact that this pandemic has had on minority populations and persons of color and other groups that have faced discrimination in the past. And so the confirmation that these protections apply to LGBTQ individuals is significant.

Beyond just the ruling on this week's case, last week the administration released a rule overturning some provisions in regulation that prevented discrimination against individuals in health care situations, who are LBGTQ individuals and other categories of persons. So while this doesn't directly impact that rule, it will add significant firepower for advocates who will be challenging those discriminatory provisions as well.

Unger: Well, inequities in health care have driven a lot of our advocacy efforts. What other policy changes are we advocating to address COVID-19's impact on minoritized populations?

Askew: Well, one of the critical first elements is data. I mean, we know from just observing who is impacted, seeing who is in the hospital, seeing who is dying, that persons of color and other minoritized populations have faced a disproportionate burden of the current pandemic in terms of disease, disability and death. So data is critical to beginning to understand that, and we have worked to push the administration and Congress to increase capacity, to gather this data, to require that this data be reported. That's an ongoing effort, and we will also continue to push the states collect that data, because it's key to understanding what is really going on.

We're also seeing a lot of interest in Congress. There have been a number of hearings, both over the last few weeks and scheduled, for members of Congress to gather information and to hear from witnesses about the impact of the pandemic on these populations so that they can begin to formulate policies. We've made a number of recommendations in this area. We've emphasized the need to address implicit bias, not only in how we educate physicians, but in society as well, so that we have a better understanding how we view these populations, but how we work with them in partnership to address the needs.

We've also, in addition to the data challenges we mentioned, have placed a lot of emphasis on dealing with the social determinants of health. It's not necessarily just the immediate cause that is causing a disproportion impact for these populations, but it's everything around them. It is the environment that they live in, it's the tools that they have access to, whether that be housing or education or health care in their community, and so we need to address all of those elements if we're going to begin to kind of get a handle on how we can prevent any particular population from suffering the disparities that we've seen laid bare by the current pandemic.

And we also need to invest in professional diversity. We need a workforce, a health care workforce that looks like the population it serves. Better cultural understanding and a better ability to communicate and to provide culturally competent care to everybody.

Unger: Absolutely. Well, let's turn our attention to the subject of testing. There's been a lot of confusion, particularly around antibody testing, as well as a lack of diagnostic testing. That continues to be a challenge as states reopen. What is the AMA doing on this front?

Askew: There's several key elements here. Obviously, in terms of COVID testing, testing for the presence of the virus, it was very slow and kind of a little bit chaotic in getting started and coming up to the capacity that is needed. We've certainly seen great improvements, and a larger, much larger number of tests are available, and we're beginning to start to match the capacity with the demand. And so that's significant, in that we're able to better recognize the spread of disease in communities.

That said, the problems we had faced with supplies, not only the tests themselves, but the swabs, the transport medium, other tools that you need to conduct the test, including PPE, continue to be a challenge. And as we face new increases in COVID cases, in new areas that are experiencing them for the first time maybe, or the potential of a second wave that we're seeing in certain areas that may have been impacted initially, keeping those supplies at hand and accessible is critical to being able to determine where this disease is and where it's moving.

The second element, which has received a lot of attention, is antibody testing, and there are a number of concerns here. There are obviously a lot of tests out on the market that are not very good, and so there's question about the reliability of some of the tests that are out there. Only a handful have actually been approved by the FDA to date, and that is something that is increasing, but people need to use caution when using these tests, and physicians and other providers need to be educated on what it really means.

We don't know, A, if the test is accurate, and B, if it does indicate a previous exposure to COVID by the presence of the antibodies, we don't really know what that means. Obviously, in a lot of other similar diseases, exposure confers some sort of, some level of immunity in most cases, we don't know if that's true for this disease. And so we have to caution people that just because you may have a positive antibody test does not mean that you are now immune and you can go about your life without the risk to yourself or the risk you may be able to infect others because we don't know if that's true. There is an important role, however, for antibodies testing, specifically in monitoring populations, and as we seek to get a better understanding of this disease, how it has moved through the country, antibody testing will be a critical part of that going forward.

And obviously the last thing I'll mention is coverage for testing. There's a lot of issues coming up. We obviously have seen expansion of Medicaid and private health plans stepping up to make sure that people are able to afford testing when it's presented to them, but there are other questions beginning to be raised such as, if we're going to conduct broad surveillance testing of large populations, private health insurers and employer-sponsored insurers are not exactly excited about being the ones to fund large surveillance testing.

And the same thing comes when you have some employers deciding to use testing as they bring employees back to work in the coming weeks and months. Obviously insurance companies are not excited about being on the hook, if you will, for covering those tests in all cases. And so there's a lot of policies that we still need to work out, a lot of issues surrounding testing that still need to be addressed, and those conversations are ongoing.

Unger: Well thanks, Todd. Increased use of telehealth as a result of COVID-19 has prompted coverage and payment questions. What's the AMA been able to achieve in this rapidly growing area?

Askew: Well, I think, Todd, right at the beginning of the pandemic, we recognized the importance of telehealth, initially for things like being able to triage patients so you're not having potentially sick patients come into the emergency room and potentially expose themselves to other patients unnecessary. Remote monitoring, caring for a lot of the patients who could be cared for at home, those were important things early in this disease. We also obviously saw greatly diminished willingness of individuals to take care of their basic health care needs and even some more urgent needs, as not only elected procedures were put off, for good reason, but also people that had illness were not going to the doctor. And so the expansion of telehealth and the offering of new telehealth services that weren't previously covered by physicians really enabled them to continue to care for their patients going forward in the midst of this crisis.

As these things have kind of become more commonplace, Medicare has adjusted and made some important policy improvements. The originating sites, there's more flexibility, there's new services that could be offered that Medicare will cover that previously were not covered through telehealth. They were covering audio-only care, they still are, for those elderly populations or those who may not have access to smartphones or broadband services. So things like that, even including the prescribing of controlled substances through telehealth, really enabled people, physicians and other providers, to take care of their patient's needs at a distance. And I think that now that those things are out there and people have engaged in them, that we have moved forward a decade in the use of telemedicine in this country, and it is going to become and will remain an increasingly important part of physician practices going forward.

So we are working with Medicare to advocate that some of these changes, the improvements, we would say they're improvements, made in response to pandemic stay in place because they've proven so efficient in providing care. And quite frankly, a lot of members of Congress agree with us. Just within the last few days, 30 members of the Senate, 15 Republicans and 15 Democrats, led by Republican Senator Roger Wicker of Mississippi and Democratic Senator Brian Schatz of the state of Hawaii, led a letter to the administration calling for that, calling to maintain this progress that we've made.

And of course we also need to continue to work with employer-sponsored insurers and private insurers, some regulated by the states, some regulated by the federal government, to ensure and encourage them to continue to offer access to these services for their beneficiaries as well. So this has accelerated telemedicine to an exciting new place, and we all need to work very hard to make sure that we are able to maintain the progress that we've made.

Unger: Well, that concludes part one of our AMA advocacy update. Thank you, Mr. Askew, for being here today and sharing your perspective, and we'll be back tomorrow to continue this important discussion with part two of our series.

In the meantime, for updated resources on COVID-19 go to ama-assn.org/COVID-19. Thanks for being with us here today and take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.