Dec. 16, 2022: National Advocacy Update

Registration for the 2023 AMA National Advocacy Conference, Feb. 13-15, has just opened.

Held at the Grand Hyatt Washington, the premiere physician advocacy conference brings the power of organized medicine to our nation’s capital—putting you on the front lines to advocate on the biggest issues facing medicine.  

Hear from industry experts, members of Congress and the Administration, and others about federal efforts to improve health care—and how you can get involved.   

Featured speakers include Michael Beschloss, presidential historian and bestselling author, April Ryan, White House reporter and political analyst, and Bill Whitaker, CBS News correspondent on 60 Minutes.  

Register and make your hotel reservation now.

The Centers for Medicare & Medicaid Services (CMS) recently released the Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule, which would place new requirements on Medicare Advantage (MA) plans, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service programs, Medicaid and CHIP managed care plans, and Qualified Health Plan issuers on the Federally Facilitated Exchanges to streamline prior authorization (PA) processes, reduce physician practice burdens and prevent patient care delays.

While the AMA is still digesting the 400-page rule, it is expected to align with the AMA’s PA reform campaign, which is a pillar of the AMA Recovery Plan for Physicians. Importantly, the rule reflects the AMA’s successful advocacy to address PA programs in MA plans, as they were excluded from a previous iteration of the rule that CMS released in late 2020. The AMA’s initial review suggests that the rule would bring much-needed transparency to both plans’ PA requirements and program metrics, such as approval/denial rates and average PA processing time. The AMA looks forward to providing feedback to CMS within the 90-day comment period, which ends March 13, 2023.  

In the meantime, the AMA continues to urge Congress, especially the Senate, to pass the bipartisan Improving Seniors’ Timely Access to Care Act before the end of 2022. The bill unanimously passed the House of Representatives via voice vote in September 2022. Visit FixPriorAuth.org to message your Senators about supporting the Improving Seniors’ Timely Access to Care Act and access the AMA’s PA reform resources. 

At its November meeting, the Medicare Payment Advisory Commission (MedPAC) discussed policy proposals aimed at increasing the number of physicians in training who choose to specialize in primary care by increasing Medicare payments to primary care physicians. MedPAC discussed two proposals: one to create two separate Medicare physician payment schedules and one to provide a monthly per-beneficiary payment to primary care physicians. In response, the AMA urged (PDF) MedPAC to consider overlooked causes of the problems impacting the primary care workforce and Medicare’s physician payment system, including: 

• The importance of retaining current primary care physicians who are facing extreme levels of burnout and lack of well-being. Large drivers of physician burnout are prior authorization and administrative reporting requirements.
• Compensation differences between primary care physicians and specialists are affected as much or more by employment agreements and differences in commercial and Medicaid payment rates than by differences in Medicare payments.
• Physicians should receive annual increases in payments that match their increases in costs and more primary care services, including telephone calls, should be eligible for payment in order to improve both compensation and work-life balance for primary care physicians.
• The RUC has made significant efforts to ensure appropriate relative value units (RVUs) are assigned to the services that primary care physicians and specialists provide. As a result, Medicare payments to primary care and internal medicine now represent almost half of Medicare physician payments (46% in 2020) compared to only 37% in 1991, whereas Medicare payments to surgical specialties decreased from 32% in 1991 to only 18% in 2020.
• The serious problems caused by budget neutrality would not be solved by creating separate payment schedules. The AMA recommends a comprehensive solution.

The AMA thanked MedPAC for acknowledging the growing gap between the costs of practicing medicine and what Medicare pays during its December meeting.

Policymakers should look at current practices and today’s leaders for how to end the nation’s drug overdose and death epidemic, says a new publication from the AMA and Manatt Health. “The fight to end the nation’s overdose epidemic and restore compassionate care: Profiles in leadership” (PDF) tells the stories of how a select group of physicians, policymakers and patient advocates are relying on proven policies and actions that help save lives and improve outcomes for people with substance use disorders, patients with pain and those who need harm reduction services.

In many cases, the leaders profiled are the champions behind the policies getting enacted and being implemented. Read more.  

The Centers for Medicare & Medicaid Services (CMS) recently announced (PDF) that it will continue its enforcement discretion on price transparency provisions of the No Surprises Act (NSA) that would require a “convening provider” to collect cost estimates from “co-providers” when providing a Good Faith Estimate (GFE) of costs to uninsured or self-pay patients. Prior to CMS’ announcement, it was anticipated that physicians would have to begin collecting and assembling the cost estimates of other providers involved in their uninsured or self-pay patients’ care in 2023.   

The AMA and a wide-ranging group of other stakeholders have been sounding the alarms to CMS since the GFE provisions took effect in Jan. that the technology to allow physicians, hospitals and other providers to exchange cost information prior to care was not available. Additionally, the AMA and state and national medical specialty societies have been asking that CMS consider the onerous impact of introducing such a requirement into the practice workflow—both in terms of staff time and practice resources. As such, the recent announcement is well received by physician, hospital and other provider groups.    

A related NSA provision, yet to be implemented, requires health plans to provide insured patients with cost estimates—Advanced Explanation of Benefits (AEOBs)—prior to the provision of care and triggered by provider GFEs sent to the plan. The AMA recently responded to a Request for Information on potential implementation challenges to the Departments of Health and Humans Services, Treasury and Labor and the Office of Personnel Management. The AMA’s comments (PDF) highlighted data exchange challenges as well as privacy concerns associated with supplying health plans such detailed information prior to care.   

The AMA House of Delegates declared firearm-related violence a public health crisis in 2016 and has continued to push for policy and physician leadership to prevent firearm violence. Most recently, at the 2022 Interim Meeting, the AMA House of Delegates adopted new policy to establish a task force focused on firearm violence prevention. 

“We cannot continue to live this way. Our children spend portions of school days running active shooter drills, knowing full well their classroom could be next. In movie theaters, houses of worship, hospitals, big cities and small towns, gun violence has shattered any sense of security and taken lives. As physicians and healers, we are committed to ending firearm violence by advocating for common-sense, evidence-based solutions, and this task force will be key to that ongoing effort,” said AMA President Jack Resneck Jr., MD, in his remarks on the development of the task force. 

“Just as there are millions of responsible gun owners in America, there are also people for whom firearms are a way to threaten, intimidate or inflict pain on others. Calling for sensible changes to our nation’s gun laws isn’t an attack on the Second Amendment, it’s an attempt to save lives,” added Dr. Resneck in a Leadership Viewpoint on the urgency for gun reform.  

For more information, a new AMA webpage compiles existing AMA policy, recent advocacy efforts and physician resources aimed at preventing firearm violence.  

Recently, the “Data Mapping to Save Moms’ Lives Act” was passed by both the House and Senate chambers to be sent to the President to be signed into law. The legislation would instruct the Federal Communications Commission to consult with the U.S. Centers for Disease Control and Prevention (CDC) to determine ways to incorporate data on maternal health outcomes for at least one year postpartum into broadband health mapping tools in an effort to reduce maternal mortality and morbidity in the U.S.  

The legislation is a great step forward in combatting the maternal mortality and morbidity crisis in America. The U.S. has the highest maternal mortality rate among developed countries, with CDC data showing that Black and Indigenous women are three or four times more likely to die from pregnancy-related causes than white women. The AMA sent a letter (PDF) in Nov. 2021 in support of the legislation and applauds the legislative champions for getting this important legislation across the finish line. The AMA continues to fight the maternal mortality and morbidity crisis and is glad to see this bill be signed into law. 

The AMA applauds the Department of Education for finalizing a rule that allows physicians working in states where they cannot be directly employed by hospitals or other health care facilities to be eligible for the public service loan forgiveness program (PSLF) if they work full time at a qualifying employer’s facility. The AMA provided comments (PDF) on the proposed rule—“Student Assistance General Provisions, Federal Perkins Loan Program, Federal Family Education Loan Program, and William D. Ford Federal Direct Loan Program”—vigorously advocating for this much-needed change.

This change will particularly impact physicians working in California and Texas, and the AMA is pleased that these physicians can now access PSLF for their service. 

In a recent letter (PDF), the AMA urged members of the Committee on Appropriations to provide all available disaster assistance to the Commonwealth of Puerto Rico and the State of Florida. Unfortunately, Puerto Rico and Florida were devastated by recent hurricanes Fiona and Ian, including suffering damage to their health care infrastructure and services, with total damage estimated in the billions of dollars.  

In particular, Puerto Rico has been severely impacted over the past five years by a series of disasters. Funding inequities, including struggles with lower Medicaid caps and Federal Medical Assistance Percentages than most of the U.S., have plagued Puerto Rico’s health care system and highlight the need for both short-term funding and long-term solutions to help improve Puerto Rico’s health care infrastructure and Medicaid and Medicare financing. 

The AMA supports general disaster funding for Puerto Rico and the State of Florida to assist with their rebuilding efforts following Hurricane Fiona and Ian, as well as congressional action to provide adequate, stable, long-term funding for Puerto Rico’s and other U.S. territories’ Medicaid programs. 

• Dec. 16, 2022: Advocacy Update spotlight on countdown to Medicare pay cuts
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