AMA cosigns letters urging congressional action on physician workforce bills before end of 2024
As the 118th Congress quickly draws to a close, the AMA joined a strong, diverse coalition of health care entities on a letter (PDF) pushing House and Senate leadership to enact two important workforce bills, specifically H.R. 4942/S. 665, the Conrad State 30 and Physician Access Reauthorization Act, and H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act (HWRA), before Jan. 1, 2025.
The letter (PDF) to congressional leadership was ultimately cosigned by 37 other health care organizations, including the American Academy of Neurology, American Hospital Association, Federation of American Hospitals, Physicians for American Healthcare Access, and the American College of Physicians.
Currently, physicians from other countries working in the United States on J-1 visas are required to return to their country of origin upon conclusion of their residency for two years before they can apply for another visa or a green card. Under the Conrad 30 program, each individual state is granted 30 waivers to allocate to physicians permitting them to forgo the requirement to return to their country of origin so long as they are willing to work in a medically underserved community for three years.
In addition to reauthorizing the program for an additional three years, the Conrad State 30 and Physician Access Reauthorization Act:
Outlines a process to gradually increase the total number of waivers per state
Mandates additional transparency in employment contract terms
Permits greater immigration flexibilities for spouses and children of participating physicians
Requires an annual report from the U.S. Citizenship and Immigration Services to the Department of Health and Human Services on the annual utilization of the waivers in hopes of better informing rural states on how to make full use of the program
To ease the current per-country backlog, the legislation also authorizes physicians who practice in underserved areas or Veteran’s Affairs facilities for five years to receive priority access within the green card system. The Conrad State 30 and Physician Access Reauthorization Act currently has 111 bipartisan House and 23 bipartisan Senate cosponsors, respectively.
HWRA, however, sets up a process to reclaim a total of 40,000 unused employment-based visas, specifically 25,000 for foreign-born nurses and 15,000 for foreign-born physicians, over a period of three years. This recapture of unused employment-based visas would play a tremendous role in reducing the overarching physician shortage throughout the United States. According to projections published by the American Association of Medical Colleges in March 2024, the United States faces a shortage of up to 86,000 physicians by 2036. HWRA currently has 57 bipartisan House and 19 bipartisan Senate cosponsors, respectively.
A separate letter (PDF) cosigned by the AMA and 32 other national health care organizations was also sent to Representatives Tom Suozzi (D-NY) and Morgan Luttrell (R-TX) in support of both the Conrad 30 and HWRA being included in a discrete immigration package these two bipartisan House members are potentially considering for introduction in both the 118th and 119th Congress.
CMS finalizes new mandatory transplant model with substantive changes and delayed start
On Nov. 26, the Biden administration finalized the Increasing Organ Transplant Access (IOTA) Model, a new mandatory model for roughly half of transplant hospitals across the country based on whether they meet eligibility criteria and their Donation Service Area (DSA) was selected. The model is a two-sided risk model to incentivize kidney transplants. It will run for six years starting July 1, 2024, after the model’s start date was initially delayed to allow for more time to incorporate stakeholder feedback. Downside risk will start in the second performance year of the model.
The AMA sent a joint letter (PDF) along with the American College of Surgeons and American Society of Transplant Surgeons with feedback when the model was proposed over the summer. Though the administration did not heed calls from the AMA and other stakeholders to make the model voluntary, it did make several substantive changes to the model’s design based on feedback from the AMA and other interested parties, including increasing the maximum amount a transplant hospital may receive under the model from $8,000 to $15,000, lowering the target number of transplants to the average number of transplants cumulatively over the three baseline years (as opposed to the highest number of transplants in any single baseline year), amending the quality strategy including removing three measures, and removing the requirement for providers to inform patients of organ offers declined on their behalf on a monthly basis.
New educational videos explaining information blocking released
The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) created five videos on information blocking that are geared toward educating clinicians on the practice. For the past year, the AMA has been urging ASTP/ONC to develop such materials. The videos are available on the ASTP/ONC YouTube page, and present the regulatory information in clear, easy-to-understand language.
The videos focus on the following topics: who does information blocking apply to; what health information is required to be shared; what is an information blocking exception; and how can I report information blocking. The AMA Information Blocking page includes links to the ASTP/ONC videos along with a suite of information blocking resources that are available on the AMA website.
As a quick refresher, information blocking is a practice that is likely to interfere with the access, exchange or use of electronic health information (EHI). Information blocking defines three categories of actors under this regulation (PDF): health care providers (including physicians, nurses, clinicians, or hospitals); health information network or health information exchange; or a health IT developer of certified health IT. There are different knowledge standards for the regulated actors, and health care providers must know that a practice is unreasonable, and likely to interfere with the access, exchange or use of EHI. ASTP/ONC has defined nine exceptions to the information blocking provisions (PDF)—when an actor’s practice meets an exception, it will not be considered information blocking. Even in cases where a practice does not meet any of the exceptions, it does not automatically mean that information blocking has occurred. Information blocking will be evaluated on a case-by-case basis to determine whether it has occurred.
More articles in this issue
- Dec. 6, 2024: Advocacy Update spotlight on the 2024 AMA overdose report highlights
- Dec. 6, 2024: Medicare Payment Reform Advocacy Update
- Dec. 6, 2024: State Advocacy Update
