March 7, 2025: National Advocacy Update

With the United States facing an ongoing shortage of physicians, especially in rural and underserved areas, the AMA applauded the introduction of bipartisan, bicameral federal legislation to reauthorize the Conrad 30 program on Feb. 25. 

In the Senate, Senators Amy Klobuchar (D-MN), Susan Collins (R-ME), Thom Tillis (R-NC) and Jacky Rosen (D-NV) introduced S. 709, the Conrad State 30 and Physician Access Reauthorization Act.  Representatives David Valadao (R-CA), Brad Schneider (D-IL), Don Bacon (R-NE) and Sylvia Garcia (D-TX) introduced an identical companion bill, H.R. 1585, in the House of Representatives.  

Both Senator Klobuchar and Representative Valadao led joint press releases, respectively, announcing the introduction of the legislation.  

“With the physician workforce crisis showing no signs of abating, the Conrad 30 program remains an important tool to help ensure patients, particularly in rural and underserved communities, continue to have access to physicians,” said AMA President Bruce A. Scott, MD. “The Conrad 30 program has expanded the physician workforce across all communities, yet it would benefit greatly from the long-term reauthorization and targeted policy improvements outlined in this legislation. Once again, [Senators, Klobuchar, Collins, Tillis, and Josen, as well as Reps. Valadao, Schneider, Bacon, and Garcia,] have stepped up for patients and physicians, and we applaud them for introducing the Conrad State 30 and Physician Access Reauthorization Act.”   

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, and 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 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 AMA was joined by the Federation of American Hospitals, American Academy of Neurology, Association of American Medical Colleges, and Physicians for American Health Care Access as proud supporters of this bipartisan legislation. 

In a letter (PDF) to the Centers for Medicare & Medicaid Services (CMS), the AMA wrote there is no better opportunity to fulfill Executive Order 14192, Unleashing Prosperity Through Deregulation, than by cutting the morass of complicated rules and requirements for compliance with the ineffective Merit-based Incentive Payment System (MIPS) program in the 2026 Medicare Physician Fee Schedule (MPFS) proposed rule. Despite being implemented in 2017, MIPS has yet to demonstrate better health outcomes for Americans or lower avoidable spending. Nevertheless, the program imposes steep compliance costs on physicians. Even worse, the program disproportionately hurts small and rural practices, which are small businesses, by cutting their Medicare reimbursement up to –9% despite being “approximately as effective as chance in terms of identifying high versus low quality performance,” according to a JAMA study. The AMA provided detailed recommendations to reduce the regulatory burden of MIPS, including: 

• Awarding multi-category credit and ensuring MIPS Value Pathways are clinically relevant so patients can compare quality and cost across physician practices 

• Reducing unnecessary quality measure reporting burden and eliminating arbitrary scoring rules that drive up the cost of compliance with MIPS and disincentivize reporting on new and substantially revised measures 

• Fixing the long-standing inaccuracies with the MIPS cost measures and nullifying their negative impact on Medicare physician payment and patient access to care until these issues can be properly addressed 

• Sharing timely, critical MIPS performance data and Medicare claims data with physicians to facilitate better quality and lower costs 

• Maximizing usage of electronic health records and other emerging technologies while minimizing wasteful “check the box” reporting exercises 

The Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration jointly published a final rule on Jan. 17, 2025, expanding physicians’ ability to prescribe buprenorphine for opioid use disorder (OUD) treatment for patients who have not had an in-person evaluation. The new rule was supposed to take effect on Feb. 28, 2025, but after Trump administration review, the DEA decided to delay the implementation date until March 21, 2025. 

A new AMA comment letter (PDF) urges the DEA to proceed with implementation of the buprenorphine final rule without further delay, noting that the final rule provides greater flexibility than the proposed rule and adopts several recommendations that the AMA made in response to the 2023 DEA proposed rule. For example, while the proposed rule would have required patients to have an in-person visit as a condition of being prescribed buprenorphine to treat OUD beyond 30 days, the final rule extends the period that patients can be prescribed buprenorphine for OUD based on audio-only visits to six months. After six months, prescriptions can be based on a different telemedicine modality, such as audio-video, or an in-person visit. In addition, the final rule removes special recordkeeping and documentation requirements that the AMA had opposed. 

The AMA also urged the DEA to make clear that no action will be taken by the federal government against any party solely for not including buprenorphine products approved by the Food and Drug Administration to treat OUD in suspicious order reporting. The AMA has received multiple reports from physicians and pharmacy colleagues that distributors are delaying or suspending orders of buprenorphine because of fear that they will be investigated by the DEA for suspicious orders. The net result is that patients with OUD suffer delays and denials of care—situations that cause harm and could lead to tragedy.

The AMA signed on to a letter (PDF) led by the Washington Committee of AANS and CNS expressing concern about a new policy from the National Institute of Health (NIH) that would impose a 15% cap on indirect cost recovery for all NIH grants. Previously, research institutions negotiated their indirect cost rates.  

“The university research ecosystem is fundamentally built on federal research funding, with indirect cost rates intended to reflect expenses required to sustain groundbreaking scientific work,” says the letter. “The proposed 15% cap on indirect cost recovery would disrupt this well-established research ecosystem, forcing institutions to absorb critical infrastructure costs. No major research university could sustain its operations under this funding model, which would dismantle the very framework that has enabled U.S. institutions to lead in global research and innovation.” 

The absence of stable federal funding would threaten the sustainability of scientific research that advances medical breakthroughs, fosters innovation and improves patient outcomes. With these concerns in mind, the organizations encourage the NIH to rescind this policy and instead work collaboratively toward a solution that balances transparency, efficiency and sustainability. 

• March 7, 2025: Medicare Payment Reform Advocacy Update
• March 7, 2025: State Advocacy Update
• March 7, 2025: Advocacy Update other news