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What does the AMA advocate for? What does the AMA do? Is Medicare reducing payments to doctors? Are there telehealth exemptions in 2025?
Todd Askew, senior vice president of advocacy at the American Medical Association, joins from the AMA State Advocacy Summit to outline the AMA’s top priorities for 2025. This includes reversing Medicare payment cuts, extending telehealth policies, fixing prior authorization issues to reduce administrative burdens for doctors, as well as continuing grassroots and physician engagement with elected officials to support key health care policies. AMA Chief Experience Officer Todd Unger hosts.
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- Reforming Medicare payment
- Fighting scope creep
- Fixing prior authorization
- Reducing physician burnout
- Making technology work for physicians
Speaker
- Todd Askew, senior vice president of advocacy, American Medical Association
Transcript
Askew: I think physicians need to understand that their voice is a strong one, but it's only has an impact if it's heard. And so, to continue to reach out, be involved in the process, be engaged, talk to your elected officials about how their decisions affect not just your practice, but your patients.
Unger: Hello and welcome to the AMA Update video and podcast. Today we're talking with the AMA Senior Vice President of Advocacy, Todd Askew, who's going to be attending the State Advocacy Summit in La Costa, California, here shortly. He's here to give us an update on our advocacy efforts and where we stand at the start of a new year. I'm Todd Unger, AMA's chief experience officer in Chicago. Todd, it's a pleasure to have you back.
Askew: Hey glad to be back, Todd. Thanks.
Unger: Well, there were a lot of developments at the end of the year in Washington, including one on Medicare physician payment. Todd, let's talk a little bit about the outcome there and what the next steps are.
Askew: So we'd like to think of it not as an outcome, but pretty much like a temporary state. We hope that is the intent. It was very unfortunate, towards the end of the last Congress in December, there was a bipartisan, bicameral package that had been negotiated and was set for passage. It would have mitigated most, not quite all, of the Medicare physician payment cut and made a number of other important changes.
Unfortunately, last minute complications arose in the effort to get the package passed, and Congress kind of reverted to the narrowest, smallest package they could pass. And that unfortunately did not include stopping the Medicare physician payment cuts. So on January 1, just a few days ago, payments were reduced 2.83% for services provided to Medicare beneficiaries.
We certainly hope this is temporary. Even the policies that they did advance were only advanced to mid-March, meaning Congress—the new Congress, which has already begun its work—will come back and work to finalize all of those things they did not do, including funding for the federal government through the end of the fiscal year. And that package will have to be passed by March.
Our hope, in fact, our plan, and working with some members of Congress on both sides of the aisle who want this to happen, is to include language that would reverse that cut and make physicians whole going forward for the rest of the year, including hopefully a small increase. That would be a huge step, but that is what we're going to be pushing for. That is what our allies on Capitol Hill are pushing for. And there's a lot of work to be done. But that's where we stand right now.
Unger: Todd, one of those items you mentioned, there were some things that were kind of given a narrow extension for the next few months. One of those things was certain flexibilities around telehealth. How will the AMA respond on that?
Askew: Well, exactly. And so, telehealth was one of the things that was included as an extender. It's policies that would normally expire should Congress not act on them, and those are really the only things that made it into this package. Telehealth is very popular on both sides of the aisle. It's an important tool in the Medicare program.
And so really up until a couple of days, I mean, I had physicians calling and telling us they were canceling telemedicine appointments in January and February, not knowing that those flexibilities were going to continue. Congress did extend that until mid-March, and it is virtually certain that those will be extended for at least the remainder of the year, if not more, in the final package that they will act on in March.
I think the original package that was slated to pass in December had several years of telehealth extension, which is a positive sign and denotes the support of the issue in Congress. And so we're hoping that that will be included. It certainly remains a high priority for us, and we think it should be included in the next package that we see in March.
Unger: All right. Well, between Medicare payment reform and extending those telehealth capabilities, there's a lot on the plate within the next couple of months. Todd, I'm curious, looking back a year ago to almost this very time last year, there was a big win that we had on prior authorization at the federal level. Do you think that we're going to see any more movement on this in Washington this year?
Askew: So again, going back to the package that we were trying to get through in December, there was an effort, a bipartisan effort to include a codification of those prior authorization changes in the form of the Seniors Timely Access to Care Act. I mean, essentially, this is as easy as it gets. Vast majorities in the House and Senate, bipartisan, support the bill. It cost zero. Because of the regulatory changes, the cost to the federal government to enact this law now was essentially zero. And yet they still could not come to an agreement to include it in that final package.
So there is a lot of momentum on that issue to codify those changes, to prevent future administrations from making changes to the regulations that we wouldn't support. But it could not, again, get over the finish line. So, we'll continue to push that package very strongly. It's got, like I said, very good bipartisan support.
I think a lot of the action on prior authorization is going to come at the state level. And we have seen this over the last several years, states being very engaged in prior authorization issues. And I think that is definitely going to continue. And we'll see many state legislatures take up prior authorization, gold carding, other types of reforms that help ease the friction in the payment process and the approval process.
Unger: Well, let's just dig a little bit deeper there. You are on the cusp there of the State Advocacy Summit. Obviously, that's going to be a big topic of conversation there. You mentioned a few of the particular initiatives around this topic. Any other things on the horizon at the state levels that you want to highlight?
Askew: Well, I think obviously prior authorization will continue to be. We're seeing states get involved in AI issues a lot. That's going to be something to watch very closely, not only at the federal level, but there's considerable interest at the state level.
One thing that states are going to be engaged in—and it's really a state and federal issue, I think, in the coming months—is the issue of Medicaid and the Affordable Care Act. There is some concern that Congress may seek to find savings through the Medicaid program. And so that is something that the governors will be very engaged in. State legislatures will be very interested in it, and of course, the federal government, the Congress will be the ones looking to do that.
And so, I think we're going to see a lot of discussion around Medicaid and certainly the Affordable Care Act, with the expiration of the enhanced premium subsidies or tax credits for premiums—premium tax credits, I'm sorry—expiring at the end of this year. I think there'll be a concerted effort at the federal level to extend those premium tax credits. And certainly, that's of great interest to the states in terms of making sure that all their citizens are insured.
Unger: Well, Todd, obviously, unlike a situation that we were facing last year at this time, big changes. Of course, there is a brand new administration. Big picture, how does something like that affect your advocacy efforts?
Askew: Well, every two years you kind of have to press the reset button in Washington. We now have, in this case, Republican control of both chambers of Congress, although with very thin margins, as well as the White House. We'll see an entire new slate of players in the federal agencies that we deal with, an entire new set of priorities. Those aren't exactly clear yet. The nomination process is well underway. We would expect hearings in the coming weeks. There will be an effort to have many nominees in place by the time of the inauguration on January 20, but certainly there will be many more nominees to offices that we're interested in that will play out over the next weeks and months.
A lot of what you hear on the campaign trail, a lot of what you hear in the media, it's all speculation right now. I think we need to see who is put in place. We'll sit down with them. We'll talk about their priorities. We'll talk about our priorities. There will be issues, certainly, where we can find common ground, and there will be issues where we have disagreements. And those will be honest disagreements, and we will work through them as those issues come up.
Unger: Well, before we wrap up here, anything else you would like physicians to as we kick off yet another very important year of advocacy?
Askew: Well, I think, I guess a word of thanks and continued urging folks. Thank you for their involvement over the past year. We've seen truly impressive numbers of communications to Congress and to folks elected officials at the state and federal level, and to the administration. Engagement in the advocacy process by grassroots physicians is absolutely key to what we do.
And urge them to continue. I think physicians need to understand that their voice is a strong one, but it's only has an impact if it's heard. And so, to continue to reach out. Be involved in the process. Be engaged. Talk to your elected officials. Talk to them about how their decisions affect not just your practice, but your patients. And that, ultimately, is how we'll find success in the many things that we're trying to accomplish.
Unger: Well, Todd, thank you so much for joining us. And we'll check back in with you again soon to find out about the progress that we're making.
To support AMA's advocacy efforts and all the ways that we're fighting for physicians, we encourage you to become an AMA a member at ama-assn.org/join.
That's it for today's episode. 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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