Just months after Congress again failed to stop in its entirety a pay cut that threatens Medicare patients’ access to high-quality physician care, the AMA House of Delegates made crystal clear the imperative to step up the pressure on the nation’s lawmakers and boost patient awareness about the dire need for Medicare payment reform.
In a federal budget deal struck to continue operating the government, Congress in March reduced to less than 2% the 3.37% across-the-board physician pay cut that took effect in January.
The House of Delegates (HOD) directed the AMA to:
- Increase media awareness around the 2024 AMA Annual Meeting about the need for Medicare payment reform, eliminating budget-neutrality reductions, and instituting annual cost-of-living increases.
- Step up its public relations campaign to get more buy-in from the general public about the need for Medicare payment reform.
- Increase awareness to all physicians about the efforts of our AMA on Medicare payment reform.
- Advocate for abolition of all Merit-based Incentive Payment System (MIPS) penalties in light of the current inadequacies of Medicare payments.
This direction from the HOD bolsters the AMA’s aggressive efforts in leading the charge to reform the Medicare payment system.
The AMA is relentless in working to advance comprehensive fixes to the unsustainable Medicare physician payment system. Among the fixes is H.R. 2474, the Strengthening Medicare for Patients and Providers Act. This bipartisan legislation would provide physicians with an annual, permanent inflationary payment update in Medicare tied to the Medicare Economic Index.
“Top advocacy priority”
In his final address to the HOD as AMA president, Wisconsin anesthesiologist Jesse M. Ehrenfeld, MD, MPH, called out the AMA’s work to reform Medicare payment.
“Reforming our broken Medicare payment system that punishes doctors for being doctors is why we fight. Medicare reimbursement has plummeted 29% [PDF] since I was in medical school,” he said, referring to the impact to the pay rate after adjusting for inflation.
“Medicare reform is our top advocacy priority because it’s crippling the sustainability of physician practices, threatening patient access to care, and choking the pipeline for future physicians. I am proud to stand here before this House to tell you that momentum is shifting toward significant reform. And we are changing the conversation.
“Thanks to our AMA’s comprehensive Fix Medicare Now campaign, multiple hearings, media visibility, and our extremely persistent lobbying efforts, there is now broad acceptance that the current Medicare payment models don’t work. And there is growing support in Congress for Medicare reforms aligned with AMA’s models that seek to put physicians on equal footing with all other health care providers [PDF].”
The AMA is “keeping up the pressure,” Dr. Ehrenfeld said, “because our current system is unsustainable, and because physicians shouldn’t have to worry about how they’ll keep the lights on."
The Fix Medicare Now campaign has generated over 60 million paid impressions, nearly 700,000 engagements, and almost 340,000 messages to Congress. Send a message to your member of Congress and urge them to support Medicare payment reform.
Looking ahead, the campaign is starting an aggressive promotional ramp-up ahead of the November elections.
Anticipated activities include:
- Targeted inside-the-beltway media company sponsorships.
- Podcast audio promotion with 15- to 30-second audio ad placements on a range of podcasts targeting custom audience segments.
- Paid and organic social media promotion targeting audiences across Facebook, Instagram, X and LinkedIn.
- Out-of-home advertising featuring high-trafficked placements throughout D.C., such as train stations, bus shelters, digital billboards, rideshare, urban panels.
- August recess call to action for the Physicians Grassroots Network.
Fighting for Physicians
Get updates on how the AMA is fighting for physicians on critical issues—delivered to your inbox.
The AMA has a plan to replace MIPS
On the Medicare Merit-based Incentive Payment System, the AMA has long been concerned about the undue administrative burden placed on physicians subjected to MIPS reporting requirements, the program’s lack of improvement in patient outcomes and quality of care, and the limited scope of quality measures for specialists.
There is also a growing body of evidence that MIPS is disproportionately harmful to small, rural and independent practices, as well as practices that care for underserved patients. The 2022 Quality Payment Program Experience Report recently showed that 27% of small practices, nearly 50% of solo practitioners, and 18% of rural practices are receiving a MIPS penalty this year. Finally, MIPS does not provide actionable, timely feedback to physicians to understand their utilization and identify opportunity to reduce avoidable spending for Medicare patients and the program, despite this being required by Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
With substantial input from national medical specialty societies and physicians across the country, the AMA has developed a statutory proposal to replace the MIPS tournament model of payment adjustments with a more sustainable approach tied to annual payment updates, give the Centers for Medicare & Medicaid Services incentives to share data with physicians, and improve the measures.
The MIPS replacement, called the “Data-Driven Performance Payment System,” would freeze the performance threshold to avoid a penalty at 60 points for at least three years and call for a study to improve the threshold methodology. It would also eliminate the win-lose style payment adjustments that include a maximum penalty of negative 9% and instead link performance in MIPS to a percentage increase or decrease of the annual update, which would better align across Medicare payment programs, such as the Hospital Inpatient Quality Reporting System. More details about this proposed replacement for MIPS will be formally announced in the coming weeks.
This replacement system would replace steep penalties that are unevenly distributed, ensure timely access to data, reduce unnecessary administrative burden, and increase the clinical relevance of the program to physicians and their patients.
The AMA created the Medicare Basics series, which provides an in-depth look at important aspects of the Medicare physician payment system. With these six straightforward explainers on budget-neutrality rules, MIPS, the MEI and more, policymakers and physician advocates can learn about key elements of the payment system and why they are in need of reform.
Read about the other highlights from the 2024 AMA Annual Meeting.
