AMA House of Delegates Takes Action on Medicare Payment, Prior Authorization, Physician Network Inadequacies and More

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During interim meeting, ACP introduced a resolution for reform of the Relative-Value Scale Update Committee, which was referred for study

Dec. 15, 2023 (ACP) -- A large delegation from the American College of Physicians attended the interim meeting of the American Medical Association House of Delegates, held Nov. 10 to 14, and pushed for action to support reform in several crucial areas: Medicare payment cuts, prior authorization, insufficient physician networks in insurance plans and the setting of Medicare payment rates.

ACP representatives are pleased that AMA leaders approved resolutions regarding several ACP priorities and agreed to further consideration of a measure calling for the overhaul of the Relative-Value Scale Update Committee (RUC), said Dr. Sue Bornstein, vice chair of the ACP delegation.

“We make up the largest delegation in the AMA House of Delegates with 34 delegates. In fact, we're larger than any of the state delegations,” said Bornstein, former chair of the ACP Board of Regents. “So, we have a powerful voice.”

During the meeting, the delegates voted on a resolution introduced by ACP supporting reform of the RUC, a volunteer panel of health care professionals that advises Medicare about physician payment. “ACP has had a long history of involvement with RUC,” Bornstein said. “The resolution calls for updating the methodology by which the RUC makes recommendations regarding payment and increasing the transparency of their efforts.”

As she explained, much of the committee's work is based on surveys of physicians about their payment rates. But the return rate on the surveys can be exceedingly low. “We want them to update their methodology and shift from a reliance on survey data to a broader use of evidence-based data and things like metadata,” Bornstein explained.

The American Academy of Family Physicians, Florida Medical Association, Oregon Medical Association and other medical organizations supported the resolution. The discussion about the resolution at the AMA meeting was “intense,” Bornstein noted, because there is disagreement among physicians about how Medicare payments should be distributed. There is fear among some, she explained, that higher payments to internal medicine physicians will lead to lower payments for others, since the Medicare Physician Fee Schedule does not allow for a net increase in spending.

“We were ready for battle,” Bornstein said. “Ultimately, we had what we think is a good result: The resolution was referred for study. In AMA parlance, that's pretty good.”

There were other options, she said. The AMA delegates could have approved the resolution or rejected it. Instead, they chose a kind of middle ground. “We feel that that's a win because we got the message across of how important this is,” Bornstein said.

ACP was pleased that AMA delegates once again agreed to support reform of the Medicare payment system, which continues to lower physician reimbursement over time.

As the AMA notes in a press statement, “In addition to this year's 2 percent cut in Medicare physician pay, doctors face a further 3.37 percent cut set to take effect in January. After adjusting for inflation, physician pay actually fell by 26 percent since 2001.”

ACP is also continuing to advocate to reverse this cut with efforts that will extend into January.

“We cannot live in this environment where we're facing cuts at the end of every year,” Bornstein said. “No one can run a practice, develop their practice, expand their practice. What other professions face something like that?”

AMA delegates agreed to reinforce their support of reform via a press release and call to action. “AMA did a nice job of crafting the policy to emphasize access for Medicare beneficiaries. If your physician cannot sustain their practice, then it is going to ultimately affect access to care,” Bornstein said.

The AMA delegates also voted to highlight onerous prior authorization requirements. The delegates told the AMA to “advocate for a change to existing public and private processes including utilization management, prior authorization, Medicare and Medicaid audits and Medicare and state public health surveys of clinical care settings, to only allow physicians with adequate and commensurate training, scope of practice and licensure to determine accuracy of medical diagnoses and assess medical necessity.”

Finally, a new AMA policy was approved targeting limited physician networks in insurance plans. In a statement, AMA President Dr. Jesse M. Ehrenfeld said the policy “will help the AMA encourage a multilayered approach for regulatory oversight that includes meaningful standards, transparency of network breadth, parameters for out-of-network care and effective monitoring and enforcement of existing standards.”

In the big picture, the recent successes of ACP at AMA meetings show how ACP has become an influential player in the internal deliberations of the nation's largest physician society, Bornstein noted. “We've deliberately tried to increase our visibility, and we've been successful,” she said.

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