ACP, AMA Champion Medicare Payment Reform

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At June meeting, AMA House of Delegates passed resolutions on Medicare payment reform, protecting access to gender-affirming care, delaying change to journal publication rules

July 14, 2023 (ACP) — Medicare payment reform and protecting access to gender-affirming care took center stage at the 2023 American Medical Association (AMA) House of Delegates meeting, and the American College of Physicians delegates had front-row seats for the action.

The meeting took place in Chicago from June 9 to 14, 2023.

“The AMA passed a resolution that aims to make Medicare payment reform an urgent advocacy and legislative priority,” said Dr. Sue Bornstein, chair of the ACP Board of Regents. Medicare physician payment has effectively declined by 26 percent from 2001 to 2023 when adjusted for inflation, according to the AMA.

This issue is highly relevant for ACP members, as internal medicine physicians care for many Medicare patients. “If payments aren't adjusted, physicians aren't going to participate, and this leads to access-to-care issues,” she stressed. “We need a significant change in how Medicare physician payments are funded.” Members will report on progress at upcoming meetings.

ACP sponsored two resolutions at the meeting, and both passed, according to Bornstein. The first aimed to protect access to evidence-based gender-affirming care for transgender and gender-diverse individuals and to make sure there are no criminal or legal penalties associated with providing or receiving such care. This is a hot-button issue, as many states are currently seeking to ban or criminalize gender-affirming care.

“The resolution essentially opposes any criminalization or penalization against patients, family members and clinicians,” Bornstein explained.

This resolution, which is consistent with ACP policy, passed overwhelmingly, she said.

The second ACP-sponsored resolution aims to slow or put the brakes on a potentially seismic change to publication rules that would require that journals make any research involving public funds accessible as soon as published. This means no paywall or subscription, which could upend the business model of most peer-reviewed medical journals, including Annals of Internal Medicine, Bornstein explained.

“We are asking to delay this change, as there wasn't much notice given, and if this research needs to be made available, it needs to be done in a way that doesn't destroy the publishing aspect of a business,” she said.

Ensuring access to telehealth, especially in underserved areas, was another focus at the meeting. “Telehealth is here to stay,” Bornstein noted, “but there are still lots and lots of people who don't have access to telehealth or broadband for economic or geographic reasons.”

The AMA now plans to continue advocating for solutions to meet the needs of these populations, she said.

The Bigger Picture

ACP has a large and growing influence in the AMA, said Dr. William Golden, who heads the ACP AMA delegation.

ACP members elected to councils at the meeting included: Dr. Ankush Bansal to the Council on Science and Public Health; Dr. Kelly Caverzagie to the Council on Medical Education; Dr. Elisa Choi to the Women Physicians Section Governing Council; and Dr. Ricardo Correa to the Council on Medical Education.

In addition, Dr. Sandra Adamson Fryhofer just completed her year as chair of the American Medical Association Board of Trustees, Golden noted.

“We have one of the largest delegations at the AMA, and the AMA is increasingly developing policies that align with what ACP has been advocating for years. This traction translates to the national level,” he said.

Every member's voice should be heard, Golden said. “Get involved and contact your local leadership and chapter governor to help shape priorities,” he said. “This does make a difference.”

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Back to the July 14, 2023 issue of ACP Advocate