AMA 2024: Championing Change: The AMA's Vital Advocacy Initiatives for Physicians
One of the AMA's primary focuses has been on reforming prior authorization processes, which have long been a significant burden for physicians. Recently, the AMA secured a CMS final rule that mandates government-regulated health plans to reduce the timeframes for prior authorization decisions and publicly report program metrics. Additionally, these plans must offer electronic prior authorization technology integrated with electronic health records (EHRs). This development builds on Medicare Advantage requirements implemented in January 2024, which ensure the validity of prior authorization clinical criteria and protections for care continuity.
In the legislative arena, the AMA successfully advocated for reintroduction of H.R. 4968, the GOLD CARD Act of 2023, which allows physicians with a strong record of complying with prior authorization requirements to be exempt from this utilization management technique in Medicare Advantage. The AMA has also worked closely with state medical associations across the country to enact prior authorization reform using AMA model legislation, data, testimony, and other resources. Over the past year, ten new state laws have been enacted, and the AMA continues to support more than a dozen bills currently under consideration in state legislatures. Moreover, the AMA facilitated significant reductions in prior authorization requirements by major insurers such as United Healthcare and Cigna, which reduced their volume by 20% and 25%, respectively.
Reducing physician burnout is another critical area of focus for the AMA. Collaborating with the Federation of State Medical Boards and the Dr. Lorna Breen Heroes’ Foundation, the AMA has urged state medical boards, credentialing bodies, and other entities to remove stigmatizing and potentially discriminatory questions from their applications that may deter physicians from seeking care. This advocacy has led to statewide changes in Massachusetts and Virginia, as well as modifications in more than 26 states, numerous national, regional, and state hospitals and health systems, and other facilities. These efforts have positively impacted hundreds of thousands of physicians. Additionally, the AMA has supported new laws and policies in over a dozen states that protect physicians who seek care for wellness and burnout. The organization is also working to implement and reauthorize the Dr. Lorna Breen Health Care Provider Protection Act through the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (H.R. 7153/S. 3679), which recently passed the House Energy and Commerce Committee.
In terms of Medicare payment reform, the AMA has achieved consensus across the medical community to pursue four pillars of reform: establishing an annual inflation-based payment update for Medicare physician payments, revising policies and processes used to adjust payments to maintain budget neutrality, simplifying and improving clinical relevancy reporting programs under the Merit-based Incentive Payment System (MIPS), and extending policies that support practices transitioning to value-based payment systems. The AMA secured the introduction of H.R. 2474, which aims to apply an automatic inflation update to Medicare physician payments by tying the Medicare physician fee schedule to the Medicare Economic Index. H.R. 2474 currently has more than 130 bipartisan House cosponsors.
The AMA also advocated for the introduction of H.R. 6371, which seeks to revise budget neutrality policies to mitigate inappropriate payment schedule conversion factor cuts and minimize revenue instability. Key components of this bill were included in H.R. 6545, bipartisan legislation that passed out of the House Energy and Commerce Committee. Additionally, the AMA supported H.R. 5013/S. 3503, the Value in Health Care Act, which extends incentive payments for advanced alternative payment models. To raise awareness and drive legislative action, the AMA launched the grassroots campaign and website FixMedicareNow.org, which has facilitated over 312,000 contacts to Congress.
Through these comprehensive advocacy efforts, the AMA continues to work diligently to improve the practice environment for physicians and enhance patient care across the United States.
Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center, @RuchikaTalwarMD during the 2024 AMA Annual Meeting, June 7 to June 12