AMA 2023 Interim: Highlights from Newly Adopted AMA Policies on Medical Service, Practice and Insurance

( At the 2023 Interim Meeting of the American Medical Association (AMA) held in National Harbor, MD, the House of Delegates approved a number of significant policy measures pertaining to Medical Service, Practice, and Insurance, which are significant for the field of urology.

Urologists are a critical member of teams that provide gender-affirming care, and there has been ongoing state legislation passed around the country that seeks to limit coverage of care for transgender patients. Policy was formally passed that directs the AMA to create a temporary committee or task force, including physicians from specialties involved in gender-affirming care, payers, community advocates, and state Medicaid directors or insurance commissioners. This group's goal will be to pinpoint the problems related to physician payment and reimbursement for gender-affirming care and to propose strategies to overcome these obstacles.

Rising prescription drug costs have been a major issue for physicians and patients alike. The House reaffirmed prior policy on this issue, encouraging actions to limit pharmaceutical companies' anti-competitive behaviors, measures to increase market competition and patient access to generics, drug price transparency, legislation to manage drug costs, including rebates for Medicaid if generic prices outpace inflation, shorter exclusivity for biologics, and actions against price gouging. However, a new policy passed now formally opposes Direct Member Reimbursement plans that can lead to significant upfront patient expenses.

After the end of the public health emergency declared, Medicaid flexibilities led to large number of redeterminations, whereby many adults and children lost insurance coverage. However, physicians were also affected via network considerations and prior authorization issues. In response to this, the AMA House of Delegates sought to amend its policies to encourage state Medicaid agencies to implement measures to prevent inappropriate terminations from Medicaid/CHIP for procedural reasons and to improve renewal processes. The policy also called for states to ensure continuity of care and access to coverage status information for providers. It reaffirmed existing policies advocating for 12-month continuous eligibility and auto-enrollment in health insurance with appropriate safeguards. Overall, the AMA backed strategies to address wrongful Medicaid disenrollments, establish special enrollment periods for those disenrolled from Medicaid to join ACA marketplace plans, and prevent wrongful disenrollments of physicians from Medicaid/CHIP programs.

Lastly, important policy was passed regarding prior authorization procedures and specialty physicians, such as urologists. The new policy calls for the AMA to advocate for changes in current public and private processes, including Utilization Management, Prior Authorization, and Medicare and Medicaid audits, to ensure that only adequately trained and licensed physicians can make judgments on medical diagnoses and medical necessity. Additionally, to prevent delays in patient care, the AMA supports prioritizing the judgment of the treating physician if the reviewing physician is unavailable.

Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center during the 2023 AMA Interim Meeting, Nov 10 to Nov 14