AMA 2023: AMA Advocacy Priorities Update

( At the American Medical Association’s 2023 Annual Meeting in Chicago, Mr. Todd Askew, Senior Vice President for AMA Advocacy, provided a comprehensive overview of the AMA’s advocacy priorities. He started the presentation providing a background of the current state of politics, and described the environment as extremely partisan. Although the recent debt ceiling bill was passed with bipartisan support, divisions are rampant, even within each specific party. He explained that this tone underscores the difficult nature of successfully accomplishing healthcare focused priorities, especially as Congress now turns to addressing discretionary spending.

Askew then referenced several recent healthcare focused legislative accomplishments, including the Senate Committee on Health, Education, Labor and Pensions (HELP)’s series of recent bills to lower prescription drug costs. Furthermore, the Senate Finance Committee is currently addressing major concerns surrounding Pharmacy Benefit Managers (PBMs) role is high prescription drug costs for consumers. He added that the Energy and Commerce Committee recently passed bills dealing with how the corporatization and consolidation in medicine affects patient facing costs, encouraging transparency and regulation.

Next, Askew reviewed the AMA’s top legislative priority issues: Medicare payment reform, prior authorization, scope of practice issues, telehealth coverage, and physician wellness. He emphasized that physician wellness is at the top of the list, explaining that although resilience in healthcare workers is indeed important, it is not the solution to burnout. Rather, the healthcare system must address underlying issues that lead to burn out, citing financial concerns, administrative burdens, and lack of improvement in fragmented systems. Per Askew, the AMA is working with individual health systems and licensing boards to eliminate questions that inquire about a history of seeking care of behavioral or mental health issues. He stated that those sorts of questions contribute to the stigma surrounding mental health care in physician, discouraging them from seeking care of mental health issues.

He then stressed the broad financial concerns that face physicians today, starting with Medicare payments. Physicians payments are the only category that does not receive an adjustment for inflation, and Askew described how this will eventually erode access to care for America’s seniors. He also stressed the importance of fixing Merit-Based Incentive Payment System (MIPS), especially given the burden of MIPS reporting given the lack of clinical correlation between measures reported and the actual care provided. Of note, this has been a major issue for urologists, and was recently the topic of a publication by Dr. Maganty from Universrity of Michigan that was discussed in a UroToday video.

Prior authorizations (PA) was the next issue that Askew covered, underscoring not only the burden that PA places on physicians, but also the negative effects of PA on patient care. There is a high frequency of patients abandoning care plans, services, or medications after a denial, but the current administration has focused on this issue. He emphasized the improved rules for Medicare Advantage plans that limit PA and establish baseline qualifications needed for people conducting PA review. Askew predicted a broader rule coming this fall that will require health insurance plans to specifically state why care was denied, and stipulations on what is required to obtain approval. Lastly, he discussed the potential benefits of transparency regarding PA denial rates from specific insurers, so that both employers and patients can consider this data when shopping for insurance plans.

Additional issues that Askew delved into included scope of practice expansion for non-physician providers, stressing that multidisciplinary care with physician led teams is key to maintaining high quality, low cost healthcare, and telehealth preservation and payment parity, which has been a major advocacy focus of organized urology. Lastly, he emphasized the AMA’s commitment to addressing gun violence, now the number one killer of children in the US, and preserving access to reproductive and gender affirming care in the face of attacks on both services.

Presented by: Todd Askew, Senior Vice President, Advocacy for the American Medical Association

Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center, @RuchikaTalwarMD during the 2023 AMA Annual Meeting, June 9 to June 14