The physician role in changing health care: How does the AMA support medical specialty societies?


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What is the main purpose of AMA? Why is health care legislation important? Do physicians need organized medicine? What does the AMA do—and why is the AMA important?

Our guests are AMA President-Elect Bruce Scott, MD, and AMA Board of Trustees Member Bobby Mukkamala, MD. AMA Chief Experience Officer Todd Unger hosts.


  • Bruce Scott, MD, president-elect, AMA 
  • Bobby Mukkamala, MD, member, Board of Trustees, AMA 

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Unger: Hello and welcome to the AMA Update video and podcast. Today we're addressing common misconceptions about organized medicine by looking at the value the AMA provides through the lens of one specialty, and that's otolaryngology.

With us are two otolaryngologists and AMA leaders. Dr. Bruce Scott is the president-elect of the AMA in Louisville, Kentucky. And Dr. Bobby Mukkamala is a member of the AMA Board of Trustees coming from Flint, Michigan. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Scott, Dr. Mukkamala, I'm really looking forward to our discussion. Welcome.

Dr. Scott: Thank you.

Dr. Mukkamala: Thanks, Todd. So are we.

Unger: A lot has changed with what we refer to as organized medicine. Of course, over the years it started out as really the only way for physicians to be heard by policy makers. These days, of course, with social media and other communication tactics, the individual physicians can advocate online and potentially reach millions of people. Dr. Mukkamala, what would you say is the role of organized medicine today?

Dr. Mukkamala: Well, it's an interesting development that you mentioned, Todd. And I think social media has been great at helping doctors realize that what we're dealing with in our own offices and hospitals isn't unique. I mean, it provides a real time tool to be able to share these experiences with each other. And it helps us to figure out what's headed our way based on what other doctors are facing elsewhere.

But when those issues are something that requires a solution, it requires an action to be taken, especially when that action happens in a state capital or a nation's capital, that's when traditional organized medicine, like our academy, our American Medical Association, is critical.

And to get an audience with lawmakers is just much easier when your group represents tens of thousands or hundreds of thousands of doctors asking for that audience. And so, to me, the ability of doctors to advocate online and reach millions and then the organizations that represent them to advocate to policy makers in the halls of our Capitol are the left and right hands of the same being. And when they work together, that's when things get done.

Unger: Let's just take one particularly issue, and that's prior authorization. This is, of course, top of mind for many physicians today as something that really interferes in patient care. Dr. Scott, why don't you take this one. Can you discuss how overused prior authorizations have impacted your own practice and tell us more about the work of the AMA in this area?

Dr. Scott: I will tell you that prior authorization is one of the greatest administrative burdens that takes physicians away from providing care to our patients. And it harms patients as well.

Studies the AMA have shown that on a national level, large percentages of physicians believe that prior authorization results in delayed and denied cares and that it ultimately harms patients. But I think it's particularly bad for us as otolaryngologists because we're specialists and we do complex procedures.

I will tell you from my own practice that I deal with the burden of prior authorization every day. Part of my frustration is that the person on the other end of the phone has not had an opportunity to get a history from the patient, examine the patient, and what's even worse, a lot of times they haven't even been to medical school. Rarely, in my experience, have they been otolaryngologists. Heck, most of the time they can't even pronounce otolaryngology.

And as a result, I'm talking to someone who's making the decision about my patient's care who simply does not have the knowledge to make the decision. And now, the AMA has stepped in. And we've been successful. In fact, we were able to convince the Center for Medicare and Medicaid Services to pull back on prior authorization for Medicare Advantage plans, for Medicare, for Medicaid and the other federal funded plans. These differences will be implemented, will make prior authorization less of a burden. Now what we need to do is extend that to the other health plans as well.

Unger: And so that was big progress in the area of prior auth, and as you point out, the issue around peer review, another thing that is particularly troublesome to physicians. Dr. Scott, let me ask you about something else you've been very vocal about, and that is the devastating consequences of Medicare payment cuts, another huge priority for the AMA.

Talk about how those cuts may affect ENTs, in particular, and the work that AMA is doing on that front.

Dr. Scott: Well, every physician in practice faces the challenge of the financial destruction that has resulted over the last 30 years by the plummeting Medicare payment schedule to physicians. In fact, adjusted to inflation, physicians have faced a 30% cut in what they're paid by Medicare since 2001.

So the AMA has stepped in and said, what we need to do is we need to tie the Medicare payment rate to the annual inflation rate. This isn't some radical idea. In fact, the hospitals and others in health care already get an annual update related to inflation.

Yet, physicians face this annual cycle, like we did again this year, where we're facing a payment cut. It's simply not sustainable. And the problem is that patients' access will suffer. Physicians that I know, including otolaryngologists, are already limiting the number of Medicare patients that they can see. Others have stopped accepting new Medicare patients, and some are considering dropping out of Medicare completely.

As otolaryngologists, we have expensive equipment that we have to buy. We have materials that get more expensive every year, not to mention the salaries for our staff. We take care of a large number of Medicare patients with hearing problems and with other significant problems that need otolaryngologists. And if the spiral downward continues, I fear that that care will suffer.

Unger: And both those issues that you've just discussed, including prior auth and Medicare payment reform, key parts of the AMA's Recovery Plan for America's Physicians and top priorities for the organization.

We tend to talk about those at the federal level, as you've been discussing, but a lot of the work really happens also at the state level. And I think there's a misconception there that national groups, like the AMA, rarely influence state or specialty-based work.

Dr. Mukkamala, what are some of the examples of how the AMA has worked with your own state or your own specialty group to support you and your practice?

Dr. Mukkamala: Yeah, so it's an interesting question timeliness wise because just this week here in Michigan, we had a hearing in our state Senate about nurse practitioners wanting independent practice with no physician involved.

So our state medical society, the Michigan State Medical Society, is trying to defeat this bill and the AMA Scope of Practice Partnership helped to fund that fight with a grant. And they did the same when it came to the nurse anesthetists wanting to expand their scope last year.

And so at a time when a lot of state medical societies are frankly struggling, and at a time when the desire of non-physicians to do what we are best trained to do is at an all time high, these grants from the AMA are critical.

So for example, when the audiologists want the ability to take care of Medicare patients without the involvement of physician, we call that out as inappropriate. And these are the battles that come back year after year after year in all 50 states. And knowledge of what worked to defeat it in one state is critical when that battle comes to our state, and that knowledge is what the AMA brings.

So dealing with the aftermath of things like the No Surprises Act is something that the physicians just can't manage on their own. When we hear about independent dispute resolution that goes in doctor's favor but still isn't getting paid, we fight on that. When we're asked to file one NSA claim at a time and not be able to batch those together to be more economical with our precious resources, we fight. And that's where the AMA helps with that fight for our state societies and for our specialty societies.

Unger: Dr. Mukkamala, a lot of these examples that we've talked about, obviously, demonstrate both the need and the power of organized medicine, but there are still people out there that either take take it for granted or don't understand the support that organizations like the AMA can offer. In your own view, what's the biggest challenge to getting your fellow ENT colleagues and other physicians to see the value of participating in organized medicine and supporting the AMA?

Dr. Mukkamala: Yeah, it's an important question, Todd. And I noticed that doctors that are managing OK and not dealing with a particular crisis don't really look for help, and thus, they don't see the AMA as helpful. But when a crisis hits, whether that's a crappy insurance contract from an insurance company or dealing with fallout from the No Surprises Act or just not getting paid by a huge company like United Healthcare and Change Healthcare due to massive security breaches, that's when they discover the value in organized medicine.

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And honestly, it shouldn't take a crisis to just familiarize themselves with the tools that we have for them. So when private practices, for example, are struggling with ever increasing costs that Bruce just mentioned and no buffer against them like a larger institution has and relatively lower payments for the same service when compared to those larger institutions, those practices need to know that the AMA is fighting those battles for them.

And all of this difficult work is being done, but not—but it's not on their radar. And so I would say to them that if there's an issue that they're dealing with, just literally type in that issue in a search engine followed by AMA and I would bet that there will be links with information about it as well as what we're doing about it.

And if it is unique, if it's an issue that isn't on our radar yet and it's just now starting, reach out to the specialty society, reach out to the academy, reach out to your state society, and reach out to your AMA delegation to tell us about it to put it on our radar. But I would venture a guess that 90 some percent of those things are already on our radar and have already been something that we've acted on.

Unger: Now, both of you have been extremely active in the AMA and your fellow ENTs are lucky to have you represent them in the organization. In fact, in June, Dr. Scott, you're going to become president of the AMA. And I'm curious what you would say to your fellow ENTs about joining you in the fight and getting involved.

Dr. Scott: Well, Todd, what I would say is we are fortunate as otolaryngologists that we have a really strong academy. But the academy alone cannot do the heavy lifts that Bobby was talking about. And I'm proud to say that the AMA has worked closely together with the Academy of Otolaryngology on issues that have affected us closely, issues like the 25 modifier.

Years ago when they tried to stop allowing office-based allergy serum production on the issues that we've already talked about here today. And I would ask my fellow otolaryngologists, if not the AMA to handle these larger issues along with the academy, then who will?

I mean, the academy alone cannot handle all of this. We need to group together as physicians united on those issues that affect all of us, and particularly, those issues that affect us as otolaryngologists. The pharmaceutical companies are not going to watch out for us. The insurance companies are not going to watch out for us. And really, the AMA is that organization that cares about our profession and our patients.

I hope that you will take this opportunity to join our fight because together we are stronger.

Unger: Dr. Mukkamala, anything to add?

Dr. Mukkamala: Todd, we're all busy and we all have things that we're passionate about. For some, that's family. For some, that's fitness. For some, that's our home communities. And for some, it's improving health care.

And there's always room for doctors in this last category to join others like Bruce and me in representing the profession in these important ways. I'm a better doctor for my community because what I learn by being involved in organized medicine.

And so to know how these decisions are being made, to know what led up to the latest press release from payers or the CDC or an insurance company, this information makes me a better doctor for my community. And it's one of these—it's one of the other sort of non-health care passions. If it's one of those things that are pulling you, that's great.

But please remember to at least support the efforts of those fighting on the health care battlefield because successes on that battlefield is what makes your day job more satisfying.

Unger: There's a lot that physicians are up against in delivering what they love, which is patient care. And I'm grateful to both of you for joining us today, also, for just being outspoken advocates. To support the work of the AMA on issues like prior authorization, Medicare payment reform and more, please consider becoming an AMA member at ama-assn.org/join.

That wraps up today's episode and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today and please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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