Public Health

AMA COVID-19 daily video update: AMA advocacy efforts at the state and national level

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.


Featured topic and speakers

AMA Chief Experience Officer Todd Unger speaks with AMA President Patrice Harris, MD, MA, Director of Congressional Affairs Jason Marino and Vice President of the AMA Advocacy Resource Center Michaela Sternstein, JD, on updates regarding COVID-19 including COVID-19 related efforts on the advocacy front, including AMA's call for robust testing capacity to be in place across the country.

Learn more at the AMA COVID-19 resource center.

Transcript

Unger: Hello. This is the American Medical Association's COVID-19 update. Today we're bringing you the latest on AMA's COVID-related efforts on the advocacy front.

I'm joined today by Dr. Patrice Harris, AMA's president and a psychiatrist and former county health director in Atlanta, Jason Marino, AMA's director of congressional affairs in Arlington, Virginia and Kai Sternstein, vice president of AMA's advocacy resource center in Evanston, Illinois. I'm Todd Unger, AMA's chief experience officer, in Chicago.

Dr. Harris, with the recent conversation turning to when and how we reopen the country, what is the AMA advocating for as we navigate the next phase?

Dr. Harris: Well, first and most importantly, we should open up with an eye towards data and the evidence. We need to see a decrease in infection rate. We need to make sure we have surge capacity in our hospitals, and critically, we need to make sure that there is robust testing capacity, and that means implementation of tests from making sure that the labs are ready, we have the swabs, we have the test kits, and that's why the AMA continues to call on the administration to have a federally coordinated response to making sure that there is a robust testing capacity in place across this country.

Unger: Yeah, some of the stories that we're seeing about competition for resources and testing and PPE, what's your reaction to that?

Dr. Harris: Certainly that is not ideal. States are competing against one another. States are competing against the federal government. This is an all hands on deck moment, and if there was an overarching federal plan, I think that would serve us all well. We have called, at the AMA, we have called on FEMA to take a lead role in making sure these test kits and all of the supplies related are manufactured and distributed to the areas that need them most.

Unger: Jason, in the world of financial impact, more discussions going on in Congress about alleviating that. What is the AMA doing at the federal level about easing financial strain on physicians and protecting the access to care?

Marino: Yes, so right now we are working on, so there's been recently, a couple of weeks back, there was the CARES Act. Now we're working on what's called the CARES 3.5 bill. This is because the House of Representatives and the Senate have gone home, and they're not coming back until May 4, but they're operating under what's called unanimous consent. So everyone in the Senate has to agree. One Senator can block it. The House has to call people back if they're not agreeing to unanimous consent. They have to call back to get a quorum.

So in this environment, we're trying to find what can we pass big picture, immediate relief, and small business loans, PPP programs running out of money. And so there's an effort right now, it's going to come back into session for pro forma at 4:00, and they're going to try and pass a potentially $310 billion for the small business program. They're also going to replenish what's called the Public Health Emergency Fund, which are grants to physicians in hospitals and others. That'd be $75 billion. And they're also going to potentially include $25 billion for increased testing capacity around the country.

So right now they're behind the scenes, trying to iron out an agreement, and we hope to have the good news by 4:00 today and the Senate would pass it by UC agreement. Then the House would come back by Thursday and pass it. The president would sign it soon after. So we're hopeful that another tranche of economic support and loans and grants is coming our way.

Unger: Dr. Harris, any perspective on the need for supporting physician practices financially at this moment?

Dr. Harris: Support for physicians has to be a part of the package, and of course, thus far, we have seen support for physicians, but of course we need more. We need more because independent physician practices are worried about their viability. When we get on the other side of this pandemic, we are going to see a pent up demand for health services, and it is critical that physicians get direct financial support so that the practices can remain viable and we can serve our patients on the other side of this pandemic.

Unger: Kai, I know the AMA has made significant progress also at the state level. Will you share some about the work that we're doing locally to protect physicians and patients?

Sternstein: Sure, Todd. Thank you so much, and you know, I think that one element of the success that we continue to have in the state advocacy resource center that I run is due to the incredible collaborative relationships that we have with the medical associations across the country. And it's really an honor to do the work that we do and to work with states all over the country to get this important work done.

We work hand in hand with states and national specialties. Straight from the chute, we identify policy actions that states can take in the immediate moment to improve the situation for them in this pandemic, things like costs for testing, treatment for symptoms, telemedicine, access to medications, expanding Medicaid, ensuring access to coverage, spending prior authorization, licensure, credentialing, liability, scope of practice and more.

We also have an incredible sweet spot for the AMA, and that's our relationship with national policy organizations like the National Governors Association, the National Association of Insurance Commissioners and the National Conference of Insurance Legislators, to name a few. Those policy makers, those regulators in the states, have been scrambling from day one and we're there to help provide guidance and provide them with things that they could do immediately to make sure that physicians are protected, as well as patients.

Unger: Jason? Dr. Harris?

Dr. Harris: Yes, I would say first of all, I'm always proud of the work we do at the AMA on the national level and in partnership with state partners, as both Kai and Jason mentioned. At the end of the day, it is so important that we all work together to support physicians so that we can best take care of our patients. So I want everyone out there to know that the AMA is working hard on your behalf.

Unger: So Jason, another topic the AMA has been working on, regarding PPE. Do you want to talk about additional information, about our letter to FEMA or any other kind of ways that we're working to resolve that?

Marino: Let me speak of a silver lining that touches on that. We met a few months back at the AMA National Advocacy Conference, and we spoke about telemedicine. We talked about how there's an economic saying that the future is already here, it's just not evenly distributed. And as of three months ago, only about one percent of Medicare beneficiaries were using telemedicine. Since then, since some of the COVID bills, we've greatly expanded, in this emergency, telehealth coverage for Medicare, and it's been a game changer. A lot of physician practices, that's what they're using now. The patients can stay home. They don't have to go to the hospital, they don't have to use that protective equipment. It's gone so well that now you see disparity in private plans that the states can't regulate, and we're seeing a push by insurance to step up and also to offer to expand their coverage for telemedicine.

And that is one key way of keeping people out of the emergency rooms, out of facilities where they have to use protective equipment. Also, on the issue of productive equipment, we've written a letter to FEMA, strongly encouraging them to centralize and take control of the distribution. We don't like to hear of some states getting more than they need and other states not getting enough, and so we are encouraging them to stay organized and centralized and get equipment where it's needed.

Dr. Harris: And Todd, if I could add one more thing, because the AMA has for several weeks now called on the president to fully engage on the Defense Production Act. I mean, that will just go such a long way in getting physicians on the front lines the PPE that is needed now. But as we think about reopening, it will be needed even more, and the test kits and all the supplies, the reagents, the chemicals, the nasal swabs. So the AMA continues to call on the president to fully engage on the Defense Production Act so that we can get the supplies that we need now and the supplies that we are going to need in even greater numbers as we open up.

Sternstein: Todd, also if I could real quick just to tag onto what Jason talked about, I think it's important for the audience to know, physicians to know, that our work at the state level is tied so closely to the work that's done, the phenomenal work at the federal level. We work so closely with Jason and his team, and in fact everyone in the DC office, the different units, and telemedicine is a great example of that.

Once we got our accomplishments at the federal level, we took it to the state level, and we figured out really early on that there were state laws that were not in place that needed to be, that would ensure broad coverage and payment and that would push the boundaries of the type of modalities such as phone visits.

So we worked really closely with the states, we scoured executive orders and all the bulletins that were going on in all 50 states, and helped the state medical associations try to push for their relief the way that they needed to. We're still in the middle of it. There's still a lot of work to be done. But I'm really proud of that work, and it's just a great example of how we work together within the AMA, all facets of advocacy, to get this good work done.

Unger: I think another great example of that kind of federal and state advocacy work together is in the area of opioid treatment programs. There's obviously a concern about the continuation of those in the face of the pandemic. Any comments on AMA's advocacy work in those areas?

Dr. Harris: So sure, I'll start, and certainly this is another example, an area where it's the federal team working with our state team, and of course AMA has had, since 2014, an opioid task force, and I've had the honor of chairing that task force. But as it relates to what's going on now, and I was just on a call last week, and of course not a surprise, but we are unfortunately seeing relapses increase, and there is a concern about services. So the AMA has been engaged in making sure that regulations are loosened up regarding take home medications for those who are in recovery, regulations around privacy and confidentiality.

The telehealth that both Kai and Jason have talked about has been instrumental in making sure that physicians can continue to take care of our patients with substance abuse disorders. So again, COVID-19 is amplifying other health needs. We cannot forget about those health needs, and the AMA is not forgetting about those issues, particularly around the opioid epidemic and those who have a substance use disorder.

Sternstein: If I can jump in, we're so lucky to have the leadership of Dr. Harris when it comes to our opioid task force, and from the very beginning we were incredibly concerned that within the pandemic that you were going to have negative impacts on patients with both opioid use disorder and patients that have pain. And once we realized what was happening, we stepped in and gave three to-dos to the state medical associations that they could really quickly start working on.

One, we asked states to immediately adopt new DEA and SAMHSA guidance, allowing patients with opioid use disorder to receive their medications via telemedicine evaluations and prescribing, like Dr. Harris said.

Two, we asked states to follow leading states like Minnesota and Maine and take action to increase the ability of patients with pain to get refills and to access things like sterile needles and syringes to prevent spread of infectious disease.

And finally, three, we told states not to forget to keep working on mental health and substance use disorder parity, so incredibly important. We are there leading the way every day, pushing the states, our colleagues, on this incredibly important issue throughout the pandemic.

Unger: Well, thank you, Kai. That's it for today's COVID-19 update.

I want to thank today's guests, Dr. Patrice Harris, Jason Marino and Kai Sternstein, for being here today. We will be back tomorrow to take a closer look at how the AMA is helping residents navigate the COVID-19 pandemic.

For updated resources on COVID-19, go to ama-assn.org/covid-19. Thanks for joining us.