Aug. 1, 2025: National Advocacy Update

No Surprises Act Enforcement Act introduced with AMA support

Bipartisan legislation (H.R. 4710/S. 2420) was introduced on July 23 by Senators Roger Marshall, MD (R-KS) and Michael Bennet (D-CO) and Reps. Greg Murphy, MD (R-NC), Kim Schrier, MD (D-WA), John Joyce, MD (R-PA), Jimmy Panetta (D-CA), Bob Onder, MD (R-MO), and Raul Ruiz, MD (D-CA) in response to reports that many health plans fail to adhere to statutory timelines for payment after an Independent Dispute Resolution (IDR) entity has made a final and binding determination. 

The No Surprises Act (NSA) was signed into law in 2020 to address unexpected gaps in insurance coverage that result in “surprise medical bills” when patients unknowingly obtain medical services from physicians and other providers outside their health insurance network. The AMA fiercely advocated for the NSA to protect patients while fairly balancing the process for physicians and health plans to settle disputes over out-of-network payments. The AMA was actively involved in ensuring that NSA implementation adhered to the letter of the law. Unfortunately, many health plans fail to abide by the law after an IDR determination. A 2024 survey by the Emergency Department Practice Management Association (PDF) of emergency department practices found significant noncompliance, with 24% of respondents reporting that their IDR awards were either unpaid or paid incorrectly within the 30 business days required by the NSA. This is a clear violation of the NSA’s statutory requirement that an IDR determination “shall be binding upon the parties involved.”  

If enacted, the No Surprises Act Enforcement Act would help enforce IDR decisions and reestablish the balance achieved in the statute. Specifically, it permits penalties on parties that do not adhere to statutory timelines for payment after an IDR entity has made a final and binding determination. The legislation also imposes additional reporting requirements on the governmental agencies charged with NSA enforcement. 

2025 APM incentive payments now available

The Centers for Medicare & Medicaid Services (CMS) recently announced that it has issued 2025 Alternative Payment Model (APM) incentive payments to qualified physicians and other health professionals who participated in Advanced APMs in 2023 under Medicare’s Quality Payment Program (QPP). The current APM incentive payments are calculated at 3.5 percent of the physician’s total Medicare Part B payments for professional services.

The AMA has learned that, due to CMS system problems, some payments are being reprocessed and will be sent later in the summer. As is the case every year, however, there is a subgroup of qualified APM participants for whom CMS does not have up-to-date billing information. Physicians whose organizations have not yet received their APM incentive payment should check the 2025 QP Notice for APM Incentive Payment zip file and locate their name so that they can complete the 2025 Billing Information Collection Form (also found in the zip file) to ensure they receive their payment. Completed forms should be submitted to the QPP Help Desk at [email protected] no later than Sept. 1, 2025. Information about the incentive payments has also been published in the Federal Register (PDF).

CMS re-opens the Physician Compare preview period

CMS has reopened the calendar year (CY) 2023 Doctors and Clinicians (DAC) preview period because updates were made to the CY 2023 Quality Payment Program (QPP) performance data available during the preview period that closed in June. As a result, CMS is encouraging all clinicians and groups to review their Merit-based Incentive Payment System (MIPS) performance information again for any changes, even if they already reviewed their information during the previous preview period, before the current preview period closes on Aug. 21, 2025, at 8 p.m. Eastern time. During the re-opened preview period, physicians once again can inform CMS if they would like to opt out of having their 2023 MIPS data posted on Care Compare. If you already opted out of having your 2023 data publicly posted, CMS will maintain the opt-out unless the physician indicates the change in status.

Resident Physician Shortage Reduction Act introduced in Senate

Bipartisan legislation was introduced in the U.S. Senate on July 24 to both eliminate the current cap on graduate medical education (GME) and provide relief to the ongoing physician workforce crisis in the United States. Senators John Boozman (R-AR) and Raphael Warnock (D-GA) introduced the Resident Physician Shortage Reduction Act, which increases the total number of Medicare-supported GME slots by 14,000 over a period of seven years.    

“The American Medical Association commends Sens. John Boozman (R-Ark.) and Raphael Warnock, (D-Ga.) for introducing this crucial bipartisan legislation that aims to address the physician shortage and resulting access challenges for patients,” said AMA President Bobby Mukkamala, MD. “By expanding federal support for graduate medical education over the next seven years, Congress is taking a critical step toward ensuring patients nationwide have access to well-trained physicians in their communities." 

The Association of American Medical Colleges (AAMC) estimates that the United States is facing a projected shortage of up to 86,000 physicians by 2036. Last Congress, the Resident Physician Shortage Reduction Act generated 222 bipartisan House (189 Democrats and 33 Republicans) and 18 bipartisan Senate cosponsors (16 Democrats, 2 Republicans) in the 118th Congress.  

AMA looks forward to working diligently to add additional Senate cosponsors, as well as the Congressional leads to advance it through both chambers in the 119th Congress. 

Legislation would eliminate some barriers that prevent formation and expansion of physician-owned hospitals

Recently introduced bipartisan legislation, H.R. 4002, the “Patient Access to Higher Quality Health Care Act of 2025,” would repeal the Affordable Care Act’s (ACA) restrictions on the whole hospital exception to the Stark physician self-referral law, thereby eliminating statutory and regulatory barriers that prevent the formation or expansion of physician-owned hospitals (POH). The AMA strongly supported the previous version of this bill, H.R. 977 in the 118th Congress, and reaffirmed its support in this new session in a letter sent (PDF) on July 23, 2025.

Congress has a clear opportunity to improve care and promote competition without creating new spending programs or administrative burdens by repealing section 6001 of the ACA and allowing physicians to invest in hospitals. This is a logical step toward a more dynamic and patient-focused health system. The AMA urges swift passage of this legislation.

AMA President-elect emphasizes importance of physician leadership to National Medical Association

AMA president-elect Willie Underwood III, MD, MSc, MPH, was recently welcomed to the National Medical Association’s 2025 Convention to Spotlight Leadership, Advocacy, and Health Equity as a special guest and keynote speaker. Dr. Underwood III delivered a powerful address reaffirming the organization's unwavering commitment to advancing health equity in America. Emphasizing the importance of physician leadership, he reflected on the AMA’s strategic plan, which centers on improving access to care, promoting equitable treatment, diversifying the health workforce, addressing social determinants of health, and maintaining a vocal commitment to health equity. He underscored the disproportionate impact of chronic conditions and maternal mortality on marginalized communities—especially Black women—and illustrated these disparities through a personal story about his mother and daughters. Despite the nation’s wealth, he stressed that access to quality care is regressing, leaving vulnerable populations behind.

The speech also criticized recent federal legislation that cut vital health care funding programs like Medicaid and CHIP, warning that such changes will worsen health outcomes and overburden already struggling health care systems, especially in rural areas. Dr. Underwood called on physicians to raise their voices against policies that harm patients and to take on a larger role in advocating for meaningful reform.  

More articles in this issue

• Aug. 1, 2025: Advocacy Update spotlight on pharmacy benefit managers under scrutiny
• Aug. 1, 2025: Medicare Payment Reform Advocacy Update
• Aug. 1, 2025: State Advocacy Update