Feb. 13, 2026: National Advocacy Update

Medical boards, health systems making progress on physician well-being

Forty-three medical boards and more than 2,100 hospitals, freestanding emergency departments, freestanding surgery centers, urgent care centers and independent primary care clinics have now been verified by the AMA and Dr. Lorna Breen Heroes’ Foundation that their licensing and credentialing applications do not include intrusive, stigmatizing mental health and substance use questions. This progress represents an increase from 19 medical boards and less than 100 care facilities in 2022.  

“This milestone marks real progress, and it’s helping physicians and health care professionals across the nation,” said Bobby Mukkamala, MD, AMA president. “The AMA applauds the leadership of licensing boards, hospitals, health systems, and credentialing bodies driving this effort. We are optimistic about continued progress in 2026 as we work with the Dr. Lorna Breen Heroes’ Foundation to continue removing inappropriate questions that create unnecessary barriers to mental health care and treatment for substance use disorders. This commitment should be embraced across health care systems so every health worker can seek care without fear.” 

The progress is the direct result of the combined efforts of the AMA, the Breen Foundation, American Osteopathic Association, Federation of State Medical Boards, Federation of State Physician Health Programs and many other physician and health care organizations.  

“We ask health workers to take care of us every day; and yet for too long, the system has made them choose between their own wellbeing and their license and credentials,” said Corey Feist, co-founder and CEO of the Dr. Lorna Breen Heroes’ Foundation. “No one should ever have to fear for their job because they sought mental health care. By removing these invasive questions, our Wellbeing First Champions are doing more than updating paperwork—they’re letting their workforce know it’s safe to ask for help. That change protects clinicians, and it makes our entire healthcare system stronger.” 

The AMA urges medical societies to continue to work with us to directly engage the remaining licensing boards, hospitals and health systems in the states to ensure that their credentialing applications do not contain inappropriate, stigmatizing language about mental health and substance use.  

View the list of licensing boards, hospitals and health systems that have been verified as having applications consistent with the recommendations of the AMA, Breen Foundation and many other national partners. 

Learn more (PDF) about the AMA Advocacy Resource Center campaign to support medical student, resident and physician health and wellbeing. 

AMA wants feedback on WISeR

On Jan. 1, the Centers for Medicare & Medicaid Services (CMS) launched the Wasteful & Inappropriate Service Reduction Model (WISeR). In Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, WISeR vendors will use enhanced technologies, such as augmented intelligence tools, to conduct prior authorization and prepayment review for targeted Medicare fee-for-service services. If you are directly impacted by WISeR, the AMA wants to hear from you to enhance our advocacy efforts with CMS. 

AMA pushes for overhaul of MIPS cost measures and physician feedback 

The AMA appreciates the significant reforms that CMS has made to the Cost Performance Category of the Merit-based Incentive Payment System (MIPS) in recent years, including overhauling the benchmarking methodology, instituting a two-year informational-only feedback period for new measures, and making the attribution methodology for Total Per Capita Cost more accurate. Nevertheless, the AMA continues to have concerns as many physicians are facing Medicare payment reductions resulting from ongoing challenges within the MIPS Cost Performance Category. 

That is why the AMA sent a letter (PDF) urging CMS to: 

• Fix the cost measures so physicians are not unfairly penalized 

• Solicit broad feedback via a formal Request for Information (RFI) in the 2027 MIPS proposed rule, targeting cost measure issues and improved risk adjustment 

• Enhance and expand physician performance feedback, plus provide updated reports for the 2024 performance period 

The AMA is committed to ensuring MIPS is fair, accurate and transparent for all physicians. 

AMA recommends important changes to Ambulatory Specialty Model, CMS releases ASM participant list

In comments on the proposed Medicare physician payment regulations for 2026, the AMA provided a detailed analysis and recommended improvements in the proposed Ambulatory Specialty Model ASM), which is slated for initial implementation in January 2027. The ASM targets physician management of patients with either heart failure or low back pain and would mandate participation by selected physicians in seven specialties. CMS did not adopt the AMA recommendations in its 2026 final rule, prompting a new AMA letter (PDF) to CMS this month urging that it adopt three major policy changes to ASM in its 2027 proposed rule: 

1. Increase the redistribution percentage from 85% to 100% so that any reductions in payment rates for participating physicians are used to increase rates for other participants. Instead of using any funds from payment reductions for physicians who get lower ASM scores to increase payments for those with higher scores, CMS will remove 15% from the incentive payment pool to save money for the Medicare program. This guarantees that no matter how well physicians perform, the majority of physicians in ASM will face payment cuts. 

2. Set ASM measure performance thresholds in advance so that physicians know what is required for success and are rewarded for achieving it, instead of penalizing them for good performance simply because other physicians had higher scores. Even though CMS has the data needed to set performance thresholds in advance, it has chosen to set up ASM so that the only way a physician can avoid a pay cut is to achieve a significantly higher score than most other physicians. This will discourage improved collaboration and teamwork instead of encouraging it – the opposite of what value-based care models strive to achieve. 

3. Reduce the maximum risk level in the initial two years from 9% to 2% to allow physicians to gain experience with the new model before being subject to higher levels of risk and significant penalties. In other CMS payment models, including those in which hospitals and health systems participate that are accountable for care delivery to thousands of Medicare patients, there is a glide path to downside financial risk. The AMA has serious concerns that individual physicians will not be able to manage being at risk for up to 9% payment cuts based on their first year of ASM participation and that this could have unintended consequences for practice sustainability and patient access to care. 

CMS has recently released preliminary information on which physicians will be required to participate in ASM. Physicians who find their names in the participant list should review the ASM participant roadmap (PDF) developed by CMS to help them prepare.  

The participant list is likely to change prior to ASM implementation in 2027 when more recent data becomes available. The AMA also contacted CMS when the preliminary list was published because it does not display the specialty designation of the physicians, and they are considering adding this element. Analysis by AMA and specialty staff indicates that the preliminary list includes a total of 2,600 participants in the heart failure cohort, including more than 2,000 cardiologists, 300 interventional cardiologists, and fewer than 100 physicians in other specialties. There are 4,027 physicians required to participate in the low back pain cohort, including about 1,000 physiatrists, between 300 and 700 physicians each specializing in anesthesiology, interventional pain management, general surgery, orthopaedic surgery and neurosurgery, as well as smaller numbers of physicians with other specialty designations. The AMA will continue to engage CMS to fix the critical issues with ASM.  

Improvements proposed for Transplant Model in year 2, additional changes needed

The AMA submitted comments (PDF) to CMS regarding proposed changes (PDF) to the Increasing Organ Transplant Access (IOTA) Model, a mandatory six-year model that began on July 1, 2025. The AMA was largely supportive of the newly proposed changes, many of which directly reflected the AMA’s previous recommendations (PDF) including raising the low volume threshold. The AMA also took the opportunity to reiterate several outstanding concerns with the model overall, including flawed performance measures and the fact that the model is mandatory. The AMA asked the administration to continue to work with the AMA and other stakeholders to continue to refine the model to mitigate unintended consequences that could hinder patient access to lifesaving transplants, particularly for patients served by hospitals in rural and underserved areas that may struggle to meet new administrative requirements under the model. 

AMA provides feedback to CMS on 2027 candidate MIPS Value Pathways

For the 2027 performance year, CMS is considering the addition of three MIPS Value Pathways (MVPs) to the MIPS program: Diabetic Disease, Hospitalist and Critical Care, and Hypertension. The AMA’s comments (PDF) acknowledged our appreciation to CMS for taking our recommendation by considering two condition-specific MVPs for the 2027 program (Diabetic Disease and Hypertension), but refinements are needed. As currently drafted, the two condition specific MVPs are overly broad and the groupings within the MVP are by specialty. 

The AMA also raised concern with the “Hospitalist and Critical Care” MVP since it is based around a specialty rather than a specific health condition or group of similar conditions. It also combines hospitalists and critical care medicine into a single specialty-based MVP and combines two different types of patients into one MVP.  Within our comments, the AMA urged CMS to work with the applicable physician specialty societies to develop the most appropriate MVPs for the conditions they treat and make MVPs more meaningful, as well as decrease administrative burden. 

Updated AMA resource: Model HIPAA Notice of Privacy Practices for physicians

With new regulatory requirements taking effect on Feb. 16, the AMA has updated (PDF) a Model Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices (NPP) for HIPAA Covered Entities. Every physician should consult their legal counsel regarding the required changes to NPP content, which align HIPAA privacy protections with those of 42 CFR Part 2 Substance Use Disorder (SUD) Treatment Programs, as required by the 2024 Confidentiality of SUD Patient Records Final Rule and the 2024 Final Rule on HIPAA Privacy Rule to Support Reproductive Health Care Privacy.  

Updates to each physician’s NPP are mandated by law. The HHS Office for Civil Rights (OCR), the agency that administers and enforces HIPAA, administers the HIPAA Privacy Rule, which applies appropriate safeguards to protect the privacy of protected health information and sets limits and conditions on the uses and disclosures of such information without an individual’s authorization.  

Physicians, other health care providers, and health plans must share an NPP with patients that describes how they may use and share their health information. The NPP must also include an individual’s health privacy rights. In most cases, an individual should receive the NPP on their first visit with a physician or other provider. 

New speakers announced: AMA National Advocacy Conference

The 2026 AMA National Advocacy Conference is less than two weeks away—Feb. 23-25 at the Grand Hyatt in Washington, D.C. Register now. 

New speakers just announced  

Don’t miss hearing from the following Administration and Congressional speakers at this year’s conference: 

• Daniel Brillman, director of the Center for Medicaid & CHIP Services, deputy administrator of the Centers for Medicare & Medicaid Services 

• Chris Klomp, director of the Center for Medicare, deputy administrator of the Centers for Medicare & Medicaid Services 

• Rep. Steven Horsford (D-NV) 

• Rep. Mariannette Miller-Meeks, MD (R-IA) 

• Rep. Greg Murphy, MD (R-NC) 

• Rep. Jill Tokuda (D-HI) 

• Sen. Peter Welch (D-VT)

See the agenda (PDF) and register now.  

Key topics will include: 

• Reforming Medicare payment 

• Fixing prior authorization 

• Protecting access to care in Medicaid

More articles in this issue

• Feb. 13, 2026: State Advocacy Update