- House Ways and Means Health Subcommittee holds hearing examining rural GME issues
- How physician leadership guides licensing and credentialing application reform
- Senate HELP Committee bills: Promote health care cybersecurity, protect living donor organ donors
- AMA advocates for strong technology policies
- Reminder: AMA wants feedback on WISeR
- More articles in this issue
House Ways and Means Health Subcommittee holds hearing examining rural GME issues
On Feb. 24, the House Ways and Means Health Subcommittee held a hearing entitled “Advancing the Next Generation of America’s Health Care Workforce,” that focused primarily on rural Graduate Medical Education (GME) issues.
Since there is a projected shortage of 86,000 physicians over the next decade and physicians are more likely to remain in the communities where they complete medical residency training, both parties highlighted the importance of expanding patient access to care, especially in rural areas. The various causes for the dearth of physicians and policy solutions offered to address the workforce shortage, however, differed across party lines.
Republicans largely stressed how fewer than 10% of additional residency slots recently allocated by Congress went to rural areas and the desire to increase the supply of American physicians through policies such as the Rural Residency Planning and Development Program. Democrats, however, mostly cited a multitude of recent policy changes including Medicaid reforms, student loan caps, vaccine schedule modifications, and H-1B visa filing fee increases, as contributing to physician burnout and exacerbating the ongoing shortage of physicians in the United States. Thankfully, members of both parties touted the importance of passing the AMA-supported H.R. 4731/S. 2439, the Resident Physician Shortage Reduction Act (PDF), legislation to provide 14,000 new Medicare-supported GME slots over 7 years, as one bipartisan solution to the workforce challenges.
The AMA submitted a detailed statement for the record commenting on many of the topics that were explored during the Health Subcommittee hearing. In fact, AMA reiterated its longstanding support for eliminating the current Medicare cap on GME funding via swift passage of the Resident Physician Shortage Reduction Act, as well as the importance of providing additional resources to the Children’s Hospitals GME program and National Health Service Corps. The statement also highlighted a multitude of bills that would help physicians cope with student loan debt and offer new opportunities to train in rural and underserved communities. Furthermore, the statement highlighted the important role that international medical graduates (IMG) can play to help alleviate the ongoing shortage of physicians in the United States. Both H.R. 5283/S. 2759, the Healthcare Workforce Resilience Act, and H.R. 1585/S. 709, the Conrad State 30 and Physician Access Reauthorization Act, were cited as two ways to leverage IMGs to alleviate the access to care crisis.
AMA’s written comments, however, also expressed strong opposition to a multitude of bills that seek to address workforce issues by inappropriately expanding the scope of practice for non-physician practitioners. Finally, the statement for the record reiterated AMA’s opposition to H.R. 2314/S. 2715, the Fair Access in Residency (FAIR) Act, which restricts the receipt of limited GME funding by redefining “approved residency programs” to include only residency programs that “affirm” that they “consider for acceptance” applicants from both osteopathic and allopathic medical schools and that they accept both the Comprehensive Osteopathic Medical Licensing Exam of the United States (COMLEX-USA) and the United States Medical Licensing Exam (USMLE). This legislation inappropriately tries to insert the federal government into the construct of medical residency programs, as well as codifies into statute the types of licensure examinations that must be accepted in order to receive GME funding.
Overall, the AMA pushed for sustained long-term investments to ensure that patients are provided with the best care possible, and that barriers are addressed to resolve the full spectrum of pipeline, educational, and workforce issues for physicians.
How physician leadership guides licensing and credentialing application reform
Removing the stigma of mental health conditions is an essential part of improving physicians’ health and wellbeing, and removing stigmatizing questions on licensing and credentialing applications is a practical way to accomplish just that, said three physicians on a recent AMA Advocacy Insights webinar.
There are multiple ways to get started, explained AMA President Bobby Mukkamala, MD. This includes state and specialty societies working directly with the AMA to understand the types of language that support physicians who seek care for a mental health or substance-related condition. Individual physicians and medical students also can work with their state medical association to support legislation and other actions to ensure that licensing applications are free of stigmatizing, inappropriate language.
These efforts can be complemented by internal, organizational advocacy, said Stefanie Simmons, MD, and Mila Felder, MD.
Dr. Simmons, the chief medical officer of the Dr. Lorna Breen Heroes’ Foundation, shared her experience with post-partum depression during her emergency medicine residency, but delayed getting care. It was not until years later, said Dr. Simmons, that she realized “I was not alone in my career, that, far from it, there were many people who were struggling with similar situations, and that pervasive belief that it wasn't safe because of these questions, was out there.”
The “questions” are those on licensing and credentialing applications that require physicians to disclose whether they had a diagnosis or received treatment in the past (or present) for a mental health or substance-related condition regardless of whether there is a current impairment. The AMA and Dr. Lorna Breen Heroes’ Foundation have partnered to successfully help more than 40 medical boards, and more than 2,000 hospitals, health systems and other care facilities remove questions about past treatment/diagnosis.
Making these changes helps the culture, however, requires much more than just changing the words on the application, said Dr. Felder. She explained how she and her team at Advocate Health brought in partners from across the organization, including legal, risk management, managed care, the CMOs, compliance, governmental affairs, and communications.
In addition, “we also started talking to clinician leaders in the front line and CMOs about how to normalize seeking help so that as the language is being changed, everyone can feel more comfortable talking about their own personal struggles or maybe elevating those of others.”
“Institutional stigma is actually the leading reason why people don’t get help when they know they should,” said Dr. Simmons, who highlighted that even when an institution makes the changes to their credentialing applications, there are other opportunities to go to payers and malpractice insurers and call for change.
When a state—or institution—has made the changes, that can become a selling point for the state or institution, said Dr. Mukkamala. “This is in our backyard, in our communities, in our states. There’s a national perspective that guides all of it, but at the end of the day, this work is about preserving the mental health of a workforce that's critical for the health of our country.”
The broad perspective is essential, said Dr. Felder, who further emphasized that once people have agreed, then it is time to operationalize the advocacy into the institutional culture. Physicians can do that by working with the AMA, the Breen Foundation and their professional societies and regional medical societies, she said, by “Getting involved where you think it matters, where it feels personal.”
Learn more about the AMA’s campaign (PDF).
Learn more about the Dr. Lorna Breen Heroes’ Foundation.
Senate HELP Committee bills would promote health care cybersecurity, protect living donor organ donors
On Feb. 26, the AMA sent letters regarding S. 3315 (PDF), the "Health Care Cybersecurity and Resiliency Act" and S. 1552 (PDF), the "Living Donor Protection Act" before they were considered before the Senate Health, Education, Labor and Pensions (HELP) Committee.
S. 3315 would promote improved coordination across federal agencies to ensure heightened cybersecurity in the health care and public health sectors. Physician practices and the AMA continue to be concerned about a potential cyberattack, and the AMA is pleased to see this bipartisan bill pass the Committee with broad bipartisan support.
S. 1552 would provide numerous significant protections to living donor organ donors while simultaneously promoting organ donation. Again, the AMA is pleased to see both bills pass the Senate HELP Committee with broad bipartisan support.
The AMA looks forward to continuing to work with the Federation and Congress to see both be enacted into law.
AMA advocates for strong technology policies
The AMA submitted comments (PDF) on an Assistant Secretary for Technology Policy (ASTP) proposed rule that would alter EHR certification requirements, weaken AI transparency provisions, and revise information exchange and information blocking policies. Although ASTP’s stated objective is to reduce burden on EHR developers, the proposal would likely shift costs and operational risk to physicians. It could eliminate core EHR capabilities that practices rely on, including medication reconciliation and quality measurement functions, and create additional complexity in complying with information blocking requirements. Currently, AI transparency is embedded within certified EHR technology, an outcome of the AMA’s strong advocacy. The proposal would remove those provisions and reduce physicians’ visibility into how AI tools are developed, deployed, and intended to be used.
The AMA is urging ASTP to preserve the baseline EHR functionality physicians depend on, strengthen AI transparency to support patient and clinician trust, limit developer fees that may be imposed on independent practices, and continue progress toward interoperable medical records. The proposal also overlooks an opportunity to meaningfully reduce physician burden, particularly in relation to Medicare reporting programs.
The AMA will continue engaging ASTP to ensure any finalized policy changes improve usability and interoperability while protecting physicians and patients from unintended financial, compliance, and safety consequences.
Reminder: 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.
