2024 advocacy agenda: Medicare payment cuts, fixing prior auth, and reducing physician burnout


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How the AMA is addressing the most significant problems facing doctors in medicine today: Medicare payment reform, fixing prior authorization, reducing physician burnout, as well as making health care technology an asset not a burden. AMA Senior Vice President of Advocacy Todd Askew joins AMA Chief Experience Officer Todd Unger for a live chat at this year's National Advocacy Conference.


  • Todd Askew, senior vice president, Advocacy, AMA

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Unger: Hello and welcome to the AMA Update video and podcast. Today we're coming to you from the AMA National Advocacy Conference in Washington, D.C., where we'll discuss our advocacy agenda for 2024. I'm here today with the AMA's Senior Vice President of Advocacy, Todd Askew. Welcome, Todd.

Askew: Good to have you back, Todd.

Unger: Well, I'm glad to be back at NAC. We're in the shadow of the Capitol just steps away, so to speak. We've got hundreds of physicians here on hand to listen to the agenda. What has you most excited about the year to come in advocacy?

Askew: Well, I think one thing that's very exciting is the momentum that continues to build for long-term Medicare physician payment reform. That's going to play a central role in our advocacy activities throughout 2024. But first, there's still unfinished business from the previous Congress in terms of addressing the cut that went into effect in January. So right now, today, that is issue number one. And that's where we're putting a lot of effort. And hopefully, in a few weeks, we will see whether or not they're able to mitigate some of that cut. So that's number one right now.

Unger: Another big item on the agenda, when you think about the AMA's Recovery Plan for America's Physicians is prior authorization. We've talked a number of times over the past year about it. And there was a big development most recently. CMS finalized changes that we've been calling on to make for years. These changes are estimated to save physicians $15 billion over the next 10 years. I know there's a lot more work to be done there. What's next on the agenda for prior auth?

Askew: So you're right, this rule is a big deal. A lot of government programs that are employing prior authorization, like Medicare Advantage, CHIP programs, things like that. It really clears the way. It makes some significant improvements to the processes. It's not everything. There's still a lot of work to do.

The first thing we want to do is codify those rules into law so that future administrations can't change them and that we have something legislative to build on. Another thing we would like to do is, through that legislation, is perhaps try and tighten up some of the timeframes in the regulation to make the response times required by the plans a little bit shorter and better for patients, better for physicians to be able to provide good care.

Beyond that, we're going to continue to work to expand the types of programs that it applies to, different types of payers, as well as to include drugs which were not included in this particular role. That's a very significant part of PA. And then I think where we're going to see a lot of action, quite frankly, on prior authorization in the coming years at the states.

The states have really picked up on this momentum that's been built in Washington, and we are seeing more and more prior auth bills at the state level where they regulate an entirely different set of payers. So we're really excited about the progress that's been made, but also the opportunity that we're going to have in the coming year to build on that success.

Unger: Great. Now, you mentioned there's kind of immediate work to be done on the Medicare reform front, having to deal with the cut that happened in January. When you look at the big picture of everything that needs to happen there, where do we go from here?

Askew: Well, the first thing is to build on the momentum that we have. We have broad consensus across medicine, and quite frankly, with a lot of folks on Capitol Hill, about what reform should look like. The basis of reform is inflation-based updates. So that physicians' payments are able to keep up with the cost of providing the care.

We need to reform the way budget neutrality is applied. That's what's driving the cuts we're facing now is because it's one pot, and as we increase one set of services, we have to cut everybody else to pay for that. So that needs some reform on how that's applied.

We also greatly need to improve the MIPS program, the quality reporting program, to make it simpler and more relevant for physicians who are participating in MIPS. And also increase the number of APMs, Alternative Payment Models, that are available, especially to specialists, so that if they would like to innovate in their practice, move to a different payment model, they're able to do so and they'd have some options. So that's the basis of what reform looks like.

I mentioned the momentum is good. We have a lot of support in the House. We have some conversations at the Finance Committee in the Senate, where Senator Wyden has stated that he would like to take this up this year—this coming year, 2024. We also, just yesterday, had a new—or excuse me, on Friday—had a new working group of six senators, very senior senators—bipartisan—three Democrats, three Republicans, who have formed a Medicare Physician Payment Workgroup so that they can begin the work in the Senate of talking to physicians and other providers about what payment reform looks like.

We of course, have our package ready to go to talk to them about the ideas that Medicine has put together over the last year. And so we look forward to that group and having conversations throughout the year supporting their efforts, and hopefully furthering the consensus on the need for reform in the Senate much as we already have built in the House.

Unger: Let me just follow up on a related question because you mentioned these inflation-based updates as being one of the key parts of the plan. Last time we talked, we discussed H.R. 2474. This is a bill that would provide for those inflation-based updates to Medicare payment. Where does that stand right now?

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Askew: It's still there. It's got a lot of support—broad bipartisan support. What has happened here, as the spending cuts were about to go into effect, much of the focus has come off of that larger reform bill, and been more on how do we stop and now mitigate the impact of the cut that happened in January.

But 2474 is still the basis of long-term reform. It is the Medicare physician payment update—MEI, the Medicare Economic Index inflator, applied each year to Medicare payments, which would help physicians keep up with the increasing costs of providing care. That's the basis of all reform, that type of proposal. And so it's still very much in play and very much a central focus of our long-term vision for this.

Unger: Excellent. Another big priority, another key part of our recovery plan is addressing and reducing physician burnout. And we have a number of programs. But I think, oftentimes, people don't think of this necessarily as an advocacy issue. Talk about it from that perspective.

Askew: It absolutely is. Physicians are frustrated in practice. They're burned out. They have different challenges coming at them from every direction. So many of those challenges, though, are because of the way the health care system operates. And that's where we in advocacy have an opportunity to make improvements.

We've talked about Medicare payments and the challenge—the financial challenge of keeping up with inflation. We've talked about prior authorization and the huge burdens it places on physician practices just trying to provide care to their patients. We've talked about the MIPS program and the reporting requirements that are extremely burdensome. So there's three things right there at the top of the agenda that directly contribute to physician burnout, physicians leaving practice, physicians maybe choosing to go practice somewhere else or to take a different type of position within medicine.

And so we are building on this list of things that we can do beyond those three big ones. Little things that are annoyances or hindrances, like electronic fund transfer fees that payers will charge you just to get paid, right? Things like that. Every little thing like that that we can help make better, make a physician's practice a little bit easier, a little less annoyance, a little less challenge to overcome, will go a long way towards curing physician burnout.

So we're excited about the number of opportunities that are out there. The support for, and the recognition, I guess I should say, coming out of COVID and the wonderful work we've done with the Lorna Breen Foundation and that legislation, and the recognition of all the pressures physicians face and their reluctance to get help—especially when it comes to behavioral health issues—has been critical to building the recognition of how this is affecting the physician workforce. And in turn, how it's going to affect everybody's access to care.

So it's a critical issue. It's really central—when you think about all these things we're doing, physician wellness is really central to all of it.

Unger: Absolutely. Now, speaking of other sources of frustration for physicians is this issue of technology. And this has historically been a problem. But I can't imagine another time at which we are facing just a wide variety of technology challenges. The key here, of course, is making technology an asset and not a burden for physicians or for patients. How do you address something like this?

Askew: Well, that's exactly right. The technology has so much promise to address burnout, to address those day-to-day hassles, to advance medicine forward. But the way it's frequently implemented—look at the electronic medical record requirements—just makes no sense. It's not built to help the physician. It's not built to focus on the patient. It's built to meet some set of regulations or statutory requirements that frequently are at odds with what's really better or what's really needed.

We're going to see this a lot as AI develops. Are we going to let AI become an extra burden that physicians have to deal with or are we going to be able to bring it into the medical practice in a way that supports the physician's care of the patient, that relieve some of that back office work that the physician has to take care of in the evening after they put the kids to bed?

So the whole idea—and you said it exactly right—how do we make sure the technology, especially these new technologies, are an asset to a physician and not a burden that causes further burnout, takes up more time of the day, adds unneeded expense to a practice? And that's really going to be important to get a handle on this entire thing if we're going to reach our goal of reducing burnout.

Unger: That's such a great point. You talked about EHRs, and it couldn't be more clear the need to get out in front of some of these issues. We've had some really great conversations with folks about technology over the past couple of weeks and just this issue of—like what you talked about—augmenting physician capabilities and taking some of that burden off rather than adding more.

One of the things that's been a constant theme of our discussions is the need for physicians to get involved through advocacy, to hear their voices. Why is that so important?

Askew: They have the stories. The physician has the story to tell, that they can relate to a policymaker the impact of the decisions they make, the needs of their patients who are the voters back in their communities, in a way that nobody else can. We have 450 people here at the conference with us this week.

They're going to be going up to Capitol Hill and taking their stories to their legislators, and making sure that they hear from the folks back home—their constituents, their friends, the people they go to church with, the people their kids go to school with—to make sure that they understand how the decisions they make here are impacting what happens back home, how they get access to health care, whether or not the care is available in the community. And there's no better advocate for physicians than a physician.

Unger: Now, we've got a jam-packed schedule over the next couple of days. Is there one thing that you can think of that you'd like to see come from this conference?

Askew: You know, I'd like to continue to see the momentum build on everything that we've been doing. We have folks who literally were speaking here last year who might not have even brought up some of our issues as something we're going to work on this year.

This year, I think we're going to hear from member of Congress after member of Congress, and representatives from the administration, again and again, that they are with us, that they understand our agenda, that they're in agreement with it, and that we're going to work together in the coming year to implement as much of it as we can. So we're excited about that. That's what I want to hear most coming out of the conference.

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Unger: For physicians out there, how do they get involved?

Askew: Sign up. Grassroots opportunities are available on the AMA website. You can go to fixmedicarenow.org to get engaged in this. Sign up for the VIP, the Very Important Physician program. Sign up for other grassroots alerts. We'll tell you. We'll send you a message and say, "Hey, it would be really helpful if you could reach out to your legislator today or press this button to show them that you agree with something or you oppose something." Because that's it. We can help and provide physicians the tools to make those communications happen, but it's just absolutely critical that the physicians make their voice heard to their policymakers.

Unger: Absolutely. Todd, thank you so much for spending some time with us. Huge thanks to the advocacy team, our Board of Trustees, and all of the physician advocates and attendees that are going to be joining us over the next two days. It's going to be really exciting.

If you want to support AMA's efforts to advocate for physicians and patients, then you can support us by joining the AMA at ama-assn.org/join.

That wraps up today's episode, and we'll be back soon with another AMA Update as soon as we return from Washington, D.C. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. 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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