Catch up with the news and other key moments from the AMA House of Delegates’ meeting in National Harbor, Maryland. The 2023 AMA Interim Meeting concluded Nov. 14.
Special thanks to Ted Grudzinski, AMA staff photographer, for his many great shots of the House of Delegates in action.
Doctors press on all fronts to fix Medicare, protect care access
Through various actions at the Interim Meeting, the House of Delegates has made it unmistakably clear that the unsustainable Medicare payment system poses a dire threat to patients’ access to high-quality physician care across the nation. In addition to this year’s 2% cut in Medicare physician pay, doctors face a further 3.37% cut set to take effect in January. After adjusting for inflation, physician pay actually fell by 26% since 2001.
“Physicians heed the idea of ‘first do not harm,’” said AMA President Jesse M. Ehrenfeld, MD, MPH. “Yet the payment system year after year inflicts harm on the ability of physician practices to stay afloat. We also are aware of the First Law of Holes. When you find yourself in one, stop digging. We are in a veritable crater. Cutting payments is only taking us deeper.”
Learn about delegates’ actions and find out how the AMA is pushing on Capitol Hill to cancel the 3.37% Medicare pay cut in 2024 and make physician payment keep pace with inflation.
AMA keeps pluralistic approach to health system reform
The AMA maintained its opposition to single-payer health reform after delegates discussed a proposal during reference committee at the Interim Meeting. The AMA has longtime, extensive policies that support a pluralistic system that ensures choice of coverage for patients and autonomy of practice for physicians. The AMA has advocated to shape numerous major health system reform proposals in recent decades. Learn more about the AMA vision on health system reform.
Make clinical trial enrollment easier in Medicare Advantage
No institution or managed care network, however large, can offer all relevant clinical trials, so the Centers for Medicare & Medicaid Services (CMS) needs to change a policy that results in Medicare Advantage enrollees having to self-refer for consultation in an out-of-network clinical trial, according to a resolution presented at the Interim Meeting.
Last June, delegates adopted policy advocating that CMS require Medicare Advantage plans pay for the routine costs of services provided as part of clinical trials, and to ensure that physicians and other health professionals are paid directly in order to eliminate a requirement that patients seek payment for billed services.
Delegates built on this by amending AMA policy to advocate that CMS “allow out-of-network referral of patients with Medicare Advantage for the purpose of consultation for enrollment in a clinical trial, require covering plans to pay for such consultations, and that these consultations be considered administratively as participation in a clinical trial.”
Hold health plans accountable for physician network inadequacies
It is important for health plans to have adequate networks to provide access to in-network physicians and hospitals that meet enrollees’ care needs. But when networks are inadequate, it creates obstacles for patients seeking new or continued care. It also limits patients’ choice of physicians and facilities.
Regulators must do more to ensure network adequacy so that “patients have options in accessing care,” said AMA President Jesse M. Ehrenfeld, MD, MPH. The newly adopted policy “will help the AMA encourage a multilayered approach for regulatory oversight that includes meaningful standards, transparency of network breadth, parameters for out-of-network care, and effective monitoring and enforcement of existing standards.”
The AMA council’s report notes that “network inadequacies often lead to excessive appointment wait times and overburden many in-network physicians, contributing to increased burden and potential liability for delayed care.”
Find out more about the AMA’s plan to tackle narrow health-plan networks.
Medical boards must have oversight of all health professionals
Delegates restated the need for state medical boards to maintain oversight in the regulation of nonphysician health professionals.
They reaffirmed existing policy that calls on the AMA to:
- Advocate maintaining the authority of medical boards to regulate the practice of medicine through oversight of physicians and nonphysician health professionals.
- Oppose the establishment of autonomous regulatory boards for nonphysician health professionals.
- Oppose efforts to certify nonphysician health professionals in a manner that misleads the public to believe such certification is equivalent to medical specialty boards’ certification.
Also reaffirmed was existing policy calling on the AMA to work with state medical associations and national specialty societies to:
- Pursue legislation requiring health professionals to disclose the license under which they are practicing.
- Prevent deceptive practices such as nonphysician health professionals presenting themselves as physicians or "doctors."
Fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians.
Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety.
Delegates also referred for study by the AMA Council on Legislation a proposed policy directing the AMA to draft model legislation requiring “all facilities that imply the provision of emergency medical care have the real-time, on-site presence of a physician.”
A bill was introduced in Indiana’s legislature requiring hospitals with emergency departments to have a physician on site and on duty who is primarily responsible for the emergency department at all times the department is open. Legislators in other states are likely to soon follow suit. The council is expected to provide a report to delegates with policy recommendations.
Who’s making the call on prior authorization?
Governmental regulatory bodies and commercial payers routinely and regularly audit and survey the clinical practice of medicine. This is done to authorize payments made for medical care and services provided to patients in all care settings. It includes verifying and validating the accuracy of medical diagnoses made and used in determining the medical necessity of such care and services.
But this prior authorization is often performed by clinicians who are not trained, licensed or qualified in making such decisions, notes a resolution presented at the Interim Meeting.
When clinicians who are not trained, licensed and qualified to diagnose medical conditions or determine medical necessity are involved in utilization management, prior authorization, Medicare and Medicaid audits and regulatory surveys, it “creates unnecessary hurdles to safe, timely and equitable practice of clinical medicine,” the resolution says.
Learn how the AMA will advocate to only let properly trained and licensed physicians be involved in determining medical necessity.
Insurers—not doctors—should collect patient cost-sharing
Deductibles, copays and coinsurance are types of cost-sharing that patients are responsible for paying While patients are responsible for paying these forms of cost-sharing, they are typically collected by the physician, practice or hospital where the care was provided, notes a report from the AMA Council on Medical Service whose recommendations were adopted.
The collection of cost-sharing is a burden on many physicians and causes numerous adverse impacts. But it is physician private practices—especially small practices and those in rural areas—that tend to be more intensely impacted by the challenges experienced in collecting cost-sharing. On top of that, emergency physicians are providing uncompensated care about 55% of the time due to regulations around copay collection in emergency settings, Medicaid underfunding, Medicare’s lack of inflation adjustment, and uninsured or underinsured patients seeking care.
“Requiring physicians to engage in the collection of cost-sharing at the point-of-service negatively impacts many physicians,” said AMA Trustee Marilyn J. Heine, MD. “Alternative methods of collecting cost-sharing that place the onus on insurers can relieve private practices, especially small and rural practices, of significant administrative burdens that divert financial resources and staff away from patient care.”
Currently available alternative solutions to help physicians and their practices collect out-of-pocket payments include the use of collection services and insurance-controlled collection systems. But these options can also result in unintentional adverse impacts such as a loss of business autonomy in turning control of collections to insurers.
To reduce this burden placed on physicians—particularly among those working in private and rural practices—delegates adopted policy to:
- Support requiring health insurers to collect patient cost-sharing and pay physicians their full allowable amount for the health scare services provided, unless the physicians opt-out to collect such cost-sharing on their own.
- Work with interested state medical associations and national medical specialty societies to support the adoption of policies requiring insurers to collect patient cost-sharing and pay physicians their full allowable amount for the health care services provided, unless the physician should opt out.
Health care administrators must not be medical decision-makers
Most doctors in the U.S. are now employees, working for others in physician groups, insurance companies or hospitals and health care systems. Meanwhile, the growth of health care administration positions has far outpaced that of physicians in practice, according to an AMA Board of Trustees report whose recommendations were adopted at the Interim Meeting.
“The large-scale employment of physicians has brought about a change to the profession that has resulted in conflict,” said David H. Aizuss, MD, secretary of the AMA Board of Trustees. “Traditional physician autonomy in patient care is now being influenced by pressures motivated by cost versus high quality patient care.”
This tension has been recognized as a significant source of intrusion on physician autonomy, the board report says.
Learn how the AMA will work to keep medical decision-making for patients in the hands of their physicians.
Residents and fellows have rights. Here is how to protect them.
Resident and fellow physicians deserve a seat at the table when it comes to advocating for the creation and implementation of institutional policies that ensure their professional development, well-being and rights, according to policy adopted at the Interim Meeting.
Originally adopted as AMA policy more than a decade ago, the Resident and Fellows’ Bill of Rights (PDF) offers a key framework for protecting resident well-being.
To ensure residents and fellows are part of the process of ensuring policies related to well-being are in their best interest—and that they have more freedom of movement if their employment at a residency or fellowship program becomes untenable—the House of Delegates adopted new policy to encourage the formation of peer-led resident and fellow organizations that can advocate for trainees’ interests.
Learn about the other actions the AMA is taking to help protect residents and fellows’ rights.
Most medical schools don’t have defined leave policies
Roughly two-thirds of medical schools lack defined parental leave policies. Without explicit, equitable leave time, students are forced to make difficult decisions about family planning and other family and personal matters.
At the residency and fellowship levels, a 2021 requirement from the Accreditation Council for Graduate Medical Education calls on accredited programs to offer six weeks of paid leave to all residents and fellows for medical, parental and caregiver leave. The American Board of Medical Specialties requires certification boards to allow six weeks of leave during residency or fellowship training in their specialty without extending the training time required for meeting eligibility for board certification.
Compassionate-leave polices are equally undefined across the spectrum of training. It’s unclear whether any medical schools have a compassionate-leave policy. Residency programs may follow compassionate-leave policies of the host institution, but the number of days and requirements may vary.
Learn about newly adopted AMA policy calling on medical schools, residency programs, physician practices and other physician employers to develop flexible, clear, equitable compassionate-leave policies.
Give medical students a choice of health plans
With annual premiums that can run upwards of $7,000, medical school health insurance plans can be costly, creating an added financial burden for medical students who already take on considerably debt to train for their career in medicine. Those health plans also don’t necessarily represent the best option for medical students with limited resources.
In spite of those realities, medical schools who offer health insurance plans to their students may mandate that students only enroll in their health plans, without any option for waivers if a student is eligible for Medicaid, or Affordable Care Act subsidies, parental coverage or other comprehensive plans.
To address the situation, the House of Delegates directed the AMA to “encourage medical schools to allow students and their families who qualify for and enroll in health insurance plans other than the institutionally offered health insurance plans, to be exempt from an otherwise mandatory student health insurance plan requirement, provided that the alternative plan has comparable care coverage and is accepted at the primary geographic locations of training.”
In addition, medical students who need to take leave, even for health reasons, could lose their medical school health insurance plan because they are no longer active students.
On that issue, delegates adopted new policy to “support the continuation of comprehensive medical insurance benefits for inactive students taking an approved leave of absence during their time of degree completion and encourage medical schools to publicize their policies regarding the continuation of insurance benefits during leaves of absence.”
Voting starts today
This morning marks the first of two days of voting on the reference-committee recommendations presented to the House of Delegates.
Hundreds of voting delegates will gather at 10 a.m. in the Maryland Ballroom, just as they did on Friday night for the opening session of the Interim Meeting. At that time, delegates were shown a brief video on the urgent need to reform the Medicare physician payment system on behalf of patients and the doctors who care for them.
Click to watch the video below.
Find out more about AMA advocacy efforts this year and learn how you can take part in the fight to reform Medicare on behalf of your patients and practices at the AMA's Fix Medicare Now website. Join physicians nationwide in telling Congress to cancel the cut.
Get updated on AMA’s Medicare advocacy
Leading the charge to reform Medicare pay is the first pillar of the AMA Recovery Plan for America’s Physicians, and AMA leadership is hosting a Medicare advocacy educational session from 1–2 p.m. today in the Maryland Ballroom. The session will provide an update on the AMA’s advocacy efforts with Congress in advancing legislation to reform the Medicare physician payment system.
AMA Board of Trustees leadership and Advocacy staff also will discuss opportunities for delegates and other physicians to become more involved with AMA grassroots efforts and on how to best communicate with their members of Congress.
The AMA has challenged Congress to work on systemic reforms and make Medicare work better for you and your patients. Our work will continue, fighting tirelessly against future cuts—and against all barriers to patient care.
Click to watch the recent “AMA Update” episode below to learn more from AMA Board Chair Willie Underwood III, MD, MSc, MPH, about the AMA’s campaign to fix Medicare.
Other education sessions this afternoon
Among the other offerings available to delegates in National Harbor, Maryland, are those below (all times EST):
- 2–3 p.m. “Pandemic Preparedness and Response Town Hall with retireed Maj. Gen. Paul Friedrichs, MD, deputy assistant to the president and director of the White House Office of Pandemic Preparedness and Response Policy.” Maryland Ballroom.
- 2–3 p.m. “AMA Council on Ethical and Judicial Affairs Open Forum: Should the AMA Code of Medical Ethics Speak to Health Care Systems?” Potomac Ballroom D.
- 2:15–3:45 p.m. “The Climate Crisis: Pathways to Decarbonizing the U.S. Health Sector.” Potomac Ballroom C.
- 2:30–3:30 p.m. “Medical Justice in Advocacy Fellowship: Health Equity Capstone Project.” National Harbor 2.
- 3:30–4:30 p.m. “Truth, Reconciliation, Health and Transformation 101." National Harbor 2.
- 3:30–5:30 p.m. “Litigation Center: Advancing AMA Policies in the Courts.” Potomac Ballroom D.
- 3:45–5:00 p.m. “Building Sustainable Value-Based Payment Arrangements: Data Sharing Lessons Learned and Other Practical Steps for Success.” Potomac Ballroom C.
Learn more about claiming CME for Interim Meeting education sessions.
Reference committees meet today
AMA delegates will offer testimony today on more than 100 reports and resolutions up for consideration at the meeting. Delegates draw on their expertise, the best evidence in the medical and health policy literature, and the insights of their state medical associations and national medical specialty societies to weigh in on proposals that run the gamut of issues affecting patients and physicians.
These reference committees will meet from 1:30–5:30 p.m. EST today:
- Reference Committee on Amendments to Constitution & Bylaws, which covers the AMA constitution, bylaws and medical ethics matters. Potomac Ballroom A.
- Reference Committee B, which covers legislation, Potomac Ballroom B.
- Reference Committee C, which covers medical education. Potomac Ballroom C.
- Reference Committee F, which covers AMA governance and finance. Maryland Ballroom.
- Reference Committee J, which covers medical service, practice and insurance. Potomac Ballroom D.
- Reference Committee K, which covers science and public health. National Harbor 2/3.
Voting on reports and resolutions will start Monday, 10 a.m. EST., and continue Tuesday. Watch this short video below, from 2019, or explore this AMA Ed Hub™ interactive course to learn how AMA policy is made.
How do you move medicine forward in trying times? Focus
The AMA is working to stop Medicare physician pay cuts, reform the Medicare payment system, right size prior authorization, reduce physician burnout and protect patients from inappropriate scope of practice expansions.
While the American Medical Association is doing a lot, one reason there have been strong signs of progress is because these efforts are focused, aligned and coordinated as part of a long-range strategic plan—and also because the AMA has carefully selected its priorities.
“One necessary aspect of strategy is choosing what not to do,” said AMA Executive Vice President and CEO James L. Madara, MD, during his speech at the opening session of the 2023 AMA Interim Meeting in National Harbor, Maryland.
Dr. Madara was quoting noted Harvard Business School economist Michael Porter, PhD, who famously said that organizations aiming for impact “can’t be all things to all people.”
“In other words, a coherent strategy relies not only on selecting the most important areas on which to focus, but also choosing the areas of lesser importance that will not be pursued,” Dr. Madara said.
Learn more from Dr. Madara about the AMA's effective efforts to remove obstacles to care and drive the future of medicine.
Medicare pay cuts are “too deep, too relentless”: AMA president
With a looming Medicare physician pay cut of 3.37% in 2024, alarming rates of physician burnout, and the passage of unsafe scope of practice expansions, medicine is not just at a crossroads. It is in crisis, and physicians must press for a more sustainable system that preserves patients’ access to high-quality physician care.
“It has to be us—because we experience the realities of a broken health care system every day,” said AMA President Jesse M. Ehrenfeld, MD, MPH, during his speech at the opening session of the 2023 AMA Interim Meeting in National Harbor, Maryland, just across the Potomac River from Capitol Hill. (Read Dr. Ehrenfeld’s speech.)
“Our voices, our stories, and our experiences are powerful ones—and we must amplify them to shine a light on what is truly happening in our health care system,” said Dr. Ehrenfeld, who shared how his own parents have been affected by Medicare’s broken physician payment system.
His parents, both in their 70s and with “a number of age-related ailments,” have struggled to receive primary care because the woefully inadequate Medicare physician payments, which are not indexed to inflation, are not enough to sustain a growing number of practices.
“Too many seniors, like my parents, have gotten the same letter,” Dr. Ehrenfeld said of notices that practices are closing or ceasing to provide services for Medicare patients. “This usually leads to a frustrating and frantic search for a replacement and too often harm, as delays occur, things get missed in the transition, and patients often end up having to travel farther to receive necessary services.”
The looming Medicare payment “cuts are too deep, too relentless, and they touch too many lives—physicians and patients alike,” Dr. Ehrenfeld said. “We must keep the pressure on. And we will.”
Learn more from Dr. Ehrenfeld about how the AMA is leading the charge to cancel the 3.37% pay cut in 2024 and fix Medicare now.
Physicians to Congress: Stop the 3.37% Medicare pay cut—all of it
Nearly 700 physicians and medical students are gathering this week just a few miles away from Capitol Hill for the 2023 AMA Interim Meeting, where they will consider proposals across a wide range of clinical practice, payment, medical education and public health topics.
But there is one issue that is clearly at the top of agenda for delegates: The need to stop the 3.37% Medicare physician pay cut set for 2024 and enact broader Medicare reforms to ensure that the 65 million Americans who rely on it have continued access to high-quality physician care.
“Medicare reform is moving to the top of many agendas, no doubt spurred by seniors and people with disabilities concerned by the prospect of disappearing access,” Dr. Ehrenfeld noted last week after the CMS final Medicare physician pay schedule was issued.
And it assuredly remains true this week at the AMA Interim Meeting in National Harbor, Maryland, just across the Potomac River from Capitol Hill. Dr. Ehrenfeld will address delegates at the opening session tonight, with the need to fix Medicare now expected to be a central theme of his remarks.
Learn more about the bipartisan fixes that have physicians’ support.
Education sessions today
Among the educational offerings available to delegates at the Gaylord National Resort and Convention Center in National Harbor, Maryland, are these sessions below (all times EST):
- 8:15–9:45 a.m. “Augmented Intelligence: Beyond the Hype and Doom.” Chesapeake F.
- 9:30–10:30 a.m. “Professionalism, Peer Review, and Employment Contracts.” Potomac 5/6.
- Noon–12:45 p.m. “Stepping Outside the Four Walls: Understanding Street Medicine.” Chesapeake 7/8.
- 1–2 p.m. “Thinking Differently: Innovative Strategies for Private Practice Success.” Chesapeake 5/6.
- 2:30–3 p.m. “Dietary Supplements for Seniors: Considerations for Safety and Support.” Potomac C.
- 4–5 p.m. “Demystifying Medicare for Patients: Traditional Medicare vs. Medicare Advantage.” Potomac C.
These essentials will help you get the most out of the meeting.
- Access the reports and resolutions delegates will consider, as well as reference committee reports and final actions as they become available.
- Search the AMA Pictorial Directory to find your peers and stay connected before, during and after Annual and Interim Meetings (AMA members only).
- Find instructions on downloading and accessing the meeting app.
- Learn about the education sessions offered and how to claim CME.
Highlights of the meeting’s key moments and House of Delegates policy actions will be posted daily at the AMA website, the 2023 AMA Interim Meeting website, and the AMA’s Facebook page, Instagram and X account using #AMAmtg.