Fixing Medicare pay system once and for all tops advocacy agenda

Andis Robeznieks , Senior News Writer

The power of the AMA advocacy team and organized medicine to mobilize a grassroots coalition state medical associations and national specialty societies was displayed late last year when doctors and medical students inundated Congress with 250,000 emails and more than 8,000 phone calls pressuring lawmakers to stop a scheduled 10% cut in Medicare physician payment rates.

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“Put simply, this win would not have been possible without the work of the AMA and its members to educate members of Congress about the consequences of inaction—consequences that would've come at a time when many of our practices and our own well-being are so fragile,” said Bobby Mukkamala, MD, chair of the AMA Board of Trustees.

Dr. Mukkamala, an otolaryngologist in Flint, Michigan, spoke during a recent AMA Advocacy Insights webinar that was held in lieu of the 2022 AMA National Advocacy Conference, which could not happen in person due to the COVID-19 pandemic.

The webinar focused on three main issues and, for each of those, registrants received an online action kit that facilitated their virtual meetings with lawmakers:

These are the same issues being targeted during the 2022 AMA Medical Student Advocacy Conference, to be held virtually March 3–4. Registration is free to AMA members.

Before addressing this year’s advocacy priorities, Dr. Mukkamala listed some significant 2021 victories, including:

  • Using the Defense Production Act to provide personal protective equipment, vaccines and domestic production of rapid COVID-19 tests.
  • Improving and expanding COVID-19 testing.
  • Securing relief from Merit-based Incentive Payment System (MIPS) reporting requirements. This enabled most physicians to avoid negative Medicare payment adjustments.

Find out how MIPS relief, reform and research have made the program more relevant.

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Congress moves to tackle Medicare physician pay cliff

Last year’s biggest victory forms the basis of this year’s chief focus.

“Stopping the proposed Medicare payment cuts was a major victory, but this yearly cliffhanger must end—the broken record must stop playing,” Dr. Mukkamala said. “We are calling on Congress to bring about a permanent solution to end the annual battles that threaten the solvency of physician practices.”

Physicians are facing a continuing statutory freeze in annual Medicare physician payments that is scheduled to last until 2026. After that, payment updates will resume, but only at a rate of 0.25% a year indefinitely.

“That’s not sustainable,” Jason Marino, the AMA’s director of congressional affairs, said in the webinar.

The AMA wants Congress to:

  • Establish a reliable Medicare physician payment update. At a minimum, it should keep up with inflation and practice costs while encouraging innovation.
  • Develop ways to reduce the administrative and financial burdens of MIPS participation. It also needs to ensure the program’s clinical relevance.

Prior authorization is a health plan utilization-management mechanism that requires physicians to get approval before a prescribed treatment, test or medical service qualifies for payment. It has morphed into an inefficient process that requires many practices to hire extra staff and causes delays that often leads to patients abandoning treatment, and it contributes to physician burnout.

There are bipartisan prior-authorization reform bills active in the House of Representatives and Senate, which Marino said have a good chance of passing during the post-November lame-duck session.

“It's never easy, but we have a good argument and a good case to make,” Marino said.

Find out why prior authorization is bad for patients and bad for business.

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This is the year to reform Medicare pay, boost telehealth

“Many patients and physicians want telehealth services as an option,” Dr. Mukkamala said. “These changes to telehealth policy must remain even after the pandemic is over.”

The restrictive policies—that will go back in effect after the COVID-19 public health emergency is over—are based on laws that were written decades ago before anyone had an iPhone, Marino said. The longer the public health emergency stays in effect, the more patients and physicians get used to telehealth and the greater pressure grows to make the expanded access permanent.

But Marino noted that the emergency only gets extended 90 days at a time, and that makes it hard for physicians to make the investments to retool their practices to integrate telehealth into their workflows.