Last year was a tough one for patients and physicians, but momentum is building to reform the broken Medicare physician payment system in 2023 and to reduce obstacles that interfere with patient care—including prior authorization. There are also now better tools to keep up the fight against COVID-19.
That having been said, there are still unacceptably high rates of burnout among physicians, science and medicine remain under attack in social media and state capitols, and the nation is dealing with the “tripledemic” brought on by increases in seasonal influenza, respiratory syncytial virus infection (RSV), and COVID-19.
“The last few years have been a bit of a blur, but last year about this time, we were blindsided with Omicron,” along with major increases in hospitalizations, said AMA President Jack Resneck Jr., MD.
But now, he said, there are newly formulated COVID-19 bivalent vaccine booster shots available, people are able to get rapid home tests, and the oral antiviral Paxlovid has been found to be effective in reducing COVID-19 hospitalizations, risk of death and the onset of long COVID.
“I do think we're in a better place,” Dr. Resneck said, adding that people who have not received their COVID-19 bivalent booster vaccination should do so.
Dr. Resneck spoke during a recent episode of “AMA Update,” in which he explained how 2023’s challenges can be met through the AMA Recovery Plan for America’s Physicians, which is rebuilding critical components of the medical profession by:
- Fixing prior authorization.
- Leading the charge to reform Medicare pay.
- Fighting scope creep.
- Supporting telehealth.
- Reducing physician burnout.
Physician burnout a top concern
Dr. Resneck noted that levels of burnout had been declining prior to the pandemic and were down to 38% in 2020, but then soared to 63% in 2021. Meanwhile, a separate survey found that one in five physicians intend to leave practice within the next two years.
At the top of Dr. Resneck’s priority list as AMA president is “the level of burnout that I'm seeing among my physician colleagues around the country,” he said. The impact of physicians leaving an already stretched workforce is especially concerning, with patients facing increasing difficulties accessing both primary care and specialists.
It’s not just COVID-19 that is contributing to physician burnout, Dr. Resneck said, noting that the burdens that impede joy in medicine are well known.
Those drivers of burnout include time-wasting prior authorizations, burdensome reporting requirements, and what’s become an annual ritual of pleading with Congress to stop scheduled cuts to Medicare physician payments. Dr. Resneck said that, with physicians facing remarkable inflation and caring for the nation during this tripledemic, he couldn’t think of a worse time for Congress to leave a 2% cut in place, demoralizing the profession and threatening practice sustainability.
“We're also seeing politicians ... interfering with patient care in stunning ways,” he noted.
Decisions that should be made between doctors and patients in exam rooms are now sometimes rigidly set in state legislatures instead. Fighting back against that interference is “also tiring for physicians,” he said.
Doctors’ No. 1 irritant
Right-sizing prior authorization would go a long way toward reducing burnout.
“When I travel the country these days, the physicians almost universally pick that as the No. 1 annoyance in their daily practice,” Dr. Resneck said.
But, he said, “momentum is shifting.” Policymakers are hearing from patients who have had care delayed or denied, and many have had their own bad experiences with prior authorization.
Recent progress includes passage of state prior authorization-reform laws in Georgia, Illinois, Kentucky and Michigan, and a bill reforming prior authorization for Medicare Advantage plans passing the U.S. House of Representatives.
On the battle against scope creep, Dr. Resneck said that, working in partnership with state medical societies, the AMA has helped stop some 35 state-level initiatives that would have threatened patient safety by inappropriately expanding nonphysicians’ scope of practice.
While Dr. Resneck describes himself as disappointed and dismayed by the 2% cut in Medicare pay physicians will face in 2023, he is turning his attention to structural Medicare physician payment reform to fix the broken system that leads to these cuts and likely threatens access to care for Medicare patients.
“We have laid the groundwork for that more meaningful reform – physicians deserve a stable and predictable payment system that includes positive annual updates that track inflation in practice costs,” he said. He also is pushing for reform of the damaging budget neutrality rules that penalize physicians for things beyond their control.
One advocacy accomplishment is the development of Medicare payment reform principles (PDF) that received the endorsement of 120 state medical associations and national medical specialty societies.
“We're all rowing in the same direction – giving Congress a very unified message about what needs to happen,” Dr. Resneck said.
“AMA Update” covers health care topics affecting the lives of physicians and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more—because who’s doing the talking matters. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.