Last week, the American Medical Association (AMA) held its annual advocacy meeting in Washington, where AMA members heard from Biden administration officials as well as Senators and members of Congress. during the meeting Med Page today Washington Publisher Joyce Frieden sat down with AMA President Jack Resneck Jr., MD, to find out how things are going during his tenure. The interview was conducted with a member of the press present and has been edited for length and clarity.
Hi, thanks for sitting down with us! How is your year going so far?
Resneck: It’s great; It’s amazing how almost a year can go by. What an exciting opportunity to be able to represent this profession that I am so proud to be a part of, and to do so at a time that feels really important, where there are serious threats to the profession and our ability to take care of patients, and where the profession faces a lot of attrition after these last 3 years. But it seems like we’re so aligned on some things that we need to do to improve healthcare delivery for doctors and patients.
So I feel great about the policy and what the organization is doing, and it’s an exciting time to be leading it.
What are the challenges of the job or things you didn’t expect?
Resneck: Well, the challenges are: the defense is tough and Washington is a tough place. State legislatures are tough places and you can’t do everything overnight. And when you really know that, and you see things that alarm you, that keep you up at night, like high burnout rates in the profession, and you know what we need to do to fix it, we know that we can’t have across-the-board pay cuts. Medicare that cause the closure of small practices.
We know this gets out of control before authentication.[orization] The mess that the health system got us into is demoralizing for doctors… We know what we have to do, so the frustrating part of the job is not being able, in one day, to fulfill all those things that I need. know what we need
The other thing is that this is a time where the country is really fractured politically. So to talk about things that are really common sense at a time when science is questioned, there’s misinformation, and social media is such a divisive place that sometimes it makes talking about these things more difficult.
But the reality is that we bring our House of Delegates together at the AMA and we end up with a huge consensus on a lot of these controversial issues, because we have a science-based debate and an evidence-based debate, and minds change, and so on. it’s great to be a part of that. And that is actually sustaining.
How are things going with the Recovery Plan and the goals that WADA has set for itself?
Resneck: These are big and ambitious goals, and we can’t do everything overnight. But these are the most important things to sustain medical practices. Much of our work is focused on the Recovery Plan for America’s Physicians in legislative activity around reviving and supporting medical practices as we emerge from these first 3 years of the pandemic.
For example, the Medicare payment: things have gotten worse. We have a 2% across the board cut on January 1, which is incredibly demoralizing for the medical community that is dealing with rampant inflation, trying to keep their practices open, dealing with misinformation, and keeping their practices together during this difficult pandemic.
We need positive, automatic, annual, inflation-based updates, just like hospitals, nursing homes, hospices. Why the doctors are different is a freak accident of history that has to be fixed. So that’s the focus.
What’s different, though, and what’s progress is that when I talk to members of Congress about this, in the House and the Senate and on both sides of the aisle, there’s a pretty universal understanding that this is broken, not it’s fine, and it has to be fixed.
Now, the willingness to cross the finish line, the question of from a budget standpoint, for this to qualify as new spending even though it’s actually delivering on the promises made to Medicare recipients, that’s where there will be obstacles. , and that is where the work now lies.
But I feel like patients and the medical community, across geographic areas and specialties, and across the political spectrum, have been pretty clear. And yes, while you can identify some issues that can be very partisan and where we find people coming back to that perspective, I think this is not one of those areas.
I’ll put preclearance in that same category, and it’s one where we’re really starting to see real momentum and progress. We had the house, overwhelmingly bipartisan, shocking! — pass a bill to address prior authorization overreach by health plans and Medicare Advantage plans. We couldn’t cross the finish line in the Senate due to a CBO [Congressional Budget Office] punctuation issue, and we’re going to rework on that.
the sgc [Centers for Medicare & Medicaid Services] the administrator was here [at the conference] today, and she and her team put out two proposed rules in recent weeks to actually address the same thing: prior authorization in Medicare Advantage plans and some other plans that they have under their jurisdiction. And the medical community feels so heard on this issue and feels like our patients are heard, and part of that is, when I meet with a team at CMS or meet with legislators on both sides of the aisle or in state chambers, I don’t meet anyone who hasn’t personally, for themselves or a family member, had the same exasperating experience of sitting down with a doctor, figuring out a diagnosis, discussing treatment options and side effects, deciding what to they think. it’s better collaboratively, going to the pharmacy and getting the disappointing answer: “Your insurance doesn’t cover this” and it will require weeks of fighting and fax machines and phone calls between peers with people who aren’t really peers, all that stuff.
So we’re seeing all of these proposals in Medicare progress, and we’re seeing action in individual states; for example, Texas passed a “gold card” bill [allowing doctors who have good track records for getting treatments approved to skip some prior authorization]. So it’s an area where I think we’re seeing more progress.
How does WADA feel about the details in those proposed rules? For example, I think a rule gives plans specific timeframes to make prior authorization decisions and makes them include a reason for any denial.
Resneck: We actually think that those [decision] the terms should be shorter. There is a time for the urgent and another for the regular. We will continue to work with the CMS team to ensure they are short enough to be appropriate.
But there’s things in there like continuity of care, like when insurance companies say, “We authorized this surgery,” but there’s a little disclaimer at the bottom that says, “This is not a guarantee of payment,” and then , after the surgery, they say, “We withdraw the authorization”, or they only authorize it for a certain number of days, and the surgery is delayed 5 days and now it is not authorized.
It also has in those proposed regulations that the person you are talking to [at the insurance company about the prior authorization] You must have experience in the disease you are talking about. So we really feel heard.
Now, there’s a lot in those proposed regulations about tests and procedures, and less about drugs, so we’re definitely asking CMS to see if they can expand it to say more about drugs, because that’s a very sore spot for our patients.
And the issue of exhaustion?
Resneck: On wellness and physician burnout, and even the issue of physician suicide, all under that one pillar of the Recovery Plan around Burnout, we help get the Lorna Breen Law across the finish line, to help get resources to the doctors. We are beginning to see a slow but sure destigmatization of mental health issues among the medical population, with people increasingly seeking the help they need.
We’re starting to see, whether it’s state medical boards or hospitals, or others, removing questions like “Have you ever had a mental health problem?” from their credentialing forms? While it is appropriate to ask people if they have a current disability, if people know they will always be asked if they have ever they had a disability or mental health problem that prevented them from seeking help.
So I think on a number of these things, we’re actually seeing good progress.
What about telehealth?
Resneck: Congress actually extended telehealth coverage through the end of 2024. [A] permanent [extension] It would be better, but cheers, this gives us a break. And it was recognition [of the importance of] this benefit where Medicare patients, instead of going away and only being able to get telehealth on the web through some corporate provider not coordinated with their existing healthcare, they can actually get coordinated and integrated telehealth with their healthcare team that you can also see personally when they need it.
I think it was a great acknowledgment that we should not take this benefit away from Medicare beneficiaries.