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Declining Medicare reimbursement and continuing prior authorization hassles for physicians were among the familiar themes sounded by American Medical Association (AMA) President Bruce Scott, MD, at Friday evening's opening session of the AMA House of Delegates Interim Meeting in Orlando, Florida.

Scott, an otolaryngologist in Louisville, Kentucky, described one of his AMA-related travel experiences at a small regional airport, where the same woman processed his rental car return, checked him in for his flight, checked him through security, and loaded his bags onto the plane. He said that a fellow passenger joked "If she's flying the plane, I'm driving."

"This story is emblematic of healthcare today, as fewer physicians are asked to do more and more," Scott said. The challenges physicians face "are magnified in these rural areas where patients today face a shortage of 20,000 primary care physicians, where 80% of counties do not have a specialist for care, and where 1,100 counties are without a single obstetrician."

He cited statistics suggesting that one in five physicians hope to leave their practice in the next 2 years, one in three plan to reduce their hours, and 40% of medical students are unsure if they ever want to enter clinical practice. "These are not just statistics; these are our colleagues -- our brothers and our sisters in this profession," Scott said.

One frustration for physicians is a daunting financial reality, he continued. "We're all familiar with the 29% reduction in Medicare payment to physicians since 2001. And now it's official – CMS proposes another 2.8% cut for 2025, while at the same time estimating that our expenses to deliver care will increase by 3.5%. This is simply unsustainable and is pushing physician practices to the brink of financial ruin." And where Medicare rates go, so go the rates for Medicaid and private insurance; both types of payers link their rates to Medicare's, Scott pointed out.

"This puts us in an impossible position: either turn away patients, reduce your hours, or close your doors altogether," he said. "And in each of these scenarios, it's our patients who suffer, particularly our nation's elderly and disabled persons."

To fix the problem, Medicare should stop cuts like this one and instead give physicians a payment increase each year based on the medical inflation rate, said Scott. He noted that last week, some members of Congress introduced the Medicare Patient Access and Practice Sustainability Act, which would do exactly that.

"Now, Congress must prioritize this legislation during the lame duck session," he said. "Make no mistake, this is going to be an uphill battle. But I believe that if a unified voice of physicians comes together from across the country, from every state and specialty, we can fix it."

Prior authorization delays and denials are another big problem for physicians and patients, Scott said. "We all know that prior authorization denials are rarely – if ever – rooted in science or evidence. When I get on the phone to appeal a denial with a so-called peer, it's often that I'm not talking to someone who has been to medical school. It's almost never an otolaryngologist -- heck, a lot of times they can't even pronounce otolaryngology."

But thanks in part to the AMA's lobbying efforts, "we have more than two dozen prior authorization reform bills enacted in states since 2023," he said. "And when we couldn't get it fixed in Congress, we went straight to CMS. And our advocacy was instrumental in a CMS final rule for 2024 for government-regulated health plans to reduce the time frames for prior authorization, to improve transparency, and for payers, to move beyond fax machines."

Even Congress is finally hearing the AMA's message, Scott said, adding that the Improving Seniors' Timely Access to Care Act was reintroduced this year. The bill would establish an electronic prior authorization process for Medicare Advantage plans and require the Department of Health and Human Services, and other agencies, to report to Congress on their efforts to improve the electronic prior authorization process. "We urge Congress to pass this bill, and to pass it now."

Scott also briefly touched on the association's efforts to thwart scope-of-practice expansion attempts in state legislatures. "Simply put, patients deserve to be cared for by a physician," he said. "And patients agree -- with 95% of patients saying they want a physician involved in their diagnosis and treatment."

Data show "that nonphysician providers use more resources, overprescribe antibiotics and opioids, and order unnecessary diagnostic tests and images," said Scott. "And when you put it all together, patients that don't have a physician involved in their care have worse health outcomes and higher overall healthcare costs."

Lobbying by the AMA together with state medical societies has "secured significant scope victories to protect patients, defeating more than 80 bills this year, including those that would have removed physician supervision for nurse practitioners, allowed optometrists to perform eye surgery, and licensed naturopaths to prescribe medications," he said. "The only way to fight these battles ... is with a unified front. And let me be clear: the AMA will not back down."

As the nation comes out of a polarizing election, "that makes it all the more important that we find common ground on these issues that we know are harming our patients, harming our fellow physicians, and harming our practices," he concluded. "Our AMA works with Democrats and Republicans to fix the flaws in our health system and improve public health, and that means advocating for meaningful solutions regardless of who is in power. Be assured that we will always remain true to our mission."

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