AMGA lists six pillars to improve the US healthcare system
The American Medical Group Association (AMGA) said the current federal healthcare policies are not sustainable and it is imperative to reassess and refine the future of healthcare financing. Earlier this year the association released a list of six key reforms needed to support modern care delivery.
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) had a goal of converting Medicare from a fee-for-service to a fee-for-value payment system. However, its implementation over the past decade revealed many challenges due to the complexities of healthcare delivery. AMGA established the MACRA and Value-Based Care Task Force in 2023 with the goal of developing a clear set of recommendations for Congress that could lead the transformation toward a more coordinated, efficient and patient-centered payment model.
These recommendations include:
• Enhance patient engagement by getting patients involved in their own care and taking an active role in their healthcare decisions.
• Improve health outcomes by addressing disparities to ensure all populations receive high-quality care.
• Protect patient dignity at end of life by promoting compassionate care that respects patient preferences.
• Remove regulatory and statutory barriers to reduce administrative burdens that impede care delivery.
• Support practices serving rural and underserved populations by ensuring equitable resources and support for all providers.
• Ensure the long-term sustainability of high-value care by establishing a payment model that ensures long-term viability for providers.
Darryl Drevna, AMGA senior director of regulatory affairs, said the idea is to point out key areas healthcare providers see the need for reform and to get lawmakers to ask critical questions.
"Where are the pain points in either law or in regulation that are slowing care or just adding to administrative waste?" he said in the above video interview with Health Exec. "Are we supporting practices in rural or underserved areas? So it's sort of our laundry list of here's what we think is going on and our recommendations to consider when MACRA comes up for reauthorization."
The Congressional House Energy and Commerce Subcommittee on Health held a hearing May 20 examining the Medicare Physician Fee Schedule, MACRA and opportunities for payment reforms. AMGA representatives spoke at the hearing and the association said it provided an important forum for examining the structural failures in Medicare physician reimbursement and to offer ideas on needed reforms.
AMGA said testimony and discussion echoed what its members have experienced firsthand that the Medicare physician payment system is broken. The group said in a statement that since MACRA’s 2015 enactment, the Medicare Physician Fee Schedule conversion factor has fallen more than 30% after adjusting for inflation, even as practice operating costs have risen approximately 20% over the same period. The group said successive rounds of temporary patches have failed to address this structural deficiency and is undermining the ability of clinicians to provide care.
“Today’s hearing sent an unmistakable message that the status quo is unsustainable,” said Jerry Penso, MD, MBA, president and chief executive officer of AMGA in a statement. “The testimony reinforced what our members report. Payment instability is forcing practices to limit Medicare enrollment, furlough clinical staff, and curtail population health programs that patients depend on. We thank the subcommittee for its leadership and urge Congress to move swiftly from conversation to legislation.”
At the hearing, AMGA said it is prepared to assist Congress in addressing Medicare reform to develop consensus-based policy solutions in the six pillars it has outlined.
“The issues examined today are not hypothetical, but are reshaping care delivery in communities across the country,” Penso said. “Our Task Force has done the work. We have the policy solutions ready. We urge Congress to act now before more practices are forced to make irreversible decisions that will limit access for Medicare patients for years to come.”
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]