AMA president calls for physicians to take war-time footing in fight over reimbursement, care quality
Drawing inspiration from the World War II “Why We Fight” campaign that rallied support for the U.S. war effort, American Medical Association (AMA) President Jesse M. Ehrenfeld, MD, MPH, said physicians are fighting an uphill battle. The fights include dwindling reimbursements amid rising costs, physician shortages, burnout, and administrative fights against prior authorization.
Ehrenfeld, an anesthesiologist from Milwaukee, highlighted these and other challenges as immediate threats to the physician workforce and healthcare access during his speech at the AMA’s 2024 House of Delegates meeting in June 7 in Chicago. The speech was delivered the same week as the 80th anniversary of the WWII D-Day invasion of Europe.
“Reforming our broken Medicare payment system that punishes doctors for being doctors is why we fight,” Ehrenfeld explained in his speech to AMA delegates. “Medicare reimbursement has plummeted 29 percent since I was in medical school — 29 percent. And that’s after the AMA was able to claw back half of the planned cuts for 2024. Medicare reform is our top advocacy priority because it’s crippling the sustainability of physician practices, threatening patient access to care, and choking the pipeline for future physicians.”
He added that momentum is shifting toward significant reform and said the AMA has been able to help change the conversation with lawmakers in Washington. Ehrenfeld said the organization's comprehensive Fix Medicare Now campaign and persistent lobbying efforts is spreading the message that existing Medicare models don't work for doctors or patients. He said there is growing support in Congress for Medicare reforms aligned with AMA’s models.
The AMA said for years the Medicare Sustainable Growth Rate (SGR) formula has threatened payment cuts, resulting in instability for both practices and patients. While the Medicare Access and CHIP Reauthorization Act (MACRA) offered some progress, the AMA said it lacked key components, such as an annual inflationary update and adequate support for small and rural practices. Today, physicians are the only Medicare providers who do not receive an annual inflationary update.
Since 2001, Medicare physician payments have lagged 29% behind the rate of inflation growth, Ehrenfeld said.
“We are keeping the pressure on because our current system is unsustainable and because physicians shouldn’t have to worry about how they’ll keep the lights on,” he added.
Why physicians need to fight
Being AMA president requires a lot of travel, keynote speaking at numerous conferences, and sometimes being away from his practice for weeks. This takes a toll on Ehrenfeld not only professionally, but also on the "homefront" with family. While tucking in his 5-year-old son, he told him he would not be around at breakfast because he had to leave a catch a flight to another conference. His son asked him, 'Why do you have to be AMA president?'
“Every person in this room knows that a question like that from a child cuts through the heart. But, it wasn’t the first time in our home that the question had been asked. Before deciding to run for this office, my husband Judd and I had conversations where we asked ourselves, ‘Why do this now?’” he said.
Like the daunting tasks facing the United States when it entered WWII, healthcare today has challenges that may seem impossible to overcome. But, Ehrenfeld encourages providers to cling to hope and never give up. As AMA president, he said he would continue to stand up for science and more equitable patient care.
“We fight for what we know is right. A better healthcare system. A more accessible healthcare system. A more equitable healthcare system. A more financially sustainable health care system. I will take one more flight if it means unburdening physicians from the administrative headaches that are driving burnout and early retirements,” Ehrenfeld said.
He said physicians will continue to be supported by the AMA as they address the biggest problems that healthcare faces, including the opioid crisis and putting up responsible guardrails for the adoption of artificial intelligence.
“This moment in healthcare demands all of our attention. It is all of our fight. The stakes are high. The risks to patients are growing. The demands on physicians are unrelenting. The world around us is mired in uncertainty, misinformation and mistrust,” he added.
Eliminating busywork
The AMA has been very concerned with the physician burnout crisis, Ehrenfeld said. As part of an ongoing effort to address these concerns, the AMA recognized 72 hospitals and health systems through its Joy in Medicine program last year, which Ehrenfeld said highlights organizations who are reducing burnout in hopes other will adopt similar frameworks.
But, addressing the clerical burden associated with physician overwork ultimately means addressing concerns with prior authorizations to ensure practices take in the revenue they deserve.
“We all have horror stories to share about the overused prior authorization process that results in delay after delay until, too often, patients give up and abandon necessary testing and treatments altogether. We as physicians and the patients we serve deserve better,” Ehrenfeld said.
He added that AMA pressure helped push UnitedHealth Group and Cigna to each reduce the volume of their prior authorization requirements by at least 20 percent. He said there were also celebrations over the CMS final rule that simplified the prior authorization process for government-regulated health plans.
“These changes will save physician practices and our healthcare system an estimated $15 billion over the next 10 years, and never mind the countless hours and incalculable frustration of physicians and our patients. This simply would not have happened without AMA advocacy,” Ehrenfeld stressed.
Gaps in care from retail shutdowns
Ehrenfeld ended his speech with the sobering fact that some of the country’s largest chain stores and pharmacy retailers have decided to scale back, or end entirely, their experiments in healthcare by closing many of their walk-in clinics.
“Despite their stated goal of expanding healthcare access to patients with limited options, these corporations were unable to create a healthcare model that was financially viable. And now, their closures are creating gaps in care for thousands of patients who came to rely on them,” Ehrenfeld explained. “Think about that. These are some of the largest, for-profit companies in the world, and they can’t make today’s primary healthcare model sustainable. If they can’t make it work, how can we possibly expect physicians to?”
He said that is a challenge he will continue to prioritize as he leaves the presidency. He also posed some big questions to AMA members to ponder and for them to figure out solutions for the future.
“How can we make the practice of medicine sustainable? How can we ensure access to care? How can we continue to recruit and support the best and brightest into medicine? This is why we fight,” he concluded.
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: dfornell@innovatehealthcare.com