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Highlights from the 2023 AMA Annual Meeting

by Kevin B. O'Reilly

Medicare physician pay system a top priority for the AMA

The AMA has been on the road fighting for Medicare physician payment reform for well over a decade, and the system remains on an unsustainable path. Temporary patches and ongoing cuts to the Medicare physician payment system have left physician practices and patient access to care at serious risk.

Payment cuts, freezes and redistributions have further exacerbated the challenge. When adjusted for inflation, Medicare physician payment has effectively declined (PDF) 26% from 2001 to 2023.

Despite that stark reality, Congress and the administration are still not focused on fixing the root of the problem—the payment system itself. But it’s time for that to change.

“This cannot wait; we are past the breaking point,” said AMA President Jack Resneck Jr., MD. “Our patients are counting on us to deliver the message that access to health care is jeopardized by Medicare’s payment system. Being mad isn’t enough. We will develop a campaign—targeted and grassroots—that will drive home our message.”

Oversight needed on payers’ use of AI in prior authorization

As health insurance companies turn to AI to speed up patient claim and prior-authorization decisions, the AMA will advocate for greater regulatory oversight of the practice.

"The use of AI in prior authorization can be a positive step toward reducing the use of valuable practice resources to conduct these manual, time-consuming processes. But AI is not a silver bullet,” said AMA Trustee Marilyn Heine, MD.

“As health insurance companies increasingly rely on AI as a more economical way to conduct prior-authorization reviews, the sheer volume of prior-authorization requirements continues to be a massive burden for physicians and creates significant barriers to care for patients,” added Dr. Heine. “The bottom line remains the same: We must reduce the number of things that are subject to prior authorization.”

Train doctors on extreme risk protection orders

Extreme Risk Protection Order (ERPO) laws vary by state, but are generally risk-based, temporary and preemptive protective orders that authorize the removal of firearms from individuals at high or imminent risk for violence against themselves or others. People who can petition for an ERPO vary by state and not all jurisdictions include physicians.

ERPO laws “reduced gun-related suicide rates by 13.7% in Connecticut since 2007 and 7.5% in Indiana in the 10 years that followed enactment,” according to an AMA Medical Student Section resolution introduced at the Annual Meeting.

Petitioning for an ERPO can be complicated and time-consuming for clinicians, and the AMA is already at work to develop a toolkit on how to use ERPO laws. Delegates directed the AMA to work with relevant parties to “update medical curricula and physician training regarding how to approach conversations with patients and families and to use about Extreme Risk Protection Orders.”

The House of Delegates also modified existing policy to support the establishment of “laws and procedures through which physicians and other medical professionals can, in partnership with appropriate parties, contribute to the inception and development of such petitions.”

This expands on the existing list of petitioners noted in AMA policy, which included family members, intimate partners, household members and law-enforcement personnel.

“Physicians are encouraged to ask patients at risk of firearm injury about access to firearms during routine patient visits. Allowing physicians to petition the courts when they encounter a patient at risk of firearm violence is necessary and could help prevent further firearm-related tragedies,” said AMA Immediate Past President Jack Resneck Jr., MD.

AMA will educate doctors, public on how loneliness affects health

Social isolation and loneliness have been recognized as significant public health concerns, adversely affecting mental well-being as well as quality of life.

To address this growing public health problem, delegates adopted new policy to “encourage research to assess how forming networks earlier in life helps to reduce loneliness and social isolation for adults, with a special focus on marginalized populations and communities with limited access to resources.” They also directed the AMA to develop educational programs for patients and physicians on the topic.

Meanwhile, the AMA also will work to address alarming rates of suicide, depression and other mental health problems among kids.

“A large proportion of our children are not only facing mental health disorders but aren’t receiving treatment. We are in a crisis situation with children’s mental health, and we must come together as a nation to do everything possible to prioritize children’s mental, emotional and behavioral health and ensure they have access to the care they need,” said AMA Immediate Past President Jack Resneck, Jr., MD.

AMA: Use of BMI alone is an imperfect clinical measure

Body mass index (BMI) is easy to measure and inexpensive. It also has standardized cutoff points for overweight and obesity and is strongly correlated with body fat levels as measured by the most accurate methods. But BMI is an imperfect measure because it does not directly assess body fat.

For adults, measuring BMI and waist circumference may be a better way to predict weight-related risk. But for children, there is no good reference data for waist circumference, which makes BMI-for-age the gold standard.

“There are numerous concerns with the way BMI has been used to measure body fat and diagnose obesity, yet some physicians find it to be a helpful measure in certain scenarios,” said AMA Immediate Past President Jack Resneck, Jr. MD. “It is important for physicians to understand the benefits and limitations of using BMI in clinical settings to determine the best care for their patients.”