They say awareness is the first step to creating change and it appears that an issue the AMA has been fighting for relentlessly—a permanent fix to the Medicare payment system—is being acknowledged at the highest levels.

This year, the Medicare Payment Advisory Commission (MedPAC) and Medicare’s trustees warned about the problems that the nation’s older adults and patients with disabilities will have in accessing care if the gap between what Medicare pays physicians and what it actually costs physicians to provide quality patient care is left unaddressed.

The 2024 Medicare trustees report says: “The trustees expect access to Medicare participating physicians to become a significant issue in the long-term.”

The AMA has been sounding the alarm bell for years, warning that high-quality physician care in the Medicare program is jeopardized by a system that has resulted in payment rates that, when adjusted for inflation, have fallen by 29% over the past 20 years. Physicians face another 2.8% cut in pay under the proposed 2025 Medicare physician payment schedule.

Lawmakers, too, are realizing something needs to be done and they’re talking. Beyond conversations, leaders that can facilitate change in key Senate and House committees—have held a hearing and released a white paper on reforming the Medicare Access and CHIP Reauthorization Act (MACRA). Meanwhile, a bipartisan group of 233 members of the House of Representatives has written to leadership demanding inclusion of a positive 2025 payment update for physicians in the year-end omnibus.

The topic has garnered headlines in the mainstream media this year, including in a Seattle Times headline that proclaimed “Medicare is putting the care of our aging population at risk.”

As we enter the final months of the year, the AMA continues to urge Congress to enact legislation that provides:

• An annual, permanent inflationary payment update in Medicare tied to the Medicare Economic Index. The bipartisan Strengthening Medicare for Physicians and Patients Act (H.R. 2474) has already been introduced in the House of Representatives.

• Budget-neutrality reforms. A bipartisan group of senators earlier this year introduced the Physician Fee Stabilization Act. The AMA said it was a good first step, but believes the bill could go further and in a letter told lawmakers that the physician organization strongly supports H.R. 6371, the Provider Reimbursement Stability Act of 2023.

• An overhaul of the Merit-based Incentive Payment System (MIPS), whose reporting requirements are burdensome and often appear to be clinically irrelevant. The AMA has developed a statutory proposal to replace the MIPS tournament model of payment adjustments with a more sustainable approach tied to annual payment updates, give the Centers for Medicare & Medicaid Services incentives to share data with physicians, and improve the measures.

• Modifications to alternative payment models (APMs). The Value in Health Care Act, with bills introduced in both the House and Senate (S. 3503/H.R.5013), would restore the APM incentive payments to 5% for two years and establish a 50% revenue threshold that physicians in value-based care models must meet to qualify for the bonuses over the same time frame.

Following AMA advocacy, a bipartisan group in the U.S. House of Representatives in October introduced a bill that would provide a 4.7% payment update in 2025. The measure would eliminate the 2.8% Medicare physician payment cut slated for Jan. 1 and provide a positive payment update that is equal to one half of the Medicare Economic Index.

The AMA is leading the charge to reform the Medicare payment system, which is the AMA’s top advocacy priority. Learn more and get involved with the AMA’s Fix Medicare Now website.

Read on and dive deeper in the “AMA Advocacy Impact Report 2024” (PDF), to discover how the AMA has also pushed for changes this year to:

• Fix prior authorization.
• Fight scope creep.
• Reduce physician burnout.
• Make technology work for physicians.

Fixing prior authorization

The AMA’s most recent annual survey on prior authorization (PDF) showed there are many improvements that can be made to this insurance tactic that delays needed care for patient and buries physicians and their staffs in paperwork and phone calls.

AMA advocacy and its grassroots campaign has led to federal and state changes this year, including:

The Centers for Medicare & Medicaid Services released final regulations that include prior authorization reforms designed to cut patient care delays and electronically streamline the process for physicians.

A bipartisan group of lawmakers in each the House and Senate introduced in June an updated version of the Improving Seniors’ Timely Access to Care Act (H.R. 8702 and S. 4532).

Nearly a dozen states passed laws to reduce care delays and wasted time that prior authorization requirements cause.

Patients, doctors and employers can learn more about reform efforts and share their personal experiences with prior authorization at FixPriorAuth.org.

Fighting scope creep

To ensure patients have the safest and best outcomes, physicians need to be leading health care teams. Physicians have 20 times more clinical training that nurse practitioners, for example, resulting in safer, quality care for patients.

In 2024, the AMA has worked with state medical associations to oppose inappropriate scope expansions in more than 40 states. More than 80 bills to inappropriately expand nonphysicians’ scope of practice have been defeated. Among them were measures that would have allowed optometrists to perform surgery, nurse anesthetists to provide anesthesia without physician supervision and physician assistants and nurse practitioners to independently practice medicine.

Reducing physician burnout

To support medical student, resident and physician health and well-being (PDF), the AMA is working closely with state medical boards, hospitals and health systems to review language in licensing and credentialing applications that physicians must fill out to help ensure the documents do not include intrusive mental health questions and stigmatizing language. The AMA is also working with the Dr. Lorna Breen Heroes’ Foundation.

As of September 2024, the campaign and partnerships have led to 34 licensure boards, including 29 medical boards, and more than 370 hospitals and health systems verifying their licensing or credentialing applications are free of intrusive, stigmatizing language.

As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.

Making technology work for physicians

Physician voices are needed to help create and refine technology in medicine so that it is an asset to them in their practice, not a burden. To help make that happen, the AMA this year, among other things has:

• Advocated at all levels of government and across the payer community to find solutions to the Change Healthcare cyberattack that would allow practices to maintain financial stability.
• Urged Congress to take steps to strengthen cybersecurity and health care systems’ resilience.
• Advocated regulatory and legislative actions to support the appropriate development and deployment of health care AI.
• Advanced federal policies that increased interoperability and will improve prior authorization processes, reducing physicians’ EHR workflow burdens.

From Medicare payment reform to reducing physician burnout, fixing prior authorization to defending against scope creep, the AMA is fighting for you so that you can stay focused on your patients. Hear more from our AMA members.