How Medicare Advantage plans wrongly deny prior auth requests

Momentum to fix prior authorization is building in the wake of a Department of Health and Human Services Office of Inspector General report showing that Medicare Advantage plans delayed and denied patients’ access to medically necessary treatment. They also denied payments to physicians and other health professionals for services that met both coverage and billing rules.

My latest for the AMA. The whole shebang.

Why leaked abortion opinion is “antithetical to public health”

In light of a leaked draft Supreme Court opinion that would overturn the abortion rights protected by Roe v. Wade and other precedents, the AMA is profoundly worried about the impact on reproductive health in the United States if the high court ultimately rules in that fashion.

The AMA is “deeply concerned by the contents and implications of the draft Supreme Court opinion for the Dobbs vs. Jackson Women’s Health Organization case that became public this week,” said AMA President Gerald E. Harmon, MD.

“This opinion would lead to government interference in the patient-physician relationship, dangerous intrusion into the practice of medicine and potentially criminalizing care,” added Dr. Harmon, a family physician in South Carolina.

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7 turning points when the AMA met the moment in medicine

Since its founding in 1847, the AMA has been the physician’s powerful ally in patient care and an unrivaled force that promotes the art and science of medicine and the betterment of public health.

From its pioneering work to protect the public from potentially dangerous treatments, to championing the safety and efficacy of vaccines, to advocating for seat belts to be standard in all American automobiles, the AMA has often been at the forefront of sweeping movements to improve the health of our nation.

To comprehensively detail the AMA’s impact is far beyond the scope of this article, but a selective approach can be revelatory as the organization celebrates its 175th anniversary on May 7. A timeline of key dates in AMA history is one place to start, and you can learn more below about seven other critical junctures—one for roughly every 25 years in the organization’s history—when the AMA rose to meet the moment in medicine.

My latest for the AMA. The whole shebang.

Wisconsin’s Gov. Evers vetoes APRN independent-practice bill

Wisconsin Gov. Tony Evers has vetoed a bill that would have granted advanced practice registered nurses the legal ability to practice independently. The governor’s action was supported by the AMA and the Wisconsin Medical Society.

Senate Bill 394 would have removed physician supervision or collaboration requirements for nurse practitioners, nurse anesthetists and clinical nurse specialists after 3,840 clinical care hours in their respective APRN role with a physician or dentist. For nurse midwives, another type of APRN, the legislation would have removed the collaboration requirement altogether.

My latest for the AMA. The whole shebang.

Becerra sees need to end Medicare physician pay “cliffs”

In a positive sign in the long-term project of overhauling the Medicare physician payment system to make it more sustainable for doctors and the nation, Health and Human Services Secretary Xavier Becerra said he is “definitely interested” in examining the feasibility of such reform.

“I’m definitely interested, because I remember those ‘cliffs’ when I was in Congress,” Becerra said in a briefing with a group of health reporters, as quoted in MedPage Today, in reference to his days as a congressman and the annual ritual of voting to avert mandated Medicare physician pay cuts.

“We always had to deal with those, and you’d never want professionals … thinking that there’s another profession for them down the line because they’re just not making ends meet where they are,” Becerra said. “So we’d like to be supportive.”

My latest for the AMA. The whole shebang.

How doctors can use No Surprises Act to resolve billing disputes

The AMA has assembled a toolkit to help physicians navigate the new independent-dispute resolution process under the No Surprises Act.

The new federal law, which took effect in January of this year, bars surprise billing for emergency care and some nonemergency care at in-network facilities. The law and implementing regulations have established a process to determine payment for physicians, health care organizations and others that includes the IDR process.

My latest for the AMA. The whole shebang.

Cardiovascular disease epidemiologist named JAMA’s new top editor

Kirsten Bibbins-Domingo, MD, PhD, MAS, still recalls the excitement she felt early in her career upon learning that her study had been accepted for publication in JAMA.

For the prospective cohort study about NT-proBNP testing and cardiovascular disease events, she remembers “the editor in charge of the paper at the time demanding quite a number of additional analyses and revisions, many more than the reviewers had actually asked for and—finally—saying to us, ‘It’s really important we get things right. Because when JAMA publishes something, it affects clinical practice.’”

Now Dr. Bibbins-Domingo, who has had dozens of articles published in JAMA Network journals and well over 300 altogether, will feel that special obligation on the other side of the desk in medical journalism. Starting July 1, the general internist, cardiovascular disease epidemiologist and national leader in the fields of disease prevention and health equity will become the editor-in-chief of JAMA and JAMA Network.

With each succeeding JAMA Network publication, Dr. Bibbins-Domingo has “seen firsthand how practice or policy has shifted as a result, not just because of the scientific finding, but because of its publication under the trusted name that JAMA represents,” she said during a news briefing this week. “It’s truly very special and I’m thrilled to now be part of it.”

My latest for the AMA. The whole shebang.

With BA.2 in view, no time to skimp on COVID-19 funding

When Congress passed the massive $1.5 trillion spending bill earlier this month that assured telehealth flexibilities for the bulk of 2022, the lawmakers left out nearly $16 billion in COVID-19 relief funds that had been included in an earlier version of the omnibus bill.

Now the AMA is warning that, while COVID-19 hospitalizations and deaths are trending downward and pandemic restrictions have been loosened, more congressional funding is needed to help ensure such progress is sustained.

My latest for the AMA. The whole shebang.

Doctors see inequity daily. Fellowship helps them dig deeper.

Physicians have until March 14 to apply to be part of just the second cohort of fellows for the Medical Justice in Advocacy Fellowship. The collaborative initiative is empowering physician-led advocacy to advance health equity and remove barriers to achieve optimal health for all.

Two of the 12 doctors selected from 300-plus applicants for the inaugural fellowship cohort took time to share their perspectives on what they have learned and why other doctors who want to eliminate health inequities should apply to take part in this education initiative from the AMA and the Satcher Health Leadership Institute at the Morehouse School of Medicine.

My latest for the AMA. The whole shebang.

Let EPA curb greenhouse gases to protect public health

The U.S. Supreme Court should affirm the authority of the Environmental Protection Agency to regulate the greenhouse gas emissions that cause climate change and have been proven to inflict major health problems, argues a friend-of-the-court brief filed by the AMA, the American Thoracic Society and more than 15 other leading medical organizations and dozens of U.S. public health leaders.

My latest for the AMA. The whole shebang.

Dig deep on health care issues that matter with 10 top Q&As

In a year that started with the promise of safe and effective COVID-19 vaccines and is ending with concerns about the rise of yet another SARS-CoV-2 variant that could exacerbate the pandemic of the unvaccinated, physicians’ mettle has been tested like never before.

Many of the doctors who are fighting COVID-19, promoting vaccination, advancing health equity, working to end the drug-overdose epidemic, and battling burnout have taken time from their busy schedules this year to explore how they are moving medicine forward in exclusive, in-depth Q&A-format interviews with the AMA.

Read my latest article for the AMA to explore 10 of these Q&A interviews.