Physicians know all too well about the headaches and heartaches associated with prior authorization in medicine today. Here’s a handy glossary—or perhaps a devil’s dictionary—to help guide you through the folly, with pointers to how the AMA is standing up to insurance companies to eliminate care delays, patient harm and practice hassles.

Also new for the AMA. The whole shebang.

Through various actions at the 2023 AMA Interim Meeting, the House of Delegates has made it unmistakably clear that the unsustainable Medicare payment system poses a dire threat to patients’ access to high-quality physician care across the nation. In addition to this year’s 2% cut in Medicare physician pay, doctors face a further 3.37% cut set to take effect in January. After adjusting for inflation, physician pay actually fell by 26% since 2001.

“Physicians heed the idea of ‘first do not harm,’” said AMA President Jesse M. Ehrenfeld, MD, MPH. “Yet the payment system year after year inflicts harm on the ability of physician practices to stay afloat. We also are aware of the First Law of Holes. When you find yourself in one, stop digging. We are in a veritable crater. Cutting payments is only taking us deeper.”

My latest for the AMA. Read the whole shebang, and catch up on the other highlights from the Interim Meeting in National Harbor, Maryland.

Nearly 700 physicians and medical students are gathering this week just a few miles away from Capitol Hill for the 2023 AMA Interim Meeting, where they will consider proposals across a wide range of clinical practice, payment, medical education and public health topics.

But there is one issue that is clearly at the top of agenda for the AMA House of Delegates: The need to stop the 3.37% Medicare physician pay cut set for 2024 and enact broader Medicare reforms to ensure that the 65 million Americans who rely on it have continued access to high-quality physician care.

My latest for the AMA. The whole shebang.

A coalition of physician members of Congress has introduced a discussion draft of legislation to reform the budget-neutrality policies applied to the Medicare physician payment schedule.

This legislative proposal, largely based on work that emerged from the AMA Medicare Reform Workgroup, offers practical policy improvements that provide some needed stability to the physician payment system by assuring that the Centers for Medicare & Medicaid Services’ payment policy is based on reality—not projections.

My latest for the AMA. The whole shebang.

The country’s No. 1 health insurer, UnitedHealthcare, and another insurance giant—Cigna Healthcare—recently announced tentative steps to reduce the volume of care-delaying, time-wasting prior authorizations they require.

Starting this month, several UnitedHealthcare plans will start eliminating the prior authorization requirement for many procedure codes that the insurer says account for nearly 20% of its overall prior authorization volume. The company also said that next year it will implement a “gold card” program allowing those who qualify to follow a “simple administrative notification process for most procedure codes” instead of prior authorization. Cigna, meanwhile, said it is removing nearly 25% of medical services from prior authorization requirements.

The insurers’ efforts “begin to reduce the overwhelming volume of prior authorization requirements that are threatening patients’ health and wasting valuable health care resources,” said AMA Immediate Past President Jack Resneck, MD.

My latest for the AMA. The whole shebang.

Bipartisan legislation called the “GOLD CARD Act” to give physicians relief from the time-wasting burden of prior authorization has been introduced in this session of Congress.

H.R. 4968, the Getting Over Lengthy Delays in Care as Required by Doctors Act of 2023, would exempt physicians from Medicare Advantage plan prior authorization requirements so long as 90% of the physicians’ prior authorization requests were approved in the preceding 12 months. Medicare Advantage plan-issued gold cards would be applicable only to items and services—and exclude drugs—and remain in effect for at least a year. The legislation is based on a similar law enacted in Texas that took effect in 2021.

My latest for the AMA. The whole shebang.

The powerful House Ways and Means Committee has advanced provisions that would help bring badly needed reforms to the prior-authorization process within Medicare Advantage.

The provisions passed last week hew closely to the Improving Seniors’ Timely Access to Care Act. That bipartisan legislation was introduced by Reps. Suzan DelBene, D-Wash., Mike Kelly, R-Pa., Ami Bera, MD, D-Calif., and Larry Bucshon, MD, R-Ind. The bill’s provisions are strongly supported by the AMA, which played a major role in securing enough cosponsors to ensure it passed the House of Representatives (PDF) last September. The legislation, however, stalled in the Senate due to a flawed $16 billion cost estimate from the Congressional Budget Office.

My latest for the AMA. The whole shebang.

A bipartisan majority from both chambers of Congress is pressing the Centers for Medicare & Medicaid Services (CMS) to finalize a pending federal regulation that would overhaul prior-authorization requirements within Medicare Advantage.

“We urge CMS to promptly finalize and implement these changes to increase transparency and improve the prior-authorization process for patients, providers and health plans,” wrote the lawmakers. “We are pleased that these proposed rules align with the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, which proposes a balanced approach to prior authorization in the [Medicare Advantage] program that would remove barriers to patients’ timely access to care and allow providers to spend more time treating patients and less time on paperwork.”

My latest for the AMA. The whole shebang.

As part of its campaign to fix the unsustainable Medicare physician payment system, the AMA is outlining in a quick, easily navigable fashion why doctors’ Medicare payments must be tied to an inflation index called the Medicare Economic Index.

My latest for the AMA. The whole shebang.

The U.S. Supreme Court has issued a decision to restrict public and private higher-education institutions from considering an applicant’s race or ethnicity in admission decisions. The court’s action effectively overturns nearly five decades of precedent allowing for limited use of affirmative action in college admissions. The Supreme Court’s six conservative justices carried the majority in two separate cases involving race-conscious admissions at Harvard University and the University of North Carolina.

The decision “undermines decades of progress centered on the educational value of diversity and will reverse gains made in the battle against health inequities,” said AMA President Jesse M. Ehrenfeld, MD, MPH, who is a senior associate dean, tenured professor of anesthesiology and director of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin.

The AMA and more than 40 other organizations joined an Association of American Medical Colleges-led amicus brief that urged the high court to “take no action that would disrupt the admissions processes the nation’s health-professional schools have carefully crafted in reliance on this court’s longstanding precedents.”

Dr. Ehrenfeld said the ruling “restricts medical schools from considering race and ethnicity among the multiple factors in admissions policies and will translate into a less diverse physician workforce.”

My latest for the AMA. The whole shebang.

More than 900 health care facilities took active part in the most recent edition of the Human Rights Campaign’s “Healthcare Equality Index,” the country’s foremost benchmarking survey of health care organizations’ policies and practices dedicated to the equitable treatment and inclusion of their LGBTQ+ patients, visitors and employees. …

Nearly 500 facilities earned the Human Rights Campaign’s “LGBTQ+ Healthcare Equality Leader” designation, receiving the maximum score in each section and earning an overall score of 100.

Among them are these members of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

My latest for the AMA. The whole shebang.

A bipartisan group of 60 senators has reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act. The CONNECT for Health Act, S. 2016, will expand coverage of telehealth services through Medicare, make permanent COVID-19 telehealth flexibilities, improve health outcomes, and make it easier for patients to connect with their doctors.

My latest for the AMA. The whole shebang.

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 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. It’s essential that leaders in Washington work with the physician community on immediate, preventative measures, as well as long-term solutions that will reform the payment model once and for all.

“This cannot wait; we are past the breaking point,” said AMA President Jack Resneck Jr., MD. “Congress must urgently address physician concerns about Medicare to account for inflation and the post-pandemic economic reality facing practices nationwide.”

My latest for the AMA. Read the whole shebang, as reported from the 2023 AMA Annual Meeting this week in Chicago.

Also check out my other coverage of the meeting:

• Highlights from the 2023 AMA Annual Meeting
• ICYMI: 10 stories to read from the 2023 AMA Annual Meeting