Physicians are facing several challenges, including burnout, prior authorization, and unreliable Medicare payment, AMA president says.
The American Medical Association has announced the AMA Recovery Plan for America's Physicians to address pressing challenges facing the country's physicians.
Before the coronavirus pandemic, physician burnout was a national concern, and the pandemic has driven physician burnout to crisis proportions. The Association of American Medical Colleges projects there will be a shortage of physicians between 37,800 and 124,000 clinicians by 2034.
In comments before the AMA House of Delegates, AMA President Gerald Harmon, MD, said the need for action is urgent. "America's doctors are a precious, and irreplaceable, resource. Physician shortages, already projected to be severe before COVID, have almost become a public health emergency. If we aren't successful with this Recovery Plan, it'll be even more challenging to bring talented young people into medicine and fill that expected shortage."
The Recovery Plan has five key elements:
- Supporting telehealth services including insurance coverage
- Reforming the way Medicare pays for physician services
- Stopping "scope creep" that expands the scope of practice of non-physicians such as nurse practitioners
- Reforming prior authorization of medical services to reduce administrative burden on physician practices and to avoid care delays for patients
- Tackling physician burnout and reducing stigma around physician mental health
The pandemic spurred unprecedented growth in telehealth, with 90% of physicians shifting to telehealth to provide patient care, and a continuation of telehealth services is in the best interest of physicians and patients, Harmon said.
"[The Centers for Medicare & Medicaid Services] made changes to ensure that telehealth payment rates were equivalent to in-person services including audio-only visits—meaning a telephone call! And then a funny thing happened: doctors and patients discovered that this wasn't such a bad idea in many circumstances. It's safe, convenient, and certainly for patients, less time consuming than a visit to the office. In my rural community, patients have substantial geographic barriers like rivers, swamps, and islands that contribute to long travel delays. Digital health is a godsend to these patients," he said.
Telehealth gains achieved during the pandemic must be preserved, Harmon said. "We know the vast majority of patients and physicians want this type of care to continue after the declared Public Health Emergency is over. Telehealth is here to stay, and we are fighting to update our laws and regulations to reflect that fact."
Reforming Medicare physician payment
Medicare reimbursement for physician services has been inadequate for years, and annual uncertainty about Medicare physician payment is crippling for physician practices, he said.
"Medicare physician payments are the only component of healthcare delivery subject to budget neutrality and have fallen 20%, adjusted for inflation, since 2001—an average of about 1% a year. As a result of various legislative and regulatory provisions implemented prior to and during the COVID pandemic, we were threatened with a 10% cut in Medicare payments this past January. Thanks to the pressure of the AMA and others in organized medicine, Congress acted at the last minute to avert the cuts. This was a major victory. But we should not have to suffer this annual cliffhanger. We need a permanent solution to end the annual battles that threaten the economic survival of physician practices."
The need for payment reform is undeniable, Harmon said. "We must be able to predict financial returns with some reliability in order to invest in costly infrastructure like new technologies and treatments. In short—we're done with short-term patches and looming cuts."
Stopping 'scope creep'
Physicians are better equipped to play leading roles in care teams than other clinicians, he said.
"Quality, affordable healthcare is only possible with teamwork. We rely on nurses, physician assistants, and office workers to do the invaluable work they are trained to do. My practice, for example, has a superb team of staff delivering this team-based care. We currently have physicians, [advanced practice registered nurses], physician assistants, licensed social workers, dedicated office staff, and others under one roof. But patients need to trust that a physician is leading their care and leading the team. We have years' more education, and thousands of hours' more clinical training than other members of the team, and are better prepared to treat complex cases and complications."
Reforming prior authorization
Prior authorization for medical services by payers places an unnecessary administrative burden on physician practices and is bad for patients, Harmon said.
"In a recent AMA survey, 93 percent of physicians reported that hurdles imposed by prior authorization for medication, tests, and procedures resulted in care delays for their patients. Four out of five doctors said these processes have led patients to abandon their treatment! Can you believe it? And navigating these hurdles is also a burden for physicians and staff, who must spend valuable patient care time doing this. I have personally done this more times than I can count, to ensure that my patients get the care they need. Four years ago, the AMA developed a Consensus Statement on Improving the Prior Authorization Process together with other national organizations representing health plans and providers. Unfortunately, since then, insurers have done precious little to implement agreed-upon improvements."
Physician burnout and mental health stigma
Physician well-being needs to be a top priority, he said.
"The final element of our Recovery Plan—and potentially the most important—is to develop a health system that retains existing physicians, attracts new physicians, and reduces burnout. For over a decade, the AMA has worked to remove administrative barriers like prior authorization to care that can lead to burnout. But we know solutions must go even further. We must find ways for physicians to address their mental health needs without fear of negative repercussions, and to practice their skills without threats of hostility or violence. This March, we took a great step forward with the passage of the Dr. Lorna Breen Health Care Provider Protection Act. This new law—named after a young physician who took her own life early in the pandemic—will direct more funding and resources to support the mental health needs of physicians."
Reducing mental health care stigma for physicians is essential, Harmon said. "The AMA is working at the state and national levels to reform outdated language on medical licensing applications and employment and credentialing applications that may be stigmatizing. We are also supporting legislation to create confidential physician wellness programs so that physicians and medical students will have somewhere to go when they need help."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Physician burnout has reached crisis proportions during the coronavirus pandemic.
Physician shortages "have almost become a public health emergency," AMA president says.
The expansion of telehealth during the coronavirus pandemic has been a good development in healthcare and should be sustained, AMA president says.