Dr. Harmon: The US must renew its commitment to physicians

Since the last time the AMA House of Delegates gathered in person in 2019, there have been stimulus checks, the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the American Rescue Plan Act of 2021, along with several other COVID-19 related relief efforts sent from Washington.

Now the AMA has developed its own plan to help physicians and their practices recover from the hardships of the pandemic.

“It’s physicians who are rising to this moment—day after day,” AMA President Gerald E. Harmon, MD, said in his address at the opening session of the 2022 AMA Annual Meeting. (Read Dr. Harmon’s speech.)

“It’s physicians our nation turns to—for answers, for treatment, for help,” said Dr. Harmon, a family physician in South Carolina. “You’ve taken care of our nation—at great personal sacrifice—and it’s time our nation renews its commitment to you.

“We need a Recovery Plan for America’s physicians, and the AMA is ready,” he added.

Dr. Harmon detailed how, under the plan, the AMA is:

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When physician offices shut down and care considers nonurgent was postponed, patients still needed management of their chronic conditions and treatment for acute needs. Dr. Harmon recalled how physicians stepped up, with 90% offering some modality of telehealth care.

“Then a funny thing happened: Doctors and patients discovered that this ain’t such a bad idea in many circumstances,” Dr. Harmon said. “Telehealth is here to stay, and we are fighting to update our laws and regulations to reflect that fact.”

Dr. Harmon then noted how the AMA pressured Congress to pass legislation that staved off nearly 10% in Medicare payment cuts for physicians.

“This was a major victory, but we shouldn’t have to suffer this annual cliffhanger,” Dr. Harmon declared.

Because Medicare physician payments are the only component of health care delivery subject to budget-neutrality requirements, these payments have fallen 20% since 2001, an average—when adjusted for inflation—of about 1% a year.

“We need a permanent solution to end the annual battles that threaten the economic survival of physician,” Dr. Harmon said.

The AMA laid groundwork to address this by developing principles for reform that were included in “Characteristics of a Rational Medicare Physician Payment System” (PDF) and agreed to by 120 state medical and national specialty societies.

“We must be able to predict financial returns with some reliability in order to invest in costly infrastructure like new technologies and treatments, Dr. Harmon said. “In short, we’re done with short-term patches and looming cuts.”

The next element of the plan involves stopping unsafe scope-of-practice expansions for nonphysician health professionals.

Dr. Harmon noted that for his and other physician practices, these professionals are invaluable in the effort to deliver help deliver quality team-based care. But patients want these teams to be led by physicians.

“Patients need to trust that a physician is leading their care, and leading the team,” Dr. Harmon explained. “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.”

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Removing dangerous delays from the prior authorization process is an important element of the plan. Dr. Harmon noted that, four years ago, the AMA and other national organizations representing health plans and clinicians developed a “Consensus Statement on Improving the Prior Authorization Process” (PDF).

“Unfortunately, since then, insurers have done precious little to implement agreed-upon improvements,” he said. “It’s time to hold them accountable.”

The final part of the plan is to reduce physician burnout and bolster physician mental health. To this end, the AMA supported passage of the “Dr. Lorna Breen Health Care Provider Protection Act,” which is named after a physician who died by suicide early in the pandemic.

“Shortly before her death, Dr. Breen was concerned and anxious that the stigma of reaching out for help would permanently damage her career,” Dr. Harmon said. “Friends, if we’re honest, some of us might have had felt the same way sometimes.”

Dr. Harmon described the plan as ambitious but doable, and said it is what’s needed to put the medical profession on solid ground to prepare for the next health crisis.

In special remarks given prior to his opening address, Dr. Harmon described gun violence as a “plague” and the AMA House of Delegates paused for a moment of silence for its victims.

“Almost every day in this country, we bear witness to the shocking brutality of weapons of war being unleashed on society: On elementary school students, on movie theatergoers, on grocery-store shoppers, on people in houses of worship—ons and health care workers in hospitals and clinics,” Dr. Harmon said.

“This cannot be the new normal. Gun violence is out of control. Enough is enough,” he said, to delegate applause.

The AMA recently renewed its call for gun-violence prevention in the wake of the targeted killings of physicians in Tulsa, Oklahoma. Also read Dr. Harmon’s statement in response to the school shooting in Uvalde, Texas.

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