AMA's new president talks COVID-19, supply chain issues and racial disparities in healthcare

Susan Bailey's asthma and allergies were so bad when she was a child, she jokes now her allergist practically raised her.

But growing up in the shadow of the Texas Medical Center in Houston, it was among critical seeds planted at an early age.

Many of her friends' fathers were physicians. "Back then, it was always the fathers," she said. And she idolized those doctors the way others might call sports stars their heroes. 

"I knew then this is what I was born to do," said Bailey, M.D., who recently became the president of the American Medical Association (AMA). She succeeds Patrice Harris, M.D., and is the third consecutive woman to hold the position. 

After three years of college, she headed to medical school at Texas A&M University where she attended her first AMA meeting. She completed a general pediatrics residency and then an allergy/immunology fellowship at Mayo Clinic. Then she returned to Texas and joined a small single-specialty practice of three allergists in 1988 in Fort Worth.

"It was all on the job training for me learning how to run a practice, how to bill, how to manage hiring and firing and logistics of a practice. That all has come just with having experience as the years have gone by," Bailey told Fierce Healthcare.

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Susan Bailey, M.D. (AMA)

More than 30 years later, she's still caring for patients in the same Fort Worth practice as she takes on the mantle of leadership of the largest physician organization in the country. 

She previously served as president of the Texas Medical Association and recently has served as vice speaker and speaker in the AMA's House of Delegates. 

Her biggest goal? 

"Let doctors be doctors," Bailey said. 

Here's a look at Fierce Healthcare's discussion with Bailey, edited for length and clarity, about her priorities for the AMA and expectations for what may lie ahead in the next year.

Fierce Healthcare: What are your priorities as you take on this role? 

Susan Bailey: My passion to let doctors be doctors and let them know the power of the AMA is with us on this journey to help us take care of our patients, stay safe ourselves, help prevent burnout and physician suicide and do everything we can do reduce the obstacles to patient care.

FH: How has the COVID-19 pandemic changed your plans coming into this role? 

SB: The president of the AMA is chief spokesperson for the organization, and I was hoping to work on regulatory burdens, prior authorization, dysfunctional medical records, physician payment issues, helping to improve and refine the quality payment program and working to preserve the Affordable Care Act. And when the pandemic began, it didn’t really change any of my goals and priorities. If anything, it made them more acute and more intense. The physicians need help in their practices now more than ever in very different ways. They need help just keeping their practices open or reopening them. They need help with resources such as protective equipment and supplies. They need trusted evidence-based information about the pandemic, and issues like telemedicine reimbursement have come to the fore. We’ve gained about 10 years of telemedicine experience in about 10 weeks. Some of the strategy may be changing, but the ultimate goals are not. We want to help physicians take care of their patients. 

FH: What has been your experience been with COVID-19 in your own practice? 

SB: Our practice has been impacted, obviously, logistically and financially. We stopped seeing patients face to face and starting doing telemedicine in mid-March as soon as the local shutdown orders began and completely reconfigured the layout of our office so patients can physically distance while they’re there. Of course, we’ve been scrambling for PPE, and we stopped doing some procedures such as pulmonary function testing because of the concern about patients aerosolizing droplets during the procedure. Financially, it has hit us hard. We never shut down completely, but our schedules have been dramatically less busy than would be typical this time of year.

But, medically, most of my patients have respiratory symptoms. They sneeze, they cough, they get short of breath. All which can be signs of coronavirus. We’ve had many patients calling from day one concerned about, "How do I know if this is allergies or if I have COVID-19?" And, initially, it was incredibly difficult to get these patients tested. For a while all we could do for patients was, if we had a strong index of suspicion, we just had them quarantine. Now the testing is much better, but helping our patients understand what’s allergy and when to be concerned and when to go to the hospital has been very important. 

RELATED: Making history: Patrice Harris is the first African American woman elected president of the AMA

SB: The recent issues during the pandemic with physicians who are employed by large health systems not being able to get the PPE that they need, being disciplined for wearing PPE in certain situations, being furloughed, being laid off, being disciplined just for doing what they thought was best for their patient, I think, highlights the importance of physician autonomy … AMA has been very aggressive about pushing for financial support for independent physicians in the pandemic through the various stimulus packages that were passed by Congress to make sure patients were supported to help keep their offices open and maintain the protections they need to provide care to the community. Many private practices are small businesses, and small businesses are the lifeblood of any community. An individual physician practice contributes an incredible amount to the economy of a community in terms of providing jobs, needed services to the community and being very much in touch with the community they are part of. I think our healthcare system would be much poorer without private practice. 

FH: What are your projections for the issues that will be top of mind this year in light of the fact it is an election year? 

SB: Surprise billing has not gone away, and AMA has stayed focused on this and tried to keep our message consistent because there have been some efforts to tack surprise billing legislation onto some of the coronavirus-related legislation … I think telemedicine is going to continue to be a major issue. 

One issue that I think is going to be significant going forward that we haven’t paid much attention to is the healthcare supply chain. Physicians offices in the future, as well as hospitals and larger systems, are going to have to completely rethink the way they deal with keeping their physicians and patients safe, having plenty of PPE on hand, and that’s going to be a totally new twist on things. I think there’s got to be more sources. We asked the administration at the beginning of the pandemic and recently asked Vice President Pence again for the need for federal assistance in obtaining PPE, especially for physicians that are not hospital related. 

FH: CMS has highlighted its "patients over paperwork" initiatives in the last couple of years. Where would you say we are in terms of addressing regulatory burdens? 

SB: I believe we have made some improvements with "patients over paperwork." The AMA worked with CMS to usher in the largest reforms in the E/M coding system in 25 years. I think those simplifications are going to help physicians tremendously in their practice. Not only will it be easier for them to take care of their patients, I think there will be less time spent justifying what they do and trying to meet the requirements of the coding system that is more about checking boxes than about the care actually given. So I’m very hopeful and optimistic about the changes in the E/M system.

The telemedicine efforts that the AMA has been working with CMS on for years before the pandemic began, I think, has come to fruition. I think the challenge now is to make sure things don’t go back to the way they were before once the national emergency ends. We have discovered the incredibly valuable role that telemedicine can play in patient care and we’ve got to maintain those gains while continuing to work on ‘What situation is best for telemedicine? What situation is best for a face to face visit?’ I think every specialty will likely come up with its own guidelines for the use of telemedicine. But I think the bottom line is, it’s here to stay and we need to make sure that physicians get adequately reimbursed for it.

FH: The AMA recently put out a statement saying the organization has to take more "action" to address racial inequities in light of the protests over police brutality in recent weeks. What does that look like to you? 

SB: I am strongly supportive of the statement the board of trustees issued last week on our pledge to fight racism in healthcare and the fact that AMA has been working on improving health equities for a number of years. We established the Center for Health Equity a couple of years ago and it’s headed up by Dr. [Aletha] Maybank whose been with AMA for more than a year to work to embed health equity in everything that we do. Without change, inequities will persist and Americans will suffer. If our goal is to make sure everyone in America is healthy, everyone needs everybody. And that means we need to fight systems and practices that allow inequities to exist and work to fight them in any way that we can.