The country’s largest physician organization is taking a strong stance against noncompete contracts for physicians and is redoubling efforts to urge Congress to boost Medicare payments.
At its annual meeting in Chicago this week, the American Medical Association’s (AMA's) House of Delegates adopted a new policy that declared Medicare physician payment reform an "urgent advocacy and legislative priority" for the organization.
The AMA will prioritize significant increases in funding for federal and state advocacy budgets specifically allocated to achieve Medicare physician payment reform. These efforts aim to ensure that physician payments are updated annually at least equal to the annual percentage increase in the Medicare Economic Index, according to the policy AMA delegates adopted this week.
"This cannot wait; we are past the breaking point,” said the AMA's immediate past president Jack Resneck Jr., M.D., in a press release. “Congress must urgently address physician concerns about Medicare to account for inflation and the post-pandemic economic reality facing practices nationwide.
"Our patients are counting on us to deliver the message that access to health care is jeopardized by Medicare’s payment system. Being mad isn’t enough. We will develop a campaign—targeted and grassroots—that will drive home our message,” Resneck said.
In the face of inflation, the COVID pandemic and growing costs of running a medical practice, physicians have struggled to keep open their doors, according to the organization. Physicians also saw a 2% payment reduction for 2023. The AMA contends that physicians are one of the only Medicare providers without an inflationary payment update.
When adjusted for inflation, Medicare physician payment has effectively declined 26% from 2001 to 2023. The AMA argues that these increasingly thin or negative operating margins disproportionately affect small, independent and rural physician practices as well as those treating low-income or other historically minoritized or marginalized patient communities.
“We are deeply worried that many practices will be forced to stop taking new Medicare patients—at a time when access to care is already inadequate,” Resneck said. “Physicians have diagnosed the problem and are offering solutions, but obviously the body politic must respond.”
The House of Delegates also modified existing policy to “implement a comprehensive advocacy campaign, including a sustained national media strategy engaging patients and physicians in promoting Medicare physician payment reform."
During the annual meeting, Jesse Ehrenfeld, M.D., an anesthesiologist from Wisconsin, was sworn in as the 178th president of the AMA. At his inauguration, Ehrenfeld, the first openly gay person to lead the organization, spoke about health inequities and injustices, saying “the AMA has made tremendous strides in recent years to recognize past wrongs, to take a stand against discriminatory practices in medicine, to stand on the side of justice and equity, and to partner with allies who are committed to advancing the rights of all patients to receive equitable care.”
The AMA’s House of Delegates is the policymaking body comprised of physicians, residents and medical students representing every state and medical specialty.
Here are the other top issues the AMA House of Delegates took action on this week.
Noncompete clauses
The House of Delegates took action to ban noncompete contracts for physicians in clinical practice who are employed by for-profit or nonprofit hospitals, hospital systems or staffing company employers.
The delegates adopted policies to oppose the use of restrictive covenants not-to-compete as a contingency of employment for any physician-in-training, regardless of the Accreditation Council for Graduate Medical Education accreditation status of the residency or fellowship training program.
The use of noncompete agreements has been extensive in the healthcare system, affecting up to 45% of primary care physicians.
The Federal Trade Commission recently proposed a ban on noncompete agreements, though it would not cover nonprofit hospitals, which comprise 57% of all hospitals, many of which are large employers.
“Allowing physicians to work for multiple hospitals can enhance the availability of specialist coverage in a community, improving patient access to care and reducing health care disparities,” said AMA Board of Trustees member Ilse Levin, D.O.
The House of Delegates also called for a study of current physician employment contract terms and trends with recommendations to address balancing legitimate business interests of physician employers while also protecting physician employment mobility and advancement, competition and patient access to care.
The use of AI in healthcare
AMA delegates are calling for greater regulatory oversight of insurers’ use of artificial intelligence in reviewing patient claims and prior authorization requests.
The newly adopted policy calls for health insurers utilizing AI technology to implement a thorough and fair process that is based on clinical criteria and includes reviews by physicians and other healthcare professionals with expertise for the service under review and no incentive to deny care, AMA said.
A ProPublica investigation revealed that over a period of two months in 2022, Cigna doctors denied more than 300,000 claims as part of a review process that used artificial intelligence, with Cigna doctors spending an average of 1.2 seconds on each case. The new AMA policy calls for insurers to require a human examination of patient records prior to a care denial.
"The use of AI in prior authorization can be a positive step toward reducing the use of valuable practice resources to conduct these manual, time-consuming processes. But AI is not a silver bullet,” said AMA board member Marilyn Heine, M.D. “As health insurance companies increasingly rely on AI as a more economical way to conduct prior authorization reviews, the sheer volume of prior authorization requirements continues to be a massive burden for physicians and creates significant barriers to care for patients. The bottom line remains the same: We must reduce the number of things that are subject to prior authorization.”
With AI innovation occurring at a rapid pace, delegates also agreed to develop principles and recommendations on the benefits and unforeseen consequences of relying on AI-generated medical advice and content that may or may not be validated, accurate or appropriate.
The physician organization also plans to work with the federal government and others to protect patients from false or misleading AI-generated medical advice. The AMA is encouraging physicians to educate patients about the benefits and risks of patients engaging with AI.
“AI holds the promise of transforming medicine. We don’t want to be chasing technology. Rather, as scientists, we want to use our expertise to structure guidelines, and guardrails to prevent unintended consequences, such as baking in bias and widening disparities, dissemination of incorrect medical advice, or spread of misinformation or disinformation,” said AMA trustee Alexander Ding, M.D. “We’re trying to look around the corner for our patients to understand the promise and limitations of AI. There is a lot of uncertainty about the direction and regulatory framework for this use of AI that has found its way into the day-to-day practice of medicine.”
New policies on firearm violence
The AMA adopted new policies to address firearm violence. Delegates agreed to advocate for federal and state policies that prevent inheriting, gifting or transferring ownership of firearms without adhering to all federal and state requirements for background checks, waiting periods and licensure requirements.
The organization also will advocate for federal and state policies to prevent the sale of multiple firearms to the same purchaser within five business days and to implement background checks for ammunition purchases.
“As mass shootings in the U.S. continue at an alarming rate, it is critical that we further strengthen policies aimed at preventing firearm violence. No individual should be able to purchase an arsenal of firearms in a short period of time or buy ammunition without a background check.” Resneck said. “We will continue to advocate for laws and policies that reduce the risk of firearm violence and keep our communities safe.”
AMA also wants to see medical professionals included among the list of people who are able to petition the court to temporarily remove firearms from high-risk individuals through due process. Currently, more than 20 states have enacted extreme risk protection order (ERPO) laws that allow law enforcement, family or household members, and/or intimate partners to ask a court to prevent someone at imminent risk of harm to themselves or others from purchasing or possessing firearms when there is a high or imminent risk for violence.
“Physicians are encouraged to ask patients at risk of firearm injury about access to firearms during routine patient visits. Allowing physicians to petition the courts when they encounter a patient at risk of firearm violence is necessary and could help prevent further firearm-related tragedies,” said Resneck.
The policy builds on AMA policy adopted in 2022 which called for the AMA to develop a toolkit to improve physician use of ERPOs.
The physician organization also is calling on all social media sites to" vigorously and aggressively" remove posts that contain videos, photographs and written online comments encouraging and glorifying the use of firearms.
Body mass index as a clinical measure
As the healthcare industry and others increasingly recognize obesity as a chronic disease, the AMA adopted a new policy that aims to clarify how body mass index (BMI) can be used as a measure in medicine.
Under the newly adopted policy, the AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations.
Due to significant limitations associated with the widespread use of BMI in clinical settings, the AMA suggests that it be used in conjunction with other valid measures of risk such as, but not limited to, measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic/metabolic factors.
Other major policy decisions
AMA delegates signed a new policy urging medical school and undergraduate admissions committees to proactively implement policies and procedures that support race-conscious admission practices. The policy emphasizes the AMA’s unequivocal opposition to legislation that would dissolve affirmative action or punish institutions for employing race-conscious admissions. Several states that have instituted bans on affirmative action have experienced subsequent decreases in college enrollment and completion of STEM degrees by underrepresented students.
They also voted to adopt guidelines addressing systemic discrimination in medicine including the use of stigmatizing language and policies and practices that are an obstacle to equitable care. According to the newly adopted guidelines, physicians should cultivate self-awareness and strategies for change, recognize and avoid using language that stigmatizes or demeans patients in face-to-face interactions and entries in the medical record and use social history to capture information about nonmedical factors that affect a patient’s health status and access to care.
The AMA will encourage states and communities to adopt legislative and regulatory policies that allow safe and effective overdose reversal medications to be readily accessible to staff, teachers and students in educational settings to prevent opioid overdose deaths,