Value-Based Care, Medicare Advantage Become Talking Points at AMA

Value-based contracting was once again a topic of discussion at the ongoing AMA House of Delegates Interim Meeting being held this week in National Harbor, Maryland, the meeting that meets to help set policies for companies based in Washington, DC and Chicago. American Medical Association (AMA). A press release posted on the association’s website on November 13. and under the heading “Remove doctors from cost-sharing charges,” it explained what had happened: “As health insurers require patients to pay more of their health care bills, many doctors are reluctant to pay.” feel comfortable or are not adequately equipped to be the collection point for cost sharing between insurers and patients. In response, the AMA has established a new policy that supports removing doctors from the middle of cost-sharing between insurers and patients and requires insurers to collect deductibles, copayments, or coinsurance from patients. Delegates voted to adopt a policy directing the AMA to ‘support requiring health insurers to collect cost-sharing from patients and pay physicians the full amount allowed for health care services provided, to unless physicians choose not to collect such cost-sharing on their own.’”

The press release quoted Marilyn J. Heine, MD, a trustee of the AMA, who stated that “requiring physicians to participate in point-of-service cost-sharing collection negatively impacts many physicians. “Alternative cost-sharing collection methods that place liability on insurers can relieve private clinics, especially small and rural ones, from significant administrative burdens that divert financial resources and personnel from patient care.”

The press release went on to state that “The AMA Recovery Plan for America’s Physicians is working to eliminate unnecessary and costly burdens so doctors can focus on patients and keep practices open and sustainable.” And he noted that “the growth in the number of healthcare administrators (those with administrative roles such as medical director or director of health) has outpaced the growth in the number of clinical physicians. Conflicting goals, such as the ethical duties of physicians versus the financial obligations of administrators, have created tension and disconnection between the two groups. In response, delegates voted to adopt a policy directing the AMA to advocate for resistance against administrators’ encroachment on physicians’ medical decision-making.”

According to this, the press release quoted AMA Trustee David H. Aizuss, MD, as saying that “Large-scale employment of physicians has caused a change in the profession that has resulted in conflict. Physicians’ traditional autonomy in patient care is now influenced by pressures motivated by cost versus high-quality patient care.”

The press release stated on behalf of the AMA that “The primary concern regarding this change in the profession is that this new organizational and economic reality of medicine will ultimately harm patients, as physicians may feel pressured to make decisions based on cost rather than high quality. patient care, such as admitting emergency department patients who could be treated as outpatients or discharging patients from Medicare early.” “We must continue to oppose administrators’ encroachment on treating physicians’ medical decision-making that is not in the best interest of patients,” Aizuss said.

Medicare Advantage debated

Meanwhile, as MedPage todayCheryl Clark reported on November 13, a controversy broke out in the plenary session about the advantages of the Medicare Advantage program, in which more than 30.8 million seniors are enrolled. “One of the liveliest discussions involved a resolution that would mobilize doctors to fight the rapid privatization of Medicare through Medicare Advantage (MA) plans, which speakers criticized for not actually providing an ‘advantage’ over pay-for-pay. service, he said. reported.

Clark cited Daniel Choi, MD, a Garden City Park, N.Y., spine surgeon speaking on behalf of the Physicians in Private Practice section, who she said “was especially upset about MA plans, which now enroll to more than half of the 66 million Medicare beneficiaries. .” She reported that Choi said on the House of Delegates floor that “It’s a game…Every surgery is a prior authorization.”[orization] denial that results in a peer-to-peer call” and another denial. “And that patient’s surgery is delayed 3 to 6 months,” he noted. Choi said most of his MA patients tell him they are surprised. They say, ” I thought this was the best plan. That’s what my insurance agent told me.”

But, Clark noted, “Dr. Dirk Baumann, speaking on behalf of the California delegation, opposed the measure. MA plans are not only affordable, he said, but they incentivize better quality outcomes and, increasingly, there are no other options. ‘In the San Francisco Bay Area, where I practice, care is largely provided by large health care systems and PCPs [primary care physicians] within these systems they do not provide care to traditional Medicare patients, which makes it very difficult for patients with traditional Medicare plans to find care,’ he said.

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