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

Nov. 16, 2023
Value-based contracting and Medicare Advantage became major focuses of attention at the Interim Meeting of the AMA House of Delegates

Value-based contracting was once again a subject of discussion at the current Interim Meeting of the AMA House of Delegates being held this week in National Harbor, Maryland, the gathering that meets to help set policies for the Washington, D.C.- and Chicago-based American Medical Association (AMA). A press release posted to the association’s website on Nov. 13 and running under the headline “Removing physicians from cost-sharing collections,” explained what had happened: “As health insurers require patients to pay a larger share of health care bills, many physicians do not feel comfortable or adequately equipped to be the collection point for cost-sharing between insurers and patients. In response, the AMA has established new policy supporting the removal of physicians from the middle of cost-sharing between insurers and patients and require insurers to collect deductibles, copays or coinsurance from patients. Delegates voted to adopt policy instructing the AMA to ‘support requiring health insurers to collect patient cost-sharing and pay physicians their full allowable amount for health care services provided, unless physicians opt-out to collect such cost-sharing on their own.’”

The press release quoted AMA Trustee Marilyn J. Heine, M.D., as stating that “Requiring physicians to engage in the collection of cost-sharing at the point-of-service negatively impacts many physicians. Alternative methods of collecting cost-sharing that place the onus on insurers can relieve private practices, especially small and rural practices, of significant administrative burdens that divert financial resources and staff away from patient care.”

The press release went on to state that “The AMA’s Recovery Plan for America’s Physicians is working to remove unnecessary and costly burdens so physicians can focus on patients and keep practices open and sustainable.” And it noted that “Growth in the number of health care administrators—those with administrative roles such as Chief Medical Officer or Chief Health Officer—has outpaced 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 disconnect between the two groups. In response, delegates voted to adopt policy instructing the AMA to advocate for resistance against encroachment of administrators upon physician’s medical decision making.”

Per that, the press release quoted AMA Trustee David H. Aizuss, M.D., as saying that “The large-scale employment of physicians has brought about a change to the profession that has resulted in conflict. Traditional physician autonomy in patient care is now being influenced by pressures motivated by cost versus high quality patient care.”

The press release stated on behalf of the AMA that “The key concern regarding this change to 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 instead of high-quality patient care such as admitting patients from the emergency department who could be treated as outpatients or to discharge Medicare patients ahead of time.” “We must continue to oppose encroachment of administrators upon medical decision making of attending physicians that is not in the best interest of patients,” Aizuss said.

Medicare Advantage debated

Meanwhile, as MedPage Today’s Cheryl Clark reported on Nov. 13, controversy broke out on the floor over the merits of the Medicare Advantage program, in which more than 30.8 million seniors are enrolled. “One of the more animated discussions involved a resolution that would mobilize doctors to fight fast-moving privatization of Medicare through Medicare Advantage (MA) plans, which speakers criticized as not really providing an ‘advantage,’ over fee-for-service, she reported.

Clark quoted Daniel Choi, M.D., a spine surgeon from Garden City Park, New York who spoke on behalf of the Private Practice Physicians section, who she wrote “was especially upset about MA plans, which now enroll more than half of Medicare's 66 million beneficiaries.” She reported that Choi said on the floor of the House of Delegates that "It's a game ... Every single surgery is a prior auth[orization] denial resulting in a peer-to-peer call" and another denial. "And that patient's surgery gets 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 better plan. That's what my insurance agent told me."

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