The denial of Medicare reimbursement and ongoing prior authorization problems for physicians were among the familiar themes raised by American Medical Association (AMA) President Bruce Scott, MD, during Friday’s opening session evening of the interim meeting of the AMA House of Delegates in Orlando, Florida.

Scott, an otolaryngologist in Louisville, Kentuckydescribed one of her AMA-related travel experiences at a small regional airport, where the same woman processed the return of her rental car, checked it in for her flight, screened it at security security and loaded his luggage onto the plane. He said another passenger joked, “If she flies the plane, I drive.”

“This story is emblematic of today’s health care, as fewer and fewer doctors are asked to do more,” Scott said. The challenges facing doctors “are amplified in these rural areas where patients today face a shortage of 20,000 primary care doctors, where 80% of counties do not have a specialist for care and where 1,100 counties are without a single obstetrician.”

He cited statistics suggesting that one in five doctors hope to leave their practice in the next two years, one in three plan to reduce their work hours and 40% of medical students are unsure whether they will want a job. day embark on clinical practice. “It’s not just statistics; it’s our colleagues, our brothers and sisters in this profession,” Scott said.

A frustration for doctors is a daunting financial reality, he continued. “We all know about the 29% cut in Medicare payments to doctors since 2001. And now it’s official – CMS offers another 2.8% reduction for 2025, while estimating that our spending on providing care will increase by 3.5%. This is simply unsustainable and is pushing medical practices to the brink of financial ruin. » And where Medicare rates go, so do Medicaid and private insurance rates; both types of payers tie their rates to those of Medicare, Scott pointed out.

“It puts us in an impossible position: either turn away patients, or reduce your hours, or close your doors completely,” he said. “And in each of these scenarios, it is our patients who suffer, especially our nation’s elderly and disabled people.”

To solve the problem, Medicare should end cuts like this and instead give doctors a payment increase each year based on the medical inflation rate, Scott said. He noted that last week, some members of Congress introduced the Patient Access and Medicare Practice Sustainability Actwhich would do just that.

“Now Congress must prioritize this legislation in the lame duck session,” he said. “Make no mistake, this is going to be an uphill battle. But I believe that with a unified voice of doctors across the country, from every state and specialty, we can make this happen.”

Delays and denials of prior authorization are another major problem for doctors and patients, Scott said. “We all know that denials of prior authorization are rarely – if ever – based on science or evidence. When I call to appeal a denial with a so-called peer, I’m often not talking to someone who has been to medical school. It’s almost never an otolaryngologist — hell, a lot of times they don’t even know how to pronounce otolaryngology.

But thanks in part to the AMA’s lobbying efforts, “we have more than two dozen prior authorization reform bills passed in states since 2023,” he said. “And when we couldn’t resolve this issue in Congress, we went directly to CMS. And our advocacy was instrumental in the adoption of a 2024 CMS final rule for regulated health plans by the government to reduce prior authorization times and improve transparency and for payers, to go beyond fax machines.

Even Congress is finally hearing the AMA’s message, Scott said, adding that the Law improving rapid access to care for the elderly was reintroduced this year. The bill would establish an electronic prior authorization process for Medicare Advantage plans and require the Department of Health and Human Services, as well as other agencies, to report to Congress on their efforts to improve the prior authorization process. electronic prior authorization. “We urge Congress to pass this bill, and to do it now.”

Scott also briefly discussed the association’s efforts to thwart attempts to expand the scope of practice in state legislatures. “Simply put, patients deserve to be cared for by a doctor,” he said. “And patients agree: 95% of them say they want a doctor to be involved in their diagnosis and treatment.”

The data shows “non-physician providers are using more resources, overprescribing antibiotics and opioids, and ordering unnecessary diagnostic tests and imaging,” Scott said. “And when you put it all together, patients who don’t have a physician involved in their care have poorer health outcomes and higher overall health care costs.”

The AMA’s lobbying in conjunction with state medical societies has “won significant victories to protect patients, defeating more than 80 bills this year, including those that would have eliminated physician supervision for nurse practitioners , would have allowed optometrists to perform eye operations and would have authorized naturopaths to prescribe medications,” he said. “The only way to fight these battles (…) is to form a united front. And let me be clear: WADA will not back down.”

As the nation emerges from a polarizing election, “it is even more important that we find common ground on these issues that we know harm our patients, our fellow physicians, and our practices.” he concluded. “Our AMA works with Democrats and Republicans to fix the flaws in our health care system and improve public health, which means advocating for meaningful solutions no matter who is in power. Rest assured that we will always remain faithful to our mission.”