This year will mark the 175th anniversary of the American Medical Association (AMA). From the organization’s publication of the first American Medical Dictionary in 1906 to its declaration of war against smoking in 1972, it’s hard to overstate the scope of influence that the AMA has had in establishing standards of medical care, educating the public, and shaping national policy in matters of health. As a body that supports and advocates for the medical profession, the AMA’s achievements have included the founding of The Journal of the American Medical Association (JAMA), the Council on Medical Education and Hospitals, the AMA Education and Research Foundation, and the Current Procedural Terminology system.
Explore This IssueJanuary 2022
Today, the AMA continues to serve the medical community as a representative and advocate, with initiatives and programs designed to address the many operational, strategic, ethical, and financial challenges physicians encounter on a day-to-day basis. “The AMA has prioritized giving physicians and their practices the tools they need when and where they need them,” said AMA president Gerald E. Harmon, MD. “Throughout the COVID-19 pandemic, we’ve engaged with physicians in new ways, showcasing that we’re more nimble and focused. We’ve built video and podcast series to highlight science and data key to understanding and defeating COVID-19, and we’ve created showcased resources to help practices navigate changes in telehealth.”
How do the activities of the AMA directly affect the practice of otolaryngology? As an otolaryngologist and chair of the AMA Board of Trustees, Bobby Mukkamala, MD, has a unique understanding of the ways in which his specialty’s colleagues can benefit from the organization’s work. “The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the AMA are like the left and right hands of the same body, working together for the good of otolaryngologists,” he explained. “There are some issues that otolaryngologists need the help of the AMA to get solved. Efforts will be better informed and refined when worked on WITH the knowledge and power of the AMA, and vice versa.”
Through ongoing advocacy work, new and existing programs and initiatives, and its ever-growing array of tools and resources, the AMA may have never been as relevant or necessary to otolaryngologists as it is today.
Advocating for Reform
The challenges to practicing medicine in 2022 are numerous and complicated. The AMA advocates for physicians, particularly on issues related to patient care—specifically, existing obstacles to providing optimal care. “Advocacy is one of the most important services that our AMA provides, yet it often goes unnoticed by physicians,” noted Shannon Pryor, MD, an otolaryngologist whose practice is focused on clinic-based otology. “For example, as the physician workforce transitions to a predominance of employed physicians, the AMA has worked to preserve the diversity of practice options available—to make sure that private practice sustainability is preserved.”
Based in the Washington, D.C., area, Dr. Pryor has been active in the organization for more than 30 years, having served as first chair of the AMA Women Physicians Section and, more recently, as chair of the AMA Council on Long Range Planning and Development and in the AMA House of Delegates (HOD) as well as president of MedChi, the Maryland State Medical Society.
Jordan Warchol, MD, MPH, an emergency medicine physician, health policy specialist, and assistant professor in the department of emergency medicine at the University of Nebraska Medical Center, currently serves in the AMA HOD as a member of the Nebraska Medical Association delegation. “The House of Delegates is the policy-making body at the center of medicine, and it represents us all,” she said. “By bringing together physicians, medical students, and residents representing every state and medical field, the HOD works democratically to create a national physician consensus on issues in public health, science, ethics, business, and government. These policies guide our advocacy at every level.”
At the patient care level, otolaryngologists have been positively impacted by specific actions, such as those of the AMA’s opioid task force, noted by Dr. Pryor. “The policy stemming from that work has substantially benefited otolaryngologists in helping to advocate for best practices for postoperative pain relief,” she said, and added that she benefited directly from the AMA’s advocacy on the development of the new evaluation and management (E/M) codes. “A large percentage of my patients have vertigo or tinnitus. Their visits tend to be long on counseling and short on procedures. The new time-based E/M coding option has improved my ability to capture more appropriate compensation for those visits,” Dr. Pryor explained.
A short list of the AMA’s recent national advocacy efforts on behalf of all physicians includes:
Scope of Practice Partnership (SOPP). In a recent video in the AMA’s Moving Medicine video series (see “Member Programs and Initiatives,” below), Michaela Sternstein, JD, vice president of the AMA’s Advocacy Resource Center, discussed the organization’s 30-plus-year commitment to safeguarding physicians’ scope of practice. Acknowledging the vital role that non-physician healthcare providers play, most notably during the COVID-19 pandemic, she also stressed the importance of preventing the unsafe expansion of these roles outside of an emergency.
Enter the SOPP. “The AMA and its SOPP, which includes partnerships with 105 national, state, and specialty medical associations, has awarded more than $2.6 million in grants to its members to fund advocacy tools and campaigns,” reported Dr. Mukkamala, adding that the AAO-HNS recently joined the SOPP. “Every otolaryngologist I know will be pleased to know the AMA is devoted to opposing inappropriate scope expansions by non-physicians.”
Prior authorization reform. According to AMA survey data, nearly one in three physicians report that prior authorization requirements for certain drugs, tests, and treatments have led to serious adverse events for a patient in their care. “The AMA is leading a national coalition to reform prior authorization—a common pain point among physicians—so we can streamline the archaic prior authorization process and better care for our patients,” said Dr. Mukkamala. “The fact that every otolaryngologist has 1.7 full-time employees working on prior authorization needs to change. We could be much more useful to our patients when we are talking to them about their health and pre- and postop care instead of wasting hours a day on the phone to insurance companies trying to get permission to deliver that care.”
Dr. Mukkamala notes that major reforms based on the AMA’s prior authorization model bill were enacted in Illinois and Georgia in 2021, and that broad reform legislation is pending in several additional states. “We’re working closely with medical societies to provide legislative language, data, and other resources,” he said.
Out-of-network billing action. In a December 2021 article, USA Today reported that nearly one in five hospital visits results in patients receiving an unexpectedly large bill because the doctors or other providers involved in their care weren’t part of their insurer’s network. “The AMA has been working on a solution to the out-of-network billing (aka surprise billing) issue,” said Dr. Mukkamala. “After satisfactory Congressional action, now the executive branch has proposed an interim final rule that we feel is a step backwards from what we worked hard to get passed in Congress. We are actively trying to fix this proposal.”
The federal No Surprises Act was altered by regulators to include an arbitration system that, says USA Today, “starts with benchmark rates already negotiated by health insurers.” On December 9, the AMA, American Hospital Association, and individual hospitals and doctors sued the federal government to stop those added arbitration rules. In the article, Dr. Harmon stated, “Our legal challenge urges regulators to ensure there is a fair and meaningful process to resolve disputes between health care providers and insurance companies.” (See “Legal Matters” for the January 2022 issue to learn more about the arbitration rules.)
Backing the Coronavirus Aid, Relief and Economic Security (CARES) Act. The AMA was among the physician organizations that sought Congressional help to ease the financial burden and damage suffered by medical practices as a result of the pandemic. The $2 trillion CARES bill, signed into law in March 2020, has provided broad support to physicians, health practices, and even medical students. As a force behind this bill and subsequent emergency supplemental legislation, the AMA worked to secure billions of dollars to ensure that physicians would have access to desperately needed funding in Medicare advance payments, loans, and other financial assistance.
The policy stemming from that work has substantially benefited otolaryngologists in helping to advocate for best practices for postoperative pain relief. —Shannon Pryor, MD
The CARES Act also provided expanded telehealth coverage, which the AMA fought to make permanent. “We created and advocated for policy shifts in telehealth, provided tools and guides for practices, defined the medical ethics, and ensured that you could be reimbursed for remote care,” said Dr. Mukkamala. Changes to federal policy now allow for telehealth payments that are equivalent to those of in-person services.
Resources, Tools, and Benefits
As the COVID-19 pandemic presented new challenges across medicine, the AMA responded by broadening its scope of support to include more to-the-minute data and ways in which to access it. “We have defended science, facts, and evidence, and refocused our resources and expertise to keep physicians more informed, while combatting misinformation that’s damaging to public trust and public health,” said Dr. Mukkamala.
Among the resources that the AMA has created and curated are:
COVID-19 Resources. In 2020, in response to the unique circumstances of the COVID-19 pandemic, the AMA launched a series of support tools and resources to help physicians navigate the crisis. Unique articles, podcasts, and videocasts, based on the original AMA Code of Medical Ethics, provide ethical crisis-time guidelines, while a nationwide resource guide directs physicians to communities in need of additional support. Additional information and resources are available in the AMA’s online COVID Resource Center.
Ed Hub & STEPS Forward. Launched in 2019, the AMA Ed Hub is an online education center designed to centralize its many educational resources for students, residents, and physicians. Among its components are JAMA Network’s JN Learning and STEPS Forward, a series of webinar-based learning modules. “I’ve used quite a few of the STEPS Forward modules to improve my efficiency and quality of care,” reported Dr. Pryor. “The telemedicine playbook was a critical resource for me in the early months of the COVID-19 pandemic. More recently, I’ve used the sharing notes playbook to better understand how the transparency of clinical notes will affect documentation and the Saving Time playbook and Pre-Visit Planning module on Ed Hub to look at how my clinics and electronic health record use can be more efficient. The Health Coaching module changed the way in which I talk to patients about tobacco cessation and compliance in general.”
As a medical educator, Dr. Warchol credits Ed Hub with better preparing her students and residents to care for patients and themselves and, ultimately, producing a more effective workforce. “The AMA’s efforts into improving medical education have been instrumental in achieving ongoing, transformative changes to both undergraduate and graduate curricula,” she said. “We are not only attracting and matriculating a more diverse workforce that better represents the patients we serve, but also are preparing our trainees to embody the new role of a physician who looks beyond the acute problem of the patient in front of them to tackle the systems of care in which we operate.”
Moving Medicine. This ongoing video/podcast series of educational presentations, discussions, and interviews amplifies physicians’ voices and keeps users up to date on emerging issues and the latest discoveries and innovations in medicine. Some recently highlighted topics included scope of practice and patient safety, new Medicare payment legislation, and physician well-being.
Additional resources and benefits for otolaryngologists who become AMA members include access to JAMA Otolaryngology–Head and Neck Surgery, AMA Morning Rounds (a daily news roundup), and numerous discounts related to practice overhead, technology, home security, auto, customized insurance, and personal wellness. “I enjoyed a little perk last year when AMA partnered with a meditation app to offer a free membership for AMA members,” said Dr. Pryor. “My oldest daughter and I listened to the meditations together whenever we found a few free minutes.”
According to Dr. Mukkamala, some of the best benefits of AMA membership involve the ability to connect with other physicians, and to “add your voice to advocacy initiatives that protect patients and preserve physician oversight.”
Representing physicians in the House of Delegates, it has become clear to me that when more physicians with diverse viewpoints are involved in creating AMA policies, those policies are stronger. —Jordan Warchol, MD, MPH
Power in Numbers
“As a member of the AMA Board of Trustees, my goal has been to add a more prominent physician voice to the table of discussions that are often dominated by payers, pharma, lawmakers, and others,” said Dr. Mukkamala. That voice, backed by more than 250,000 dues-paying members, represents a group of individuals with very diverse points of view. “Representing physicians in the House of Delegates, it has become clear to me that when more physicians with diverse viewpoints are involved in creating AMA policies, those policies are stronger,” said Dr. Warchol. “Having worked on Capitol Hill, I have seen firsthand the strength of the AMA’s voice.”
Her fellow HOD member, Dr. Pryor, agreed. “As physicians, we can’t practice medicine in a vacuum. The environment in which we practice has a huge impact on the quality of care we provide and how fulfilled we are as physicians. Yet as individuals working alone, we can’t affect that environment much, if at all,” she pointed out. “Some physicians don’t agree with AMA policies or don’t believe that AMA represents them—but this isn’t your mother’s AMA. Through the organization’s policy-making process, there are ample opportunities for one voice to be heard, and to make a difference.”
“The AMA has achieved 10 consecutive years of membership growth, and the largest year-over-year,” said Dr. Harmon. Perhaps that’s because the time for coming together has never seemed more urgent. As Dr. Warchol noted, “At a moment like this—in the middle of a pandemic where so many of us have been on the front lines for so long—our ability to speak in a united voice and lead calls for change has never been more important.”
Linda Kossoff is a freelance medical writer based in Woodland Hills, Calif.