NANOS and the AMA
As the NANOS delegate to the AMA, I just returned home after a week in Chicago at the first live AMA meeting in nearly 3 years. NANOS has membership in the SSS (Specialty and Service Society) which is the overarching organization for specialty and subspecialty groups. Through our membership, we have a vote in the House of Delegates which has over 650 members who meet twice annually to conduct the business of the AMA. As your delegate, I interface with AAO, AAN, SSS, and Cognitive Specialty Society as well as regional Societies. Zoom meetings and e-mail discussions start many weeks before the meeting to examine all of the resolutions and how they affect each stakeholder’s organization. My plans are to continue attending both the annual meeting in Chicago every June, and the interim meeting every fall that is usually on the West Coast in order to represent NANOS and our specific interests. I am hopeful that we will find an interested member commit for a much longer period of time because that is what it takes to really have a voice. Many of the people in the AMA have been doing it since med school and have developed a deep understanding of the organization as well as a strong network of other members.
What is the business of our AMA you ask, and how is it relevant to Neuro-Ophthalmology? Well let me tell you that I was very surprised when I attended my first AMA meeting in San Diego in November of 2019. I was asked to attend as it was geographically convenient. In the past, we have had members go to one or two meetings and did not have consistency, or individuals with experience serving in the AMA which is a colossal organization with over 250,000 members and 1800 employees. While I always thought that it was a conservative organization, that changed a number of years ago and it is now quite progressive socially. It is inclusive, sensitive to racial, ethnic, and sexual orientation issues, and is very active in social issues. In this past meeting, there were over 100 resolutions which included dealing with gun violence, women’s rights, underrepresentation of minorities in medical education, food insecurity, and coverage of routine eye examinations and glasses for Medicare covered patients.
More than anything else the AMA is an advocacy organization. It is a powerful advocate on key issues impacting physicians in patients at the federal and state levels. For 2022, they are highlighting 5 specific efforts.
1) Supporting telehealth flexibility for Medicare and private insurers: Telehealth may not be as important to Neuro-ophthalmologists as to other specialties, most of us did find a way to use telehealth in unique and efficient ways, especially when the patient follow-up did not have to include reexamination. We are all hopeful that we will continue to have the ability to use telehealth when appropriate.
2) Reforming the Medicare payment system: There is a goal to establish a rational Medicare physician payment system that is clinically relevant, less administratively burdensome, produces real opportunities for participation in new payment models, and provides stability and financial viability for physician practices. The AMA was instrumental in getting the Evaluation and Management coding changed as of 1/1/21, markedly reducing the check boxes and burdensome medical record keeping but rather concentrating on complexity which includes all of the pre-visit work, post visit work, record review, report generation, and interaction with other healthcare providers. This has allowed Neuro-ophthalmologists who often see extremely complex cases that require extensive record review, review of imaging and OCT, and consultation with other providers, to use 5 level billing codes and extended service codes as long as the complexity is well documented.
3) Reducing physician burnout: The AMA is pushing for legislative solutions to direct more funding and resources to support the mental health needs of physicians. They strongly influenced Congress to pass the Dr. Lorna Breen Health Care Provider Protection Act which dedicates such resources. They launched a national campaign to help states to enact confidentiality laws that protect physicians seeking help for burnout and to remove mental health related questions on physician licensure and renewal applications.
4) Fighting scope creep: The AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety. They have been working closely with state medical associations and specialty societies along with The Scope of Practice Partnership and has been successful in many states’ legislature. As Neuro-ophthalmologists we have witnessed changes in the scope of optometric practice, and they continue to fight to increase their scope of practice in many states.
5) Fixing prior authorization: Prior authorization programs used by insurers to control health care costs are overused, burdensome, and presents significant administrative and clinical concerns. The AMA tirelessly advocates to improve this process which has resulted in prior authorization reform in multiple states including Georgia, Michigan, and Iowa and pending legislation in a dozen more states. They are also advocating for a bill before Congress requiring Medicare Advantage plans to implement key prior authorization reforms. I know this is an issue for every practice as it increases our work burden, stress, and contributes to burnout.
While the aforementioned 5 key issues are at the forefront of their efforts, other important priorities include dealing with Covid 19, surprise billing, access to care, and the drug overdose epidemic.
The AMA has been losing paying members although the organization continues to grow because as they offer reduced membership cost to young physicians, those and training, and those who are retired. They are the only strong voice for American medicine and have representation from academic medicine, private practice, and employed physicians. I will admit it in the past I was skeptical about what the AMA does. However, now that I am involved, I have been truly impressed with all of the hard work that is done by 100s of member physicians as well as the AMA staff. I am very pleased that NANOS has had adequate numbers of the AMA to sustain our membership in the SSS and therefore the AMA House of Delegates where we have a voice and a vote. However, we are really on the edge of qualifying based on the number of dues paying members of the organization and I would appeal to our members to strongly consider joining the AMA. While there is a highly discounted cost for those that are early in practice, for most of us the cost is $420 year and includes a subscription to JAMA.
If there are any of those out there who are interested in getting involved in organized medicine and specifically the AMA, this can be accomplished through your special organization, subspecialty organization, or through your state medical Association. I would be more than happy to respond to any questions, concerns, or help to get you involved. If anybody has questions, please feel free to email me at email@example.com.
Ben Frishberg, MD
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