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American Medical Association Archives - Neurosurgery Blog

Cross-Post: Physician Pay Cuts Are Another Threat to Independent Practices

By Cross Post, Health Reform, MedicareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in The Hill on Nov. 13, 2021. In the op-ed titled “Physician pay cuts are another threat to independent practices,” Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., discusses how the 9% Medicare physician pay cuts for medical services starting Jan. 1, 2022, will have enormous consequences for the entire health care system.

According to Dr. Menger, “Medicare physician pay has increased only 11 percent from 2001-2020. Meanwhile, the cost of running a medical practice increased 39 percent from 2001-2020.  Adjusting for inflation and the cost of running a practice, Medicare physician pay dropped 22 percent over the time period.” He continued, “Medicare payment to hospitals increased nearly 60 percent over the same time period.”

Medicare physician pay cuts place external pressure on physicians and drives them into more hospital-employed practices. Hospitals are merging and consolidating around regional health care markets on an astounding basis. Dr. Menger noted that a collection of the country’s leading surgical societies, the Alliance of Specialty Medicine and the Surgical Care Coalition, recognize this downward pressure as impossible to maintain.

Click here to read the full article in The Hill.

Editor’s Note: We encourage everyone to join the conversation online by following @Neurosurgery, @SpecialtyDocs and @SurgeonsCare and using the hashtag #Neurosurgery.

Prior Authorization Burdens March On, Even During COVID-19

By COVID-19, Guest Post, Prior AuthorizationNo Comments

For much of 2020, as COVID-19 case surges threatened to overwhelm the U.S. health system, physicians faced onerous, business-as-usual insurer policies on top of a public health emergency.

In December, as the Centers for Disease Control and Prevention (CDC) data showed daily new COVID-19 cases reaching the once unthinkable total of 200,000, the American Medical Association (AMA) surveyed practicing physicians to measure the impact of health plans’ prior authorization (PA) requirements on patient care and practice burdens. The results were grim: surveyed physicians reported completing an average of 40 PAs during the previous week of practice, and this weekly PA workload for a single physician consumed 16 hours — the equivalent of two business days — of physician and staff time.

The fact that these significant administrative burdens taxed our practices during an unprecedented public health crisis is extremely disturbing. While many health insurers modified their PA policies during the pandemic’s early stages, nearly 70% of surveyed physicians reported that PA requirements were relaxed only temporarily or not at all, illustrating the limited reach of health plans’ policy adjustments.

PA Hurts Patients

Beyond these practice hassles, the AMA survey also captured the harmful effect of PA on patients and their health. An overwhelming majority (94%) of physicians reported that PA can delay access to medically necessary care. These delays represent far more than just the inconvenience of waiting for treatment, as physicians linked PA to adverse effects on care delivery and outcomes:

  • 79% reported that PA can lead to treatment abandonment;
  • 90% stated that PA can result in negative clinical outcomes; and
  • 30% indicated that PA has led to a serious adverse event for a patient in their care, with 21% reporting that PA has led to a patient’s hospitalization.

These alarming data show the very real human costs of PA and raise serious questions about health plans’ claims that PA ensures appropriate, safe care and reduces costs. How can a process that so frequently leads to serious adverse events and patient hospitalizations reduce overall health care costs?

PA Burdens Are Growing

Despite the solid evidence that PA negatively impacts patients and physician practices, health plans continue to ramp up their utilization management programs. Health plans agreed over three years ago in the Consensus Statement on Improving the Prior Authorization Process — which was signed by America’s Health Insurance Plans and Blue Cross Blue Shield Association — to reduce the overall volume of PAs, yet they continue to introduce additional requirements. In the AMA survey, a strong majority of physicians reported that the number of PAs required for prescription medications and medical services has increased over the last five years. Even Medicare, which traditionally has not imposed PA, is now in the PA business: the 2020 Medicare Outpatient Prospective Payment System (OPPS) rule established PA requirements for five services that have cosmetic uses in addition to therapeutic indications, which burdens my specialty of plastic surgery. The 2021 OPPS rule hit close to home for readers of this blog, as it added PA to two neurosurgical service categories — cervical fusion with disc removal and implanted spinal neurostimulators. The AMA, the American Association of Neurological Surgeons, the Congress of Neurological Surgeons and numerous other concerned stakeholders recently sent a letter to the acting administrator of the Centers for Medicare & Medicaid Services urging a delay in implementing these new requirements.

Take Action

We see the growing harm that PA inflicts both on our profession and our patients with every passing year. It is time we step up and demand change. The AMA Advocacy Group has been active in Washington, urging Congress to support the reintroduction of the Improving Seniors’ Timely Access to Care Act (H.R. 3107 and S. 5044 in the 116th Congress). If passed, Medicare Advantage plans would be required to make many of the critical PA reforms outlined in the previously mentioned Consensus Statement, such as improving transparency and streamlining the process. All of you can play a role here in contacting your representatives to do the same. Since the problem is broader than just Medicare Advantage, the AMA is currently investigating further legislative moves to address insurance companies’ onerous PA policies.

The AMA has developed model legislation for use at the state level. We urge you to also work with your state medical association to support state PA legislation — you can join grassroots efforts to draw more attention to this critical issue. Visit FixPriorAuth.org to share your PA horror stories, watch videos of other physicians and patients telling how PA harms care delivery, engage on social media and sign a petition pushing for change.

Please also share this information with your patients — this is their problem, too. It is going to take all of us to FixPriorAuth, and legislators are more likely to respond to issues about which their constituents complain.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @AmerMedicalAssn, using the hashtag #FixPriorAuth.

Russell Kridel, MD, FACS
Chair, AMA Board of Trustees

Burnout Among Physicians: A System Issue

By BurnoutNo Comments

The prevalence of physician distress has been well documented in recent years, and data suggests that 44% of U.S. physicians experience symptoms of burnout.

A recent study titled, “Resilience and Burnout Among Physicians and the General US Working Population,” published in JAMA Network Open — a journal of the American Medical Association (AMA) — evaluated resilience among physicians and how it compared with resilience among other U.S. workers. The study also measured burnout symptoms to analyze the association between resilience and burnout among physicians.

Researchers surveyed 5,445 U.S. physicians and 5,198 U.S. workers. Results revealed significantly higher mean resilience scores among physicians than the general working population. The findings suggest that, although maintaining and strengthening resilience is important, physicians overall do not have a deficit in resilience.

Even among the most resilient physicians, burnout rates were substantial, and 29% of physicians with the highest possible resilience score still experienced burnout. This study demonstrates that solutions such as including efforts to address system issues in the clinical care environment are needed to reduce burnout and promote physician well-being.

To read the full JAMA Network Open article, click here.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.

Reflecting on COVID19, the Death of George Floyd and the Need for Change

By COVID-19, Equity, Social JusticeNo Comments

“I want to touch the world.”
George Perry Floyd, Jr.

We are living in trying and turbulent times in our country. A global pandemic has claimed the lives of more than 100,000 people across America and has threatened to overwhelm our health care systems in some of the worst affected areas. On top of this health crisis, we are now facing the greatest civil unrest our country has experienced in over 50 years in response to a recent series of tragic deaths of black men and women — the cataclysmic event being the deplorable death of George P. Floyd, Jr. while in police custody.

While we look to our politicians for the political answers that will heal the strife in our country, we are all struggling with our personal feelings and response to these events. It has been extremely heartening, however, to see the expression and renewed commitment to inclusion and diversity, particularly within the medical community.

As voices cry out across the world underscoring the systemic problems of racism and inequality, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have joined the chorus speaking out against all forms of discrimination and acts of violence — particularly that which is driven by intolerance and hatred. We reaffirm our commitment to inclusion and diversity. We reflect on the past and the messages of Dr. Martin Luther King, Jr. and Robert F. Kennedy. And we listen to our Black and Brown colleagues who provide a uniquely pertinent perspective on these issues, and we are thankful for their leadership and willingness to speak out.

We hope our readers will be inspired by the words of our colleagues from across the medical profession, which are reposted below in this piece. Millions around the world were horrified in disbelief at the killing of an unarmed man in police custody. As individuals and together as a society, we owe it to George Floyd and countless others to not let his death be in vain and to work to seek lasting change to stamp out racism, inequality and violence. We encourage you all to engage your patients, your colleagues and your communities in discussions as to how we can help heal our country and care for all who need us, including our most vulnerable.

In addition to the above message from the AANS and CNS, neurosurgeons and neurosurgical organizations spoke out.

A group of Black neurosurgeons who came together to publish an OpEd pointed out that as neuroscientists and surgeons, they see firsthand the effects of neurotrauma on those subjected to violence at especially alarming rates in the Black community. From the debilitating effects of blunt and penetrating trauma to the brain and spine to the “intangible neuropsychological effects stemming from fearing for one’s life on a daily basis,” there “is a slow but inevitable erosion of the state of health amongst Black people… This has culminated in a public health crisis shortening not only the lives of too many too early but diminishing the quality of life of those who remain to bear it.”

Reflecting on the shocking video depicting the death of George Floyd, neurosurgeon Fredric B. Meyer, MD, FAANS, the Juanita Kious Waugh Executive Dean for Education of the Mayo Clinic College of Medicine and Science and dean of the Mayo Clinic Alix School of Medicine, wrote to all medical students, residents and fellows. In his letter, Dr. Meyer reminded us “that although our country has made tremendous advances in civil and human rights, we all have significant work to do on so many levels to fight hatred, bigotry, and violence.” He recalled how Bobby Kennedy was one of his family’s heroes and how, as U.S. Attorney General, he was a strong advocate for civil rights. Dr. Meyer went on to note that in this time of terrible strife, anger, mistrust and hatred in our country, he is reminded of a powerful speech that Bobby Kennedy gave spontaneously on the back of a pickup truck when he learned of the assassination of Martin Luther King, Jr. He, along with his brother, President John F. Kennedy, and Dr. King, were all assassinated for the truth they spoke about human decency, civil rights, and a humane society. Dr. Meyer commends to the medical community the YouTube video of Bobby Kennedy announcing Dr. King’s death and to also listen to his speech on humanity, mindless violence and affirmation. His words are as relevant today as they were decades ago, and, as Dr. Meyer aptly stated, it is distressing that fifty years later, the same hatred that killed Dr. King continues to be pervasive in our society.

Leaders of the Society of Neurological Surgeons (SNS) — M. Sean Grady, MD, FAANS, president; Karin M. Muraszko, MD, FAANS, past-president; and Nathan R. Selden, MD, PhD, secretary — wrote to SNS members, neurosurgery department chairs and neurosurgical residency directors. In their message, they called on “educators to exemplify the highest moral and ethical standards for our trainees.” They noted that as educators and leaders in neurosurgery, we must ensure “that the American principles of fair and equal treatment for all are the bedrock of our Neurosurgical community.” Reaffirming a commitment to be “an inclusive organization reflective of the ‘higher’ principles,” they pledged “to grow and adapt and to listen to those we educate and those we serve. Although we may not have walked in their shoes, we will remain open to the knowledge and experience of every colleague and trainee and will respect and acknowledge them for their character and skills rather than for their appearance. Like our society, we believe we can continue to grow towards a more perfect union of our ideals and the reality in which we live,” and to strive together to reach higher ground.

The AANS/CNS Cerebrovascular Section, the Society of NeuroInterventional Surgery (SNIS) and the Society of Vascular & Interventional Neurology (SVIN) joined together to issue a statement acknowledging the difficult and disturbing times that the country is experiencing. These neurovascular organizations pointed out that “acts of violence and racism cause psychosocial stress that leads to poor well-being and cerebrovascular health, especially for communities of color. Given that heart disease and stroke are the leading causes of death for communities of color, our organizations are extremely disturbed by violent acts that cut to the core of the lives in our communities. We denounce the incidents of racism and all violence that continue to ravage our communities.”

Beyond the neurosurgical community, leading national medical organizations also spoke out.

The American College of Surgeons stated that it “stands in solidarity against racism, violence, and intolerance, noting that its “mission is to serve all with skill and fidelity, and that extends beyond the operating room. Racism, brutal attacks, and subsequent violence must end. We will help any injured, and we will use our voice in support of the health and safety of every person.”

Leaders from the American Medical Association (AMA) reminded us that AMA policy “recognizes that physical or verbal violence between law enforcement officers and the public, particularly among Black and Brown communities where these incidents are more prevalent and pervasive, is a critical determinant of health and supports research into the public health consequences of these violent interactions.”  The AMA continued, noting that the “disparate racial impact of police violence against Black and Brown people and their communities is insidiously viral-like in its frequency, and also deeply demoralizing… Just as the disproportionate impact of COVID-19 on communities of color has put into stark relief health inequity in the U.S.”

Finally, the Association of American Medical Colleges (AAMC) pointed out that “the coronavirus pandemic has laid bare the racial health inequities harming our Black communities, exposing the structures, systems, and policies that create social and economic conditions that lead to health disparities, poor health outcomes, and lower life expectancy.” The AAMC statement goes on to address how the brutal and shocking deaths of George Floyd, Breonna Taylor and Ahmaud Arbery “have shaken our nation to its core and once again tragically demonstrated the everyday danger of being Black in America.” Issuing a call to action, the AAMC expresses that “as healers and educators of the next generation of physicians and scientists, the people of America’s medical schools and teaching hospitals bear the responsibility to ameliorate factors that negatively affect the health of our patients and communities: poverty, education, access to transportation, healthy food, and health care.”

The AANS and CNS echo this call to action and concur that we “must move from rhetoric to action to eliminate the inequities in our care, research, and education of tomorrow’s doctors.”

Editor’s Note: Neurosurgery Blog invites you to join the conversation for social change at #WhiteCoatsforBlackLives and #ChangeTheSystem.

 

John A. Wilson, MD, FAANS
President, American Association of Neurological Surgeons
David L. and Sally Kelly Professor and Vice-Chair of the
Department of Neurosurgery, Wake Forest School of Medicine

 

 

Steven N. Kalkanis, MD, FAANS
President, Congress of Neurological Surgeons
Chief Executive Officer, Henry Ford Medical Group
Detroit, Mich.