AMA Debates Physician Compensation for Prior Authorization Work at Interim Meeting

Key Insights

• The American Medical Association's House of Delegates discussed a resolution to establish legislation requiring fair reimbursement for time spent on prior authorization processes across Medicare Advantage, Medicaid, and commercial plans.
• Delegates addressed the critical issue of pediatric hospital closures, with the AMA moving to form a national coalition to preserve access to high-quality pediatric inpatient and critical care services.
• An emergency resolution to combat public health misinformation failed to achieve the required 75% approval, despite growing concerns about potential threats to evidence-based healthcare policy.

The American Medical Association's (AMA) House of Delegates interim meeting in Orlando, Florida, tackled several pressing healthcare issues, with prior authorization compensation emerging as a central topic of debate.

Prior Authorization Compensation Debate

The American Association of Clinical Urologists (AACU) proposed legislation that would require fair reimbursement for physicians and their staff for time spent handling prior authorization requests. While the reference committee initially recommended referring the matter to the AMA Board of Trustees, delegates expressed varying views on the approach.

Dr. Bill Reha of Woodbridge, Virginia, advocated for the House of Delegates' involvement, requesting the board study the issue and report back at the annual meeting in June. However, Dr. Maryanne Bombaugh, representing the AMA Council on Legislation, cautioned that focusing solely on payment could undermine broader prior authorization reform efforts and existing patient coalitions.

Dr. Alex Shteynshlyuger, a New York City urologist, proposed using Bureau of Labor Statistics physician salary data to value time spent on prior authorizations, noting limited progress in existing reform legislation. "After 20 years, we have to be realistic and practical, and ameliorate our suffering and financial bleeding," he stated.

Pediatric Healthcare Crisis

The meeting addressed growing concerns about pediatric healthcare access, with delegates considering a resolution from the American Academy of Pediatrics (AAP) and Society of Critical Care Medicine (SCCM). The measure calls for recognizing pediatric hospital closures as a critical threat and building a coalition to preserve pediatric care access.

AAP president-elect Dr. Sue Kressly shared a compelling example of the risks, describing a case where a one-month-old with RSV nearly died due to care by staff with limited pediatric experience. A recent JAMA Network Open study highlighted that improved pediatric emergency preparedness could save thousands of lives at a cost of less than $12 per child.

The resolution was expanded to specifically include pediatric psychiatric facilities, addressing the ongoing mental health crisis affecting young patients. Dr. Myo Myint emphasized that psychiatric unit closures further reduce access and can worsen mental health outcomes.

Public Health Misinformation Initiative

A notable development was the introduction of an emergency resolution by the New England delegation to combat public health misinformation. The proposal sought to establish rapid response capabilities and develop comprehensive strategies for evidence-based advocacy and education.

Despite garnering 65% support from delegates, the resolution fell short of the required 75% threshold for emergency consideration. Dr. Mario Motta, speaking for the New England delegation, expressed concerns about potential threats to science-based medical practice and public health measures, particularly regarding vaccine policies.

The discussions reflect the medical community's ongoing efforts to address systemic challenges while maintaining high standards of patient care and scientific integrity. The AMA continues to navigate complex healthcare policy issues while working to protect both physician interests and public health.