Dr. Timothy McAvoy, an internist from Waukesha, Wisconsin, held his granddaughter in his arms as he stood in the Longworth House office building, waiting to speak to a congressional aide on Medicare pay increases for doctors .
Facing a highly partisan Congress in which Republicans have vowed to cut federal spending, McAvoy hoped his Midwestern allure, coupled with a dose of supporting data, would prompt members to recall the doctors’ cause.
Wisconsin Nice is a real thing, said McAvoy, who graduated from his medical school in 1973. Whether that translates into the grades we need, we’ll have to see.
McAvoy was one of about 350 doctors who recently traveled to Capitol Hill to lobby Congress on behalf of the American Medical Association. Although they had left their white coats at home, they were still there as doctors. Their goal was to build support for organizations Recovery Plan for Americas Physicians, a wish list that includes a pay raise, relief from insurance company pre-authorization requests, and more federally funded residency slots to train more doctors.
The campaign motto is a pat on the back for these medical professionals: You took care of the nation. It’s time for the nation to take care of you.
The AMA represents about 250,000 physicians, about a quarter of the U.S. medical workforce. And sending its members en masse to Washington to champion their cause is nothing new. But this was the first organized group effort in more than three years, due to the COVID-19 pandemic.
In that time, many congressional offices were claimed by new members with different legislative aides. As a result, doctors say, they must spend in-person time teaching them the intricacies of Medicare payment rules and other topics important to the practice of medicine.
Message to Congress: How Changes Will Help Patients
Though the AMA has a full staff of lobbyists in Washington, association officials say their best weapons are often the doctors themselves, who grapple with insurance company bureaucracy and reimbursement bureaucracy every day. There’s nothing like telling members of Congress how things work in their district, said Dr. Jack Resneck Jr., president of the AMA and a dermatologist at the University of California-San Francisco.
Before meeting with House and Senate members and their aides, AMA staffers briefed doctors at a downtown hotel on how to get their message across for maximum effect. The main lesson: show how these changes will help their patients, not just their business practices.
Detail how patients are facing delays in getting medications and services because insurer approval is required first. Mention that they know of doctors retiring early, selling their practices to hospitals or private equity firms, and how this makes it difficult for patients to find a doctor. We have the politics and the data, but it’s these stories that will stick in their heads, an official AMA lobbyist told them.
They were also advised to listen and seek common ground with members of Congress.
When you go up the hill, you let those congressmen know how much you care about your patients and want to keep doing your job, said one AMA staffer, almost sounding like a coach outlining how a strategy should work on game day. . Let them know how we care for our patients and want to improve the health of the nation.
But it was also a talk of money, coming from some of the incomes well above the country’s average. (A government estimate for the doctors and surgeons category put the median annual income for 2021 at $208,000.) Tell Congress that higher payments from Medicare could provide better care and services to patients, the doctors were urged. No one wants a system that isn’t fiscally stable, and no one wants to see doctors filling out paperwork to fight denials from insurers, said an AMA staffer.
Medicare payments are a big deal
They were also told to remind Congress that Medicare payments to doctors don’t include an automatic adjuster for inflation, even though hospitals and nursing homes get it. Medicare beneficiaries are at real risk of not getting treatment, Resneck said.
While Medicare payments are still a vital issue for many doctors, most doctors today work as employees of hospitals, insurers, and other corporate entities and often receive a salary rather than a fee for each patient service.
AMA lobbyists have warned them that their request for higher pay has met with pushback in recent years. This is largely because the Medicare Payments Advisory Commission, which advises Congress, has repeatedly stated that Medicare rates were high enough and there was no sign that Medicare patients were having widespread problems finding doctors. .
Indeed, in its last report, in March 2022, MedPAC wrote: The Commission’s analyzes suggest that Medicares’ aggregate payments for medical services are adequate. At their January meeting, however, MedPAC members signaled a change in this stance by approving recommendations to link physician payments to 50 percent of the Medicare economic index, which is a measure of practice cost inflation.
In its 2022 report, MedPAC also noted that Congress provided tens of billions of dollars in relief funds to physicians during the pandemic and predicted that demand for their services would meet or exceed pre-pandemic levels by 2023.
Dr. Tosha Wetterneck, an internist from Madison, Wisconsin, who joined McAvoy in Tuesday’s meeting, said after a session with Wisconsin Republican Representative Mike Gallaghers’ legislative aide that she was pleased to hear their message on the need help to keep doctors offices open and fully equipped. She pointed out that doctors need more money to pay nurses, physician assistants and receptionists when they are lured away with higher pay by other employers.
It’s not a one-time thing, he said of this week’s pressures. It’s about forming relationships. We are in it for the long term.
Wetterneck said the aide told his group that Gallagher supports changes to the insurer’s prior authorization rules. Asked if he would support higher payments to doctors, he said: Everyone supports us by trying to keep the lights on, but it all depends on how the sausage is made.
The aide told doctors about the Gallagher bill to stop anti-competitive tactics that would limit employers’ use of non-compete clauses in contracts, which the doctors said would help them when they switch companies, Wetterneck said .
For two days, Wisconsin doctors met with nine congressmen from their state, though mostly aides to the House, as the lower house was on recess.
They met with Wisconsin Sen. Ron Johnson, one of the most conservative members of Congress, who often rails against increasing government intervention and spending.
Wetterneck said Johnson spent nearly an hour with them, during which he explained he wanted doctors to be the trusted profession again rather than be overwhelmed by rules and red tape. The senator told them he understands that doctors’ offices need money to pay staff members and care for patients. But that doesn’t guarantee he’ll vote for a raise, he said.
Dr. Melissa Garretson, a pediatric emergency medicine specialist in Fort Worth, Texas, clutched a Diet Coke as she left a House cafeteria and headed to her fifth of eight House and Senate meetings.
He said the payment issue resonated with members of Congress, particularly when the message focused on helping doctors keep practices open in rural Texas.
She was ready with a story from last week: An insurer refused to cover a liquid drug for her 4-year-old patient and would only pay for a pill too big for the child to swallow. Prior authorization is a barrier to patient care, she said.
While treating emergency patients is her job, she sees lobbying Congress as an extension of her role.
Our patients need the care they need when they need it, and not arguing that’s not doing my job as a doctor, Garretson said as he entered the office of a Texas House member.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operational programs of the KFF (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides information on health issues to the nation.
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