AMA to Fix Medicare? Think Again!

by Julio Gonzalez, M.D., J.D.

Last week, the American Medical Association (AMA) announced that “fixing [the] Medicare physician pay system [is] a top priority for the AMA.” In fact, it called the system “unsustainable,” with AMA President Dr. Jack Resneck declaring, “We are past the breaking point.”

But let’s look at what the medical profession has achieved under the AMA’s advocacy efforts.  According to the AMA’s own data, physician payment has declined by 26% since 2001 relative to inflation.  Additionally, regulatory drags related to Obamacare and electronic medical records requirements (both AMA supported programs) are consistently tagged as leading causes of the skyrocketing rates of physician suicide and burnout.

And although the AMA suddenly declared Medicare payment reform as one of its top priorities, its allegiances have rested elsewhere.  Since 2021, the AMA has waged a battle to remove sex designations from the nation’s demographic documents, tried to convince us that race is not a genetically associated trait, made the argument that Americans have “stolen the wealth of African American for the past 400 years” (that would take us at least to 2009 if one uses 1609 as the starting point, the year used in the same-named Project), adopted the position that “we live in lands taken by indigenous people,” that physicians are inherently racists, whether they know it or not(!), and even adopted a statement claiming that the only way to achieve parity in the Supreme Court is when it is made up of nine women.

In light of all these nonsensical positions, one is left to wonder whether one needs enemies when graced with friends like the AMA.

Recall the last time the AMA was entrusted with representing physicians in “fixing the Medicare reimbursement scheme.”  At that point, the “flawed reimbursement formula” was the SGR or the “Sustainable Growth Rate”.  Back then, physicians were suffering from yearly Medicare reimbursement cuts of over 20%.  Congress, unable to repair the system, recurrently enacted temporary fixes sometimes lasting no more than three months.  The system had become so unstable, that the care of America’s seniors was being palpably threatened! 

Enter the AMA.  The opportunity for a permanent fix presented itself when then President Barrack Obama aimed to reform the American healthcare system and needed the support of America’s physicians.  The AMA, claiming to represent America’s doctors, agreed to endorse Obamacare (with which nearly half of AMA members did not agree) absent any commitments from the Administration other than a vague agreement “to fix the SGR.”  

The result was a resounding failure for doctors.  Doctors got “meaningful use” and MACRA (which eventually led to MIPS), a precipitous increase in physician retirements and suicides, and a massive egress of members from the AMA. 

Now, the AMA wants to place itself in the same, unchecked situation with regards to our reimbursement and our profession.  Only this time, the answer is, of course, “No!  We will not allow the AMA to represent physicians in an unchecked manner again!”

At the United States Medical Association, we believe that a physician-based professional organization ought not represent the interested of insurance companies, bureaucrats, and politicians.  Rather, it ought to represent doctors! 

Thus, we urge you to join us and help us grow our numbers so that we may effectively check whatever crazy ideas the AMA may agree to in the name of the medical profession. 

Here’s what the USMA will demand of Congress: 

1.      A fee-for-service reimbursement model.  You do the work; you get paid.  Period!

2.     No mandated fee schedules.

3.     Balanced billing.

4.     Cut the ties between budget neutrality and physician reimbursement.

5.     No EMR mandates.  Physicians document in the most efficient manner that they see fit for their practice and their patients.

6.     An end to physician hospital ownership restrictions. 

7.     Parity in hospital reimbursement rates versus physician owned healthcare centers.

8.     No Maintenance of Certification requirements.

9.     Tax and liability protections for physicians caring for Medicare patients.  

Here’s what we fear our opponents’ positions will be, which we will vehemently oppose:

1.      Continued reimbursements tied to inevitably flawed quality assessments.

2.     Enhancement of the electronic medical records programs with new restrictions and requirements.

3.     Mandatory maintenance of certification requirements.

4.     Propagandist CRT and woke training tied to reimbursement and certification.

5.     Restrictions on language physicians may or may not use in their charts tied to reimbursements.

6.     The enhancement of accountable care organizations.

7.     Meeting performance measures such as MIPS in order to qualify for full reimbursements or face mandatory deductions on reimbursements.

The fact is that we know where these negotiations will go when left in the hands of the American Medical Association and we must work to restrict them.  Whatever perceived authority the AMA has comes from its repeated claim to represent doctors when in fact, the AMA has become so divorced from the prevailing opinions of America’s physicians that it has routinely delivered the positions backed by those opposing the betterment and autonomy of the medical profession. 

Let’s not let past errors be repeated.  Join the USMA, now!  Together, we can work to dismantle the harms imparted upon our beloved profession by the organization that is representing us in name only. 

Visit the USMA by going to usmedicalassocation.org, or our sister organization, USMAAction.org and join us.  Let us save our profession for ourselves, our patients, and our posterity. 

Dr. Julio Gonzalez is an orthopaedic surgeon practicing in Venice, Florida, and a former Florida State Representative.  He is President of the United States Medical Association.