Dec. 6, 2022

By Tochi Iroku-Malize, M.D., M.P.H., M.B.A.
AAFP President

We are so close to a big win in our fight for administrative simplification. But we’re also counting down to Jan. 1, when a damaging new reduction to Medicare’s conversion factor takes effect. Family physicians’ practices and patients are at risk unless Congress intervenes this month. Lawmakers need to hear from us about both of these issues — which is why I’m writing to ask for your help. With just a few minutes of your time, you can help the Academy protect physician pay and reduce administrative complexity.

Earlier this fall, the AAFP’s steady campaign for the Improving Seniors’ Timely Access to Care Act helped get that bipartisan bill unanimously passed in the House. The legislation would streamline and standardize prior authorization in the Medicare Advantage program, protecting patients from unnecessary delays in care and bringing much-needed administrative simplification to physicians, 88% of whom say prior authorization’s burdens are high or extremely high.

It’s not a hard case to make, given the HHS Office of the Inspector General’s widely reported conclusion earlier this year that Medicare Advantage plans use prior authorization to inappropriately deny coverage and payment for medically necessary services, creating barriers to care for beneficiaries.

Now we’re asking the Senate to pick up the baton and head for the finish line. Which is where you come in. It’s crucial that AAFP members tell their senators why reforming prior authorization is a must. Our Speak Out tool lets you do just that. Please join the call.

Meanwhile, the fuse is burning on Jan. 1 Medicare cuts to physician pay, once again due to budget neutrality — the statutory requirement that any payment increase for a Medicare service be offset with a reduction elsewhere. Only Congress can fix this, and lawmakers must move to adjust 2023’s untenable conversion factor. Your Academy is, of course, fighting to ensure that we don’t start the new year with a deflated conversion factor heightening pressures on practices that already face post-pandemic uncertainty and continuing inflation.

Here again I ask you to add your voice. A separate Speak Out lets you engage your representatives in the House and the Senate to ask that they halt that pay cut by passing the Supporting Medicare Providers Act of 2022.

The Academy, as part of a strong, unified bloc of medical and specialty organizations, is helping to lead a “week of action” to resolve this payment crisis. We started with a Dec. 5 letter, signed by more than 100 groups, calling on House and Senate leaders to swiftly pass legislation restoring 4.5% to the conversion factor.

“We cannot overstate the importance of Congress stopping the entirety of the upcoming 4.5% reduction,” we wrote. “Anything less will result in an across-the-board cut that will further exacerbate the significant financial hardship clinicians are already facing and undermine Medicare’s ability to deliver on its promises to seniors and future generations.”

This week will be full of follow-up calls, meetings and a social media campaign pressing for results — and you should be part of it. Thousands of your fellow physicians across many specialties will be meeting with, writing, calling and tweeting at their legislators. The Academy has made it easy for you to do the same by joining the Speak Outs campaigns I’ve told you about here. We are all together in this critical call to action. We must also be louder.

Because this same fight has been necessary for the past two years, we’re also repeating — louder — the need for broad Medicare payment reform.

• The Academy last month gave Congress detailed guidance on how to remedy some of the shortcomings time has revealed as we’ve lived for a while with the Medicare Access and CHIP Reauthorization Act.
• I recently joined two of my fellow physician leaders — Patricia Turner, M.D., M.B.A., executive director and CEO of the American College of Surgeons; and Ryan Mire, M.D., president of the American College of Physicians — in publishing a guest editorial in Modern Healthcare that urges Congress and HHS to move toward a sustainable fee-for-service Medicare payment system.
• I also co-signed, alongside Academy Board Chair Sterling Ransone, M.D., of Deltaville, Va.; and President-elect Steven Furr, M.D., of Jackson, Ala., a November editorial in Medscape in support of the same legislation I’m asking you to help us pass.

For us as well as for our patients, these elemental needs transcend politics and are existential. It’s time to solve fundamental problems. So I ask you again to join the AAFP’s advocacy by clicking the links above to our Speak Out campaigns. Progress is within our reach when we work together.

Tochi Iroku-Malize, M.D., M.P.H., M.B.A., is president of the AAFP.