Special Advocacy Update

• CAP Leads AMA Policy Discussions on Information Blocking, Visa Rules

The CAP worked with physician colleagues across the American Medical Association (AMA) to enact new policies on prior authorization, artificial intelligence, and information blocking during the 2024 AMA Interim Meeting November 8-12.

About 700 physicians and medical students gathered in Orlando, Florida, for the AMA House of Delegates meeting, which works through a democratic process to create consensus on emerging issues in public health to improve patient care. Delegates representing the CAP provided testimony and voted on policies giving the AMA direction on the future of American medicine.

The CAP strongly encourages its members to also be members of the AMA. The more CAP members who join the AMA, the more delegates the CAP receives. The AMA House of Delegates includes representation from state medical associations and national medical specialty societies, along with AMA sections, professional interest medical associations, and the federal services. The CAP led a delegation of the Pathology Section Council, which includes delegates from the American Society of Clinical Pathology, American Society of Cytopathology, National Association of Medical Examiners, and the American Society of Dermatopathology.

Prior Authorization

Delegates adopted policy to stop payers from requiring burdensome prior authorization, and then—after the care has been delivered—backing out of paying or trying to recoup payment already made. Insurers will frequently cite vague reasons such as overpayment on their part, a redetermination that approved care was not medically necessary or incomplete paperwork. The CAP has been a leader in this effort, advocating for protections to ensure payers cannot rescind payment for nefarious reasons when prior authorization has been granted.

Learn more about the newly adopted policy and how it will strengthen the AMA as it fights to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.

Augmented/Artificial Intelligence

The AMA House of Delegates adopted as policy a comprehensive set of principles on the development, deployment and use of augmented intelligence (AI)—often referred to as “artificial intelligence.” The newly adopted policy is in large part drawn from the set of health AI principles approved by the AMA Board of Trustees last year that addresses:

• Health care AI oversight.
• When and what to disclose to advance AI transparency.
• Generative AI policies and governance.
• Physician liability for use of AI-enabled technologies.
• AI data privacy and cybersecurity.
• Payor use of AI and automated decision-making systems.

Delegates, however, adopted some changes aimed at bolstering the overall aim of ensuring AI is properly used and that physicians can intervene, when necessary, especially as the risk of patient harm rises.

Information Blocking

The CAP worked with the Hospital-Based Physician Caucus and the Cancer Care Caucus to raise awareness of issues around the federal Information Blocking Rule and ensure that no additional requirements or administrative burdens were placed on pathologists. Delegates voted to refer the issue to the AMA Board of Trustees so that the concerns raised can be addressed fully.

The CAP believes there are very real barriers, challenges, and potential safety issues that exist with the current Information Blocking Rule. Pathologists are most concerned about the myriad of situations in which automatic release of final reports to a patient portal can have disastrous psychological and practical consequences, and case-by-case implementation of an exception is impractical or unworkable. The CAP also supports allowing a delay for the release of test results available to the public through the EHR so that involved clinicians can create an integrated response before patient communication for the best care coordination.

Visa Requirement Waivers

Delegates adopted new policy stating that the AMA will advocate for federal visa and visa waiver policies to include time for administrative tasks, professional development opportunities, and other professional responsibilities within the federally mandated work week requirements for direct patient care. This was in response to concerns that waiver programs require, among other things, that IMGs engage in full-time employment, which is an average of 40 hours per week – and some states and federal programs have established minimal “direct patient care” requirements. The AMA Board of Trustees noted that visa waiver recipients should have time within their 40-hour work week to provide not only direct patient care, but also to engage in administrative duties, participate in professional development opportunities, and undertake other professional responsibilities.

Specific to pathology, there has been at least once instance of a pathologist who was initially denied a waiver due to a misperception that the pathologist did not practice “direct patient care.” The CAP will continue to advocate strongly against this misperception and work with the AMA to ensure pathologists can fully participate in these physician workforce initiatives.

Elimination of Medicare 14-Day Rule

The CAP supported a resolution asking the AMA to actively lobby the federal government to readdress and change laboratory date of service rules under Medicare, eg the Medicare 14-Day Laboratory Date of Service Rule, such that complex laboratory services performed on pathologic specimens collected from an inpatient hospital procedure be paid separately from inpatient bundled payments, consistent with outpatient rules.

The CAP appreciates the improvements to Medicare’s laboratory DOS policy to date. However, these improvements did not address hospital inpatients and payment for some tests is still problematic. Regardless of the place of service, a revised DOS policy that allows the performing laboratory to bill directly for molecular pathology tests and ADLTs, rather than receiving payment from the hospital, would reduce administrative/billing complexity for hospitals, clinical laboratories, treating physicians and Medicare beneficiaries, and promote timely access to patient testing.

Civil Litigation Concerns

The CAP also worked on efforts to ensure civil causes of action are not being conferred upon patients to augment enforcement of regulatory mandates upon physicians. At the AMA meeting, it was discussed that state legislatures have started creating new private causes of action against health care providers to enforce the legislature’s public policy decisions. This amounts to a private “bounty” system that incentivizes a flood of lawsuits against health care providers and shifts the burden of enforcing public policy onto healthcare providers and patients. Delegates voted to refer the issue to the AMA Board of Trustees to address these concerns appropriately.