The American Medical Association (AMA) House of Delegates focused on three major factors influencing the practice of medicine at its 2024 AMA Annual Meeting in Chicago – Medicare payment reform, cybersecurity attacks on health care systems, and the deployment and use of artificial intelligence in health care. The CAP and its leadership engaged in debates at the AMA meeting on these and other topics to represent the interests of pathologists and the patients we serve.

The CAP also led the delegation of pathologists, called the Pathology Section Council, at the meeting. The section council includes American Society of Clinical Pathology, American Society of Cytopathology, the CAP, National Association of Medical Examiners, and the American Society of Dermatopathology. In addition to Medicare payment reform, cybersecurity and AI, the Pathology Section Council discussed a variety of topics concerning the specialty, including medicolegal death investigations, prior authorization, and the corporate practice of medicine and private equity.

The Importance of AMA Membership

Your membership in the AMA ensures pathologists have a strong voice in the house of medicine. Learn more about AMA membership or go to ama-assn.org/cap-join to activate an AMA membership today.

Ensuring Sustainable Payment Rates

Unsustainable payment rates do not reflect practice costs, or the value of the care provided, according to an AMA Council on Medical Service report adopted at the meeting. Delegates adopted a policy stating that payment benchmarks should reflect the cost of providing care while acknowledging risk, variable expenses, an appropriate allocation of fixed costs and physician work. Delegates representing the CAP at the meeting supported the measure as pathologists have fought against across-the-board Medicare cuts to all physicians for several years and, most recently, at our Pathologists Leadership Summit in April.

Cybersecurity and Change Healthcare

The AMA House of Delegates adopted a resolution calling on the AMA to investigate the possibility of filing a class action lawsuit against Optum, United Health Group and Change Healthcare to recoup the damages from the disruption caused by the February 21 cybersecurity breach, and to distribute the unfair enrichment profits made by Optum et al to the practices whose retained payments allowed them to generate interest and investment profits.

The CAP has heard from members that the cyberattack has had “ripple effects in the pathology billing world,” with even non-Change Healthcare clearinghouse vendors continuing to have trouble transmitting and processing claims, as well as billing platforms still not backed up. Members have also said that this is a huge issue for those in small practices who are contracted with Change Healthcare and cannot pivot quickly to bring billing in-house or find another third-party option. The cyberattack has wreaked havoc on collections and caused increasing cash flow constraints.

Augmented/Artificial Intelligence

New policy on artificial intelligence builds on AMA principles that addresses the development, deployment, and use of AI in health care. The House of Delegates extensively discussed the issues around AI and requested a report back at the 2024 Interim Meeting of the House of Delegates in November. Pathology section council delegates spoke to concerns around ethics requirements, sham science, and terminology issues.

The CAP is actively engaging with the Food and Drug Administration (FDA), the Coalition for Health AI (CHAI), and others to establish a leadership role in the regulation and accreditation of AI/ML products. The CAP is also engaged internally on education and technical issues particularly related to verification and performance monitoring.

Medicolegal Death Investigations

A resolution asking the AMA to support the independent authority of forensic pathologists and to advocate with state and federal governments to ensure laws and regulations do not compromise a physician’s ability to use their medical judgement in the reporting of postmortem assessments and medicolegal death investigations was brought to the floor by the CAP along with the National Association of Medical Examiners (NAME), American Society for Clinical Pathology, and American Society of Cytopathology. The Pathology Section Council secured support of several groups, including the Hospital-Based Physician Caucus. During reference committee, NAME, the CAP, the American College of Obstetrics and Gynecology (ACOG), PacWest, American Academy of Pediatrics (AAP), and American Psychiatric Association (APA) all spoke in strong support.

This AMA has a policy against encroachment in other circumstances, but encroachment policy specific to forensic pathologists or legislative efforts impacting the practice of medicine does not exist.

Prior Authorization

The Pathology Section Council supported, and the AMA House of Delegates adopted a resolution calling on the AMA to advocate for increased legal accountability of insurers and other payers when delay or denial of prior authorization leads to patient harm.

On January 18, the CMS released a final rule that makes important reforms in prior authorization programs for medical services. The rule is a direct result of important advocacy efforts taken by the CAP together with the American Medical Association and other physician organizations to address prior authorization in government-regulated health plans. As a result of the recent final rule, legislators now see a path forward toward enacting this legislation and making these reforms into law.

Corporate Practice of Medicine and Private Equity

The AMA House of Delegates heard concerns about the corporate practice of medicine and private equity and asked the association to study how to increase competition, increase transparency, support physicians and physician autonomy, protect patients, and control costs in already consolidated health care markets. The House of Delegates also directed the AMA to oppose all restrictive covenants.

Reforming Medicare Advantage Payment Policies

To address outdated Medicare Advantage policies, strengthen traditional Medicare, and help patients make more informed choices between traditional Medicare and Medicare Advantage, AMA delegates adopted new AMA policy to:

• Encourage that risk-adjustment formulas be revised so that claims data is based on the actual cost of providing care
• Provide or create educational materials such as an infographic to compare traditional Medicare and Medicare Advantage plans so that patients are able to make informed choices that best meet their health care needs.

AMA President-Elect Meets with Pathology Section Council

Bobby Mukkamala, MD, an otolaryngologist from Flint, MI, is the new president-elect of the AMA. Dr. Mukkamala, who has been active in the AMA since residency, is chair of the AMA Substance Use and Pain Care Task Force, serving as a strong voice in advocating for evidence-based policies to end the nation’s overdose epidemic.

Dr. Mukkamala met with the Pathology Section Council (pictured below) to hear concerns affecting the practice of pathology and how the AMA can support the specialty in the future.