‘Health insurers are refusing to pay fair market rates’

Last month, emergency physician Dr. Steven Stack became the 170th president of the American Medical Association. Stack, who practices in Lexington, Ky., has been the medical director in multiple emergency departments, including St. Joseph East in Lexington. Stack has served on a number of federal advisory committees for HHS’ Office of the National Coordinator for Health Information Technology and is a former secretary of the eHealth Initiative. Modern Healthcare reporter Steven Ross Johnson and other MH staff members recently spoke with Stack about the AMA’s position on possible changes to the Affordable Care Act, its stance on electronic health record meaningful-use rules, and his views on regulating surprise outof-network medical bills. This is an edited transcript.

Modern Healthcare: What are the AMA’s priority issues for the coming year?

Dr. Steven Stack: The AMA has three bold initiatives. One is to improve health outcomes for the nation, specifically for people with diabetes and hypertension. We’re going to work very hard to minimize the number of people who convert from prediabetes to diabetes, and to better recognize and treat hypertension. The second thing is, we’re working very hard to accelerate change in medical education. We strive to radically transform medical schools so that the doctors of today and tomorrow have the skills and the knowledge they need to provide 21st-century care. The third thing is to restore joy to the practice of medicine, and to ensure that physicians are in sustainable practices where they have the resources and support they need to provide highquality care to patients.

MH: What is the AMA doing to address the looming doctor shortage?

Stack: We believe the federal government needs to increase residency slots. Medical schools are increasing the number of students they train and teach, and new medical schools have been founded. But there’s a bottleneck when graduates reach the residency portion of their training, and we need to make sure that bottleneck is not an impediment to having a sufficient workforce. We need more residency slots funded, and the profession needs to work with policymakers to ensure that patients have the doctors with the skills they need to succeed.

MH: What is the AMA’s position on possible changes to the Affordable Care Act?

Stack: We would say that every American needs to have access to high-quality care when they need it, where they need it, and at a price that they can afford. We’ve had continued, qualified support for the current version of the ACA. We support what it strives to achieve—to diminish the number of uninsured Americans. There’s a need for further improvement and further accomplishment, because as much of a wonderful success as it is to have 10 million or more Americans now insured, we still have 40 million more left to get insured. We’re committed to finding a way to get those other 40 million Americans into a system of coverage. We would be happy to work with Congress and the executive branch to find paths forward through statute and regulation to ensure that the most people get the best possible benefit. Our support is not constrained by a specific piece of legislation, nor will it be limited going forward to just that piece of legislation.

MH: Why does the AMA want the CMS to delay implementation of Stage 3 meaningful use of the EHR program?

Stack: We have concerns with the meaningful-use program because we feel it is overly burdensome and prescriptive. It doesn’t account for the variations in the way healthcare is delivered or in how patients receive it. We don’t feel that, as they have proposed it, Stage 3 will be attainable for most providers. There’s great need to mitigate the program and have it focus on interoperability and on giving physicians access to EHRs that are useful and support their practice rather than interfere with it. We’re supportive of the Obama administration’s modifications of Stage 1 and Stage 2 meaningful use. For Stage 3, we’re committed to working with the administration to have it focus on interoperability and the usability of EHRs, and, if needed, to discuss the timing of the different rules and stages and when

“Insurance regulators would do well to focus on the behaviors of the insurance industry first.”

they go forward. Every physician in the country would be grateful to know that CMS itself has said this is the final stage. That’s important because doctors and hospitals need to turn their attention to making these tools work and to realizing the promise that they offer, instead of all of these barriers and impediments that they currently throw up in the way of our care.

MH: What will the AMA do if there is no delay in Stage 3 requirements?

Stack: Right now, we’re very concerned because participation in the meaningful-use program has been declining precipitously. Our eye is on how to help physicians right now, in 2015 and 2016, to succeed and use these tools to provide better care for patients. We wouldn’t presuppose what CMS will come out with in their final rule, but whatever it is, we’ll continue to advocate with CMS that we have to attend to the impact these tools are having on physicians, and right now it’s not good. Our efficiency is diminished and patients are getting frustrated, just like doctors are, with the intrusion into the time the physician has to spend with them. Patients would rather have their doctor look them in the eye and hear their concerns, instead of clicking away with a keyboard or a mouse, which is the experience today with the current EHRs.

MH: What are your thoughts about state regulatory efforts to protect patients from surprise medical bills when they unintentionally receive care from out-of-network providers such as emergency physicians? For example, New York has required providers and insurers to work out the issue through independent dispute resolution.

Stack: It’s a big issue. The real crux of the problem is that health insurers are refusing to pay fair market rates for the care provided. Then they turn and say to the physician who is billing to get value for service that’s appropriate, “You’re the bad guy.” The patient sees the physician as the bad person because that’s who interacts with (them) and that’s who they get the bill from. When that happens, it’s entirely disingenuous to say that it’s the physician trying to bill the patient for more money, when it’s the insurer refusing to provide the beneficiary with an adequate benefit. I can’t comment specifically on the New York approach. But putting in a methodology to coerce physicians through yet another way to not receive sufficient payment doesn’t help patients, and certainly is not fair to physicians. Insurance regulators would do well to focus on the behaviors of the insurance industry first. Insurers should either be required to pay physicians fair market rates or else disclose to their members that they pay under-market value and offer an inadequate provider network.

MH: What are your thoughts on implementation of the ICD-10 coding system in October now that the CMS has given doctors more flexibility?

Stack: If CMS and others decide to move forward with it, we are committed to working with them to try to mitigate and plan for those potential disruptions, to do the very best we can to make sure that they don’t impact physicians and their patients.