Ultrasonography in Pain Medicine SIG

AMA Meeting Highlights: Telehealth, Prior Authorization, Scope of Practice

Jul 23, 2021

Angie Stengel, MS, CAE, ASRA Executive Director
prior authorization scope of practice telehealth

During the recent American Medical Association (AMA) Special Meeting, the AMA House of Delegates addressed issues a variety of issues, some of which our members face daily.  I will highlight three of the issues that affect our members: telehealth, prior authorization, and scope of practice.

Telehealth

Most of our members quickly developed telehealth practices during the COVID-19 pandemic and would like to continue this practice beyond the public health emergency. However, critical issues related to state medical licensure requirements and payments must be addressed for this mode of care to continue to flourish. The AMA House of Delegates took several actions with the aim of doing just that.

  • Modified existing policy on state licensure to exempt interstate physician-to-physician consultations from state-licensure requirements
  • Decided to allow, by exemption or other means, out-of-state physicians providing continuity of care to a patient, where there is an established ongoing relationship and previous in-person visits, for services incident to an ongoing care plan or one that is being modified
  • Advocated that physician payments should be fair and equitable, regardless of whether the service is performed via audio-only, two-way audio-video, or in person
  • Recognized access to broadband internet as a social determinant of health
  • Supported efforts to design telehealth technology, including voice-activated technology, with and for those with difficulty accessing technology, such as older adults, people with vision impairment, and those with disabilities
  • Supported expanding physician practice eligibility for programs that assist qualifying health care entities, including physician practices, in purchasing necessary services and equipment to provide telehealth services to augment the broadband infrastructure for, and increase connected device use among historically marginalized, minoritized and underserved populations.

Prior Authorization

The AMA also continues to address prior authorization as an ongoing administrative burden and barrier to care. Time was devoted to peer-to-peer (P2P) discussions between physicians and insurance providers. To that end, the House of Delegates adopted policy to advocate that:

  • P2P prior authorization determinations must be made and actionable at the end of the P2P discussion notwithstanding mitigating circumstances, which would allow for a determination within 24 hours of that discussion.
  • The reviewing P2P physician must have the clinical expertise to treat the medical condition or disease under review and have knowledge of the current, evidence-based clinical guidelines and novel treatments.
  • P2P prior authorization reviewers must follow evidence-based guidelines consistent with national medical specialty society guidelines where available and applicable.
  • Overall volume of health plans’ PA requirements be reduced, all prior authorization requirements be suspended, and existing approvals be extended during a declared public health emergency.
  • Health plans must undertake every effort to accommodate the physician’s schedule when requiring P2P prior authorization conversations.
  • Health plans must not require PA on any medically necessary surgical or other invasive procedure related or incidental to the original procedure if it is furnished during the course of an operation or procedure that was already approved or did not require PA. 

Scope of Practice

We continue to see other healthcare practitioners work to expand their scope of practice. Specifically, the House of Delegates has come out against the effort to rebrand the health-professional role of physician assistant as “physician associate,” saying the move taken recently by the American Academy of PAs (AAPA) will perplex patients seeking the benefit of physicians’ team leadership and superior training.

In addition, the AMA will “actively advocate that the stand-alone title ‘physician’ be used only to refer to doctors of allopathic medicine (MDs) and doctors of osteopathic medicine (DOs), and not be used in ways that have the potential to mislead patients about the level of training and credentials of nonphysician health care workers.”


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