WASHINGTON — Dr. Timothy McAvoy, an internist from Waukesha, Wis., held his infant granddaughter Tuesday while standing in the Longworth House Office Building, waiting to talk to a congressional aide about increasing Medicare pay for doctors.
Facing a highly partisan Congress where Republicans have vowed to cut federal spending, McAvoy hoped his Midwestern charm, along with a dose of supporting data, would sway members to remember physicians' cause.
"'Wisconsin nice' is a real thing," said McAvoy, who graduated from medical school in 1973. "Whether it will translate to the votes we need, we will have to see."
McAvoy was one of about 350 physicians who came to Capitol Hill this week to lobby Congress on behalf of the American Medical Association. Although they left their white coats at home, they were still there as doctors. Their goal was to build support for the organization's "Recovery Plan for America's Physicians" — a wish list that includes a pay raise, relief from insurance company prior-authorization demands, and more federally funded residency slots to train more physicians.
The campaign motto packs a pat on the back for these medical professionals: "You took care of the nation. It's time for the nation to take care of you."
The AMA represents about 250,000 doctors, roughly a quarter of the U.S. physician workforce. And sending its members in droves to Washington to make their case is nothing new. But this was the first organized group effort in more than three years, because of the COVID pandemic.
In that time, many congressional offices have been claimed by new members with different legislative aides. As a result, physicians say, they need to spend in-person time teaching them about the complexities of Medicare payment rules and other topics important to the practice of medicine.
While the AMA has a full staff of lobbyists in Washington, association officials say their best weapon is often doctors themselves, who wrestle with insurance company red tape and bureaucratic reimbursement rules every day. "There is nothing quite like telling members of Congress how things work in their district," said Dr. Jack Resneck Jr., AMA president and a dermatologist at the University of California-San Francisco.
Before they met with House and Senate members and their aides, AMA staffers briefed the doctors at a downtown hotel on how to deliver their message for maximum effect.
The main lesson: Show how these changes will help their patients, not just their business practices. Detail how patients are facing delays getting drugs and services because insurer approval is required first. Mention they know of doctors retiring early, selling their practices to hospitals or private equity firms, and how this makes it difficult for patients to find a doctor.
"We have the policy and data, but it's these stories that will stick in their heads," an official AMA lobbyist told them.
They also were advised to listen and seek common ground with members of Congress.
"When you go up on the Hill, let those congresspeople know how much you care about your patients and want to keep doing your job," an AMA staffer said, sounding almost like a coach outlining how a strategy should work on game day. "Let them know how we care about our patients and want to improve the health of the nation."
A bid to raise Medicare payments
But it was also a pitch about money, coming from some of the country's well-above-average income earners. (A government estimate for the category "physicians and surgeons" set the median 2021 annual income at $208,000.) Tell Congress that with higher payments from Medicare they could deliver better care and service to patients, the doctors were urged.
"No one wants a system that is not fiscally stable, and no one wants to see doctors busy filling out paperwork to fight denials from insurers," one AMA staffer said.
They were also told to remind Congress that Medicare payments to doctors do not include an automatic adjuster for inflation, even though hospitals and nursing homes get that. As a result, they argue, Medicare pay to physicians has fallen 22% since 2001. They want Congress to update their pay to keep up with inflation. Doctors say if current trends continue they may have to limit the number of Medicare patients they see. Medicare, for many doctors, is a primary revenue source. "Medicare beneficiaries are at real risk of not getting care," Resneck said.
While Medicare payments are still a vital issue for many doctors, most physicians today work as employees of hospitals, insurers, and other corporate entities and often are paid a salary rather than a fee for each patient service.
AMA lobbyists cautioned them that asking for higher pay has met pushback in recent years. That's largely because the Medicare Payment Advisory Commission, which advises Congress, has repeatedly said Medicare rates were high enough and there was no sign Medicare patients were having widespread trouble finding doctors.
Indeed, in its latest report, in March 2022, MedPAC wrote: "The Commission's analyses suggest that Medicare's aggregate payments for clinician services are adequate." At their January meeting, however, MedPAC members signaled a change in this position by approving recommendations to link physicians' payments to 50% of the Medicare Economic Index, which is a measure of practice cost inflation.
In the 2022 report, MedPAC also noted that during the pandemic Congress provided tens of billions of dollars in relief funds to clinicians, and predicted demand for their services would reach or exceed pre-pandemic levels by 2023.
Dr. Tosha Wetterneck, an internist from Madison, Wisconsin, who joined McAvoy in Tuesday's meeting, said after a session with Wisconsin Republican Rep. Mike Gallagher's legislative aide that she felt satisfied he had heard their message about needing help to keep physician offices open and fully staffed. She stressed that doctors need more money to pay nurses, medical assistants, and receptionists when they are being lured away with higher pay from other employers.
"It's not a one-time thing," she said about this week's lobbying. "It's about forming relationships. We are in it for the long term."
Face time with members of Congress
Wetterneck said the aide told her group Gallagher supports changes to insurer prior-authorization rules. Asked whether he would support higher payments to doctors, she said: "Everyone supports us trying to keep the lights on, but it all depends on how the sausage gets made."
The aide told the doctors about Gallagher's bill to stop anti-competitive tactics that would limit employers' use of noncompete clauses in contracts, which the physicians said would help them when they change companies, Wetterneck said.
Over two days, the Wisconsin physicians met with nine members of Congress from their state, though it was mostly aides in the House, as the lower chamber was on recess.
They met Wisconsin Sen. Ron Johnson, one of the most conservative members of Congress, who often rails against increased government intervention and spending.
Wetterneck said Johnson spent nearly an hour with them, during which he explained that he wanted doctors to be the trusted profession again rather than be crushed by rules and red tape. The senator told them he understands that physician practices need money to pay staff members and care for patients. But that doesn't guarantee he will vote for an increase, she said.
Dr. Melissa Garretson, a Fort Worth, Texas, pediatric emergency medicine specialist, clutched a Diet Coke as she left a House cafeteria and headed to her fifth of eight meetings in the House and Senate.
She said the payment issue resonated with members of Congress, particularly when the message focused on helping doctors keep practices open in rural Texas.
She was ready with a story from just last week: An insurer refused to cover a liquid medication for her 4-year-old patient and would pay only for a pill too big for the child to swallow. "Prior authorization is a roadblock to patient care," she said.
While treating emergency patients is her job, she sees lobbying Congress as an extension of her role.
"Our patients need the care they need when they need it, and to not advocate that is not to do my job as a doctor," Garretson said as she walked into a Texas House member's office.
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