Value Health Voices · 2026-07-16 · 44 min
Key moments - from our scoring
Substance score
67 / 100
Five dimensions, 20 points each
Dr. John Whyte, CEO of the AMA, addresses urgent threats to physician trust and autonomy in modern healthcare. The conversation opens with deepfakes - AI-generated videos cloning physicians' likenesses to market fraudulent products - a problem Whyte frames as a rapidly developing public health crisis requiring bipartisan legislation, platform accountability, and public education. The AMA has partnered with SAG-AFTRA to advocate for penalties on bad actors and faster takedown protocols, while promoting the 'Ask Your Doctor' campaign to rebuild trust eroded during the COVID era. The discussion pivots to AI's proper role in medicine, contrasting Whyte's vision of 'augmented intelligence' (tools that assist physicians) against autonomous systems like Utah's AI-driven prescription renewals, which Whyte argues constitutes unlicensed practice of medicine. He emphasizes that prescription renewal requires clinical judgment - assessing medication necessity, dosing adjustments, and contraindications - that algorithms cannot safely replicate. On patient-facing AI, Whyte worries generative tools bypass physician oversight entirely, leaving questions of liability, privacy, and accuracy unaddressed. He sees genuine AI potential in oncology decision support and reducing administrative burden (ambient AI for note-taking), but only with physician oversight. The AMA is also pushing back against private equity consolidation of practices and advocating for Medicare physician fee schedule reform tied to inflation, recognizing that corporate ownership consistently prioritizes profit over patient care.
The AMA is working on bipartisan legislation to impose civil and criminal penalties on bad actors who create deepfakes, require platforms to remove deepfakes within a limited timeframe or face penalties, and launching a multimillion-dollar 'Ask Your Doctor' ad campaign to educate the public on verifying suspicious medical claims.
Prescription renewal requires clinical judgment - determining if a patient still needs the medication, whether dosing should be adjusted, and assessing contraindications - which is the practice of medicine and cannot be safely delegated to unlicensed algorithms with unknown safeguards.
Currently, there is no clear accountability mechanism; generative AI tools are not regulated entities, have no privacy obligations, and present no expectation that someone will be liable when patients suffer harm from incorrect AI recommendations.
While the AMA supports innovation, it is concerned that some patients never consult a physician after receiving AI advice, believing the decision is already made, and that patients should protect health information as carefully as financial information and maintain physician oversight rather than outsourcing health decisions entirely to unregulated tools.
The AMA supports 'augmented intelligence' where AI assists physicians in making better decisions - such as decision support in oncology or using ambient AI to reduce note-writing burden - but opposes autonomous AI systems that replace physician judgment or oversight.
Our reviewer’s read on each dimension, with quotes from the episode.
The episode delivers solid, practical insights on AI regulation, deepfakes, prior authorization, and physician payment reform. However, much of the content covers well-worn ground (deepfake risks, AI replacing vs. augmenting physicians, prior auth harms) without sufficient novel angles. The guest does provide some substantive positions (Utah prescription renewal concerns, 'gold card' concept, the finite budget problem in payment reform), but considerable time is spent restating problems rather than proposing concrete solutions.
What problem are they trying to solve? Are prescriptions not renewed in a timely manner? We know most prescriptions are renewed within a day or two.
If we can't completely get rid of prior auth, which is a, which would be a good thing to do, then what's kind of that middle ground?
While the guest articulates a clear position on physician oversight of AI and the dangers of tech-first thinking, the core arguments are relatively conventional in healthcare policy circles. The framing of 'augmented intelligence' versus replacement is standard; the deepfake story, though compelling, is illustrative rather than novel. The connection between private equity consolidation and physician autonomy, and the finite-pie budget neutrality problem, are known issues. Few genuinely counterintuitive or first-principles arguments emerge.
The tech industry is the tail wagging the dog. And it needs to be the medical community that is leading how tech is utilized in healthcare.
I think systems that don't use AI are going to be replaced by systems that use AI with their physicians.
Dr. John Whyte is the CEO of the AMA, a practicing internist, and former senior leader at FDA/CMS - a genuinely relevant operator with authority over the issues discussed. He has held substantive policy positions and clearly engages with real congressional and regulatory work. However, he is primarily a policy and advocacy figure rather than a frontline practitioner managing these challenges operationally at scale in a hospital or practice. His credibility is appropriate for the topics but slightly moderated by his distance from daily clinical realities.
He's held leadership roles at AMA, CMS, WebMD, Discovery Health, and today he leads the nation's oldest and largest physician organization, representing more than 270,000 physicians across the country. He's a practicing internist, public health expert.
I don't know one physician who's been bought up in some capacity by private equity that a year or two later has said to me, this is great.
The episode contains some concrete examples (the physician with the deepfake video, the patient with appendiceal pain who paid for CT out-of-pocket, the major insurer that once abolished prior auth) and references actual legislation efforts. However, specific data is sparse: no metrics on deepfake prevalence, no numbers on time lost to prior auth, no details on the 'multimillion dollar' trust campaign, and vague references to working with CMS without specifics on proposals or timelines. Claims about prior auth inefficacy are stated but not backed with cited studies.
A physician whose mother had called her, worried because she had seen a video of her selling a weight loss product. The thing is, the physician never made such a video.
I had a patient last year, had abdominal pain, had a um, appendectomy a couple years earlier, wanted to order a CT scan. They told the patient they had to have a KUB first.
The hosts ask sharp, relevant follow-up questions and demonstrate deep domain knowledge (e.g., the RUC question, MEI specifics, gold-carding at state level). They push back constructively on vagueness and encourage Whyte to move beyond platitudes. However, the dynamic is somewhat deferential; there are few moments of genuine tension or productive disagreement. The hosts do not aggressively challenge claims (e.g., the assertion that prior auth has 'never' been demonstrated to save money) or press for specifics when Whyte signals he cannot discuss something (e.g., 'I'm not at liberty today to talk').
And I know you have called deepfake doctors a, uh, rapidly developing public health crisis, and then the AMA has been out front sounding the alarm. So I was curious, you know, where are we really?
Do you, uh, it's DMA's view that these regulations, these rules that have come out will meaningfully, meaningfully benefit patients or maybe they haven't gone, they're not going to go far enough.
Computed from the transcript - who did the talking, and the words that came up most.
A physician's mother called her, worried. She'd seen a video of her daughter selling a weight loss product. Her daughter had never made the video - a scammer had cloned her face. That's where we start with Dr. John Whyte, CEO of the American Medical Association, who calls deepfake doctors a rapidly developing public health crisis and has taken it on with an unlikely partner: SAG-AFTRA. As he tells it, members of Congress noticed that when the actors' guild and the physicians' lobby land on the same side, you're probably right. Underneath the fakes is the harder question - trust, and who has standing to give medical advice at all. Whyte's line: social media is the only place where you don't need a license to practice. We push him on where that line actually falls. In Utah, AI now renews prescriptions with no physician in the loop, and he doesn't hedge: the tech industry has become the tail wagging the dog, solving for problems nobody established were problems. But this isn't an anti-AI hour.
Transcribed and scored by The B2B Podcast Index.
Speaker A: So, John, I wanted to start by telling a little story about a physician whose mother had called her, worried because she had seen a video of her selling a weight loss product. The thing is, the physician never made such a video. A scammer had cloned her face. And I know you have called deepfake doctors a, uh, rapidly developing public health crisis, and then the AMA has been out front sounding the alarm. So I was curious, you know, where are we really? Are we actually naming this problem correctly? Maybe you could tell us a little bit more about it.
Speaker B: We are definitely naming this problem correctly. This concept of deep fakes, where someone steals your identity, typically for some bad purpose, such as selling a product, uh, for which we don't really know the value and can cause harm. And it's not widespread, but we're certainly hearing about it. That's why I wanted to take it on at the ama, because I heard from two physicians, same story, whose identity was stolen. So when it comes to a physician, you think, okay, it's not just your personal identity, which is bad enough. It's your professional identity as well. And these are patients that know you. These might be colleagues that think highly of you. And, and now your likeness and also your voice is being utilized to sell a product. And they're never selling healthy products that, you know, promote health. It's. It's always some special, uh, solution or drug that can cause harm. So the AMA has been very active in sounding the alarm. And it's not just for physicians. It's other professions and people as well. And here's the thing. There was no penalty if someone did this. The platforms had no requirement to take it down in a timely manner. So we really have worked on bipartisan legislation to change all that.
Speaker C: You took the question out of my mouth, John. I was wondering, beyond just naming the problem, what kind of strategy is emerging to combat it? Sounds like legislation.
Speaker B: Yeah. There has to, first of all, be issue of penalties that if you don't do anything about it, no one's going to change. So you have to get the bad actors that are responsible for this to pay either a civil or criminal penalty. You have to enforce that. The platforms that once they become aware of this, that they have a very limited time in which they must take it down or they'll pay penalties. And, um, you. We all know if we have penalties there, they'll take it down in a timely manner. But more importantly, we have to develop ways how do we help the public recognize a deep fake. And there's been some studies actually asking radiologists to spot deepfakes. And it's hard and it's only going to get harder as these tools get better. So it's a real concern. I went to an AI, uh conference recently where the presenter showed a video of them doing a conference presentation that they never had recorded. They used a, uh, AI tool to create a speech for them using generative AI and then they're likeness and it looked real. So it's a problem that we need to be proactive on.
Speaker C: Yeah.
Speaker A: And you know, it's interesting how you mentioned that, you know, it's the people, it's hard to detect. This is particularly the thing I was thinking about is elderly people.
Speaker C: Right.
Speaker A: You know, elderly people are the target of so many of these scammers, uh, for money. And so I, I wonder, you know, how can an elderly person be able to tell if something is real or not real? And I know you, you've also teamed up with Screen Actors Guild, right? Because they're facing a lot of the same, uh, crisis around actors likenesses being used for deep fakes. So I'd be curious to hear a little bit more about those.
Speaker B: And you know, I'm very happy to say that certain members of Congress commented how if you have sag, aftra, you know, the Screen Actors Guild and the AMA aligned on something that, you know, you're uh, doing the right thing because you wouldn't think that we would be working with people that might play doctors or play other actors. But you're right, it's really hard to tell because first of all, you don't want to develop a cynicism by everyone that you know. You have to be CSI and investigate every video that you see or every post. But part of it is also just raising an awareness that it is possible, maybe sometimes using some common sense principles, that if there is a product or a financial arrangement that sounds too good to be true, it probably is. And I would say it's the same for anything that you see online or anything that you get from generative tools. You should always double check it. Even if it's someone that you think highly, uh, of, you still want to check.
Speaker C: Such a compelling and interesting topic. And to see that common interest between the AMA and the Screen Actors deal is one of the reasons why we wanted to start our conversation with you tonight exactly on this topic. Our guest today on the Value Health Voices podcast has seen American healthcare from really every angle. He's held leadership roles at AMA, CMS, WebMD, Discovery Health, and today he leads the nation's oldest and largest physician organization, representing more than 270,000 physicians across the country. He's a practicing internist, public health expert, and one of the leading voices on how AI is reshaping medicine. Dr. John White is CEO of the American Medical association in the AMA. His organization, the organization Leads, finds itself at the center of some of healthcare's biggest debates. It's encouraging the responsible use of AI while pushing for safeguards around how it is used in clinical care. The AMA continues to advocate for physicians on issues of prior authorization, Medicare, uh, physician fee schedule and reimbursement, which continues to decline, especially in terms, uh, real terms, in terms of inflation, and is working to protect physicians in an era where AI can clone a doctor's image or voice without their knowledge.
Speaker A: I'm Dr. Amaravari.
Speaker C: And I'm Dr. Anthony Parafati. We are physician executives, and we're the hosts of the Value Health Voices podcast.
Speaker A: We started this podcast to break down the business and policy forces shaping American healthcare today.
Speaker C: We talk with the people shaping these decisions, and we bring a perspective from both the front lines of patient care and the C Suite.
Speaker A: Our goal is simple, give you clear, practical insights to help you lead in a system that's constantly changing. Let's get into it.
Speaker C: Dr. White, welcome to Value Health Forces Podcast.
Speaker B: Well, thank you. It is a pleasure to be with both of you.
Speaker A: Thank you. And we had started off by talking a little bit about this deep fakes and scammers. And I kind of wanted to drill that down a little bit because ultimately, you, uh, know, the question here is really about trust, right? The relationship between the physician and the patient and trust. And we know since the COVID era, a lot of that has been eroded, whether through, you know, skepticism around vaccines or science in general. And I was wondering, you know, at, uh, the ama, what is being done to kind of help combat this level of distrust? And what do you think are some solutions? And what's the responsibility on the physician to help rebuild that trust?
Speaker B: Um, you're absolutely right. Trust is under attack. And I never thought I would start at the ama, where people seem to no longer trust the fda. They don't trust the cdc. And, you know, in some ways, I'm proud in a recent study that the AMA came off as more trustworthy than FDA and cdc. But I'm also kind of sad about that as, ah, someone who worked at fda. And then the other element, and you alluded to it in some ways, is that I like to joke that, you know, social media is the only place where you don't need a medical license to give advice. So we have all these influencers that are basically saying, you should do this for weight loss, you should do this to protect your heart. And, you know, a lot of it is not based on any type of science or evidence. So we're going to be launching a, uh, multimillion dollar ad campaign about trust. And it's focused on, have you asked your doctor? Right. So when you hear these things on social or you see, you know, a deep fake that you may not know is a deep fake promoting some type of service, you want to ask your doctor as what he or she may think and what they would advise. And everything in AI is about trust. It comes to when everyone's using a wearable. Can I trust that information? Do I know that sleep score is right? And, and, and some of it is crazy in a way. If you think if you ask someone, if I asked you how was your sleep? Well, you're gonna look at your watch and your phone and tell me, I
Speaker A: have my woohoo right here.
Speaker B: What's your whoop say? As opposed to, why don't you just tell me whether you're tired or not. So it's really kind of this crazy system that we're developing that we have to focus on how we restore trust. And the good news, in many ways, people have always said to an overwhelming percentage that they trust their physician. Now it has gone down a bit in recent years, but it's still very high. And that's what we need to go back to.
Speaker C: The uh, the physician as the quarterback or you know, the primary care doctor as the shepherd of the care the patient is, is really just the way it has to be. And you know, to medicine is complex and to help patients be steered toward, towards better health and away from trouble is that solemn responsibility that we have. And I wanted to bring up as it relates to AI, where AI, you know, it's a helpful tool and it's helpful to spar back and forth about, you know, what's going on with your foot or your ankle or whatever the case may be. But I want to talk about something where AI seems to be moving already in this particular US State beyond just being a tool. And the AMA has been out front on this, and I'm talking about Utah, because there AI is being used without the involvement of a human whatsoever, without a physician or an app, or as the case may be, to renew prescriptions for patients. And the AMA has pushed back hard on this. Uh, you refer to it as a slippery slope. Walk me through your worry in your own words and what harm you're picturing to patients.
Speaker B: I could talk all day on what's happening in Utah and potentially some other places. This is how I would frame it. And I'm just going to go out there, you know, we're all friends. I'd say part of the problem is that the tech industry is the tail wagging the dog. And it needs to be the medical community that is leading how tech is utilized in healthcare. And it seems like tech finds a great tool or they think is a great tool, and then they try to solve a problem. Where we should start with the problem first and say, what are we trying to solve? So let's talk about Utah. What problem are they trying to solve? Are prescriptions not renewed in a timely manner? We know most prescriptions are renewed within a day or two. They said it's trying to improve access. I'm not sure how it improves access or improves cost. It's a B2C model where a consumer has to pay an additional price to have access to the service. And, you know, we all know on this call that renewing a prescription is more than just checking a box. Right. They may not need to be on it anymore in terms of antibiotics. They may need titration of the dose as it relates to blood pressure, uh, some of the other day. Oh, well, if they're on, you know, uh, a medication like zetimide to treat their cholesterol, it could just even start prescribing it. And I wanted to say that particular medication is not typically the first line agent in primary prevention of cholesterol. It's usually, you know, a statin. So what's the algorithm that they're using? And every drug has risks and benefits, so I don't know what problem they're trying to solve. That sounds very close to the practice of medicine to me. And how are we going to address that? Should there be a licensure standard for that? So there are so many problems with that, but I think it starts off with, what's the problem that they're trying to solve, and is that the best way to do it? The AMA's approach towards AI is augmented intelligence. It helps us as doctors make better decisions and perform better care. It doesn't replace us. And, you know, we all have examples where there have been issues with medications. And there's a reason why pharmacists don't renew medication, nurses don't renew medications, that it's a function of being a physician, and it's not an automated service that you can simply rely on, an algorithm that you know nothing about. And it's not clear to me what safeguards are in place.
Speaker A: Yeah, no, it's true. I mean, I think one of the biggest things around AI and the controversy is these guardrails as, as you're calling them safeguards. Right. Like where, where do we draw that line? Um, because the way I see AI technology is agnostic to any sort of ethics.
Speaker C: Right.
Speaker A: Or values. It all just amplifies what the system wants it to. And so if we're trying to do, uh, efficiency, then AI is a great tool for that. If we're trying to increase knowledge, then AI might be a great tool. If we're trying to speed denials and prior authorization, identification of claims that could be denied, it's a tool for that. So we, we're going to kind of get into a lot of this throughout. But I'm curious, so then where do you see the promise of AI, you said, you know, on the helping clinicians decide treatments and stuff. But what about on the patient side? Do you see an, uh, advantage to the patient going to seek out AI, like the way they used to do Dr. Google when they would come to us armed with everything? Now they're going to AI. What, what's the AMA's position around on patient interaction with AI to be better informed?
Speaker B: Here's somewhat the difference though. When, um, they went to Dr. Google or Dr. WebMD, they still went to a doctor. I'm old enough to remember when they printed everything out. And, you know, we may have, uh, pushed it to the side, but they still came in. But some of these generative tools, they don't even come in. They, they feel like the decision has been made. So that's part of the challenge. And how do I know how these tools were developed? What's the risk when they're wrong? They're not covered entities. There's no expectation of privacy. Who's liable when there's the wrong decision? I think what these tools can do, I think it can be helpful when they get their labs and certainly remove their identifying information, but have an understanding of what it could mean. I think it could help them prompt with the doctor the right questions. Part of the challenge is, you know, things are predicated upon what you put in is what you get out. So how do I help, you know, with a care plan when I go see the doctor? So these tools do have value. And I don't want anyone to, um, leave this podcast thinking that we're not Supporting innovation. We want innovation, but we also want physician oversight. And I'll just say real quickly, I wish people thought about their health information, like their financial information. I don't think most listeners would upload their bank records, all their other personal details. I mean, people don't even take off their identifiers on things. Upload it all in and tell me where you think I should invest my money and then I'll just go ahead and invest it. But I feel like in some ways health, which is their most important commodity, it's a little bit, eh, uh, I'll load it all in and see what I get. And then, you know, what's the harm in trying it? And we, we need to reset that expectation.
Speaker C: You're, you're, you're right about that whole bit about patients seeking advice from AI and then not going in to actually get care because the systems and their ability to provide confident responses to the patient have, uh, moved so far beyond any kind of regulatory mechanism to give any idea to society as to who would be accountable if a patient actually suffers harm. We've got nothing at this point, as far as I know. I don't know if you guys are more informed than me on that, but I don't know.
Speaker B: And you know, I actually think what might happen is in terms of product liability reform, kind of like we're seeing in people are suing Meta and other platforms when they get wrong information. Will we see that with some of these tools. But you ask where there can be tremendous value, I'd say it's something that both of you know very well in terms of oncology. And we know that cancer care is not scrutinized. We know there's disparity. We know if you go to a rural institution versus urban, we know if you go to a community center versus cancer center, there may be different outcomes. Wouldn't it be great if we could develop a tool with the tech industry that everyone with a cancer diagnosis gets a second opinion that a physician can use about your cancer? And what is truly a personalized treatment regimen would be. That's the power of AI. That's including the doctor, that's including the patient, but not autonomously saying, okay, let me plug in information and I'll tell you the treatment. That's the kinds of things that we should be thinking about, addressing the problem of disparity of access and then personalized treatment. That's what excites me about the power of AI not, you know, simply back office functions, but the real power of recognizing Patterns, the patterns of helping influence decision making. That's the value that we want to harness.
Speaker A: Yeah, it's interesting because when we talk, when you talk about oversight, also, you know, there, there was data, what came out like a year or two ago, uh, where they, um, had AI respond back to patients questions versus physicians, and they felt the AI bots were more empathetic. My take on that is that because of physician burnout, you know, we all work, see so many patients in a day, and we're stuck doing documentation at the end of the day. So then to answer those patients questions at the end of the day, it's not that we don't care. It's because we, we're trying to get home to see our families and type them as fast as we can. So there, I feel there might be some role for physician oversight over those AI responses back. But there, it could be a good tool, uh, because, you know, if, if it allows for decreased physician burnout.
Speaker B: Right. And, and perhaps to draft the tool, but not automatically to send it. And I'll tell you, I know that study very well because I was very interested in it and what the examples would be. And, um, you'll see, it'll say, the patient will write in this example, oh, I hit my head, you know, on the door, you know, should I go to the er and it'll say like, okay, well, I hope, you know, you feel better. And here are the five things that you should look at. And you know, do you have a bump and all of that? Or the one was an example, I think I might have splashed, splashed chlorine in my eye. And I'll say, okay, this is what you do. What would we do? Because we're pressed for time, or we're doing it in between. We'll be like, okay, if your eye doesn't itch or it's red, you're fine. Or, you know, if you don't, you know, watch your. Have someone watch you. We write a very short response and generative, uh, AI tool writes, you know, two pages and expresses concern. So of course they're going to feel it's better. But if we could utilize that to generate a response that's helpful. Right. But what's happening there that I would argue is let's use those tools to reduce some of the administrative burden that we have. Where, you know, there's been recent articles about that the number of emails that we get has increased, you know, 60% in a short period of time. And I've seen that. And both of you know this, the email just generates more emails sometimes too. And we don't have that time in the day. And we should be reducing the pajama time where we're all finishing notes late at night and responding to emails and following up on tests. And that's not necessarily the best way to practice anymore.
Speaker C: Awesome. Absolutely. Yeah. The uh, the use of the so called ambient AI to facilitate note writing has been, uh, associated with less of that pajama time. I wanted to, we've talked a lot about AI. I want to take us to an update on some of the other things the AMA is doing. And um, in preparation for talking with you this evening, John, we looking at uh, the most recent House of Delegates ama, uh, House of Delegates meetings. And one of the things we read there is that you voted, your delegates voted in that meeting to take a tougher stance on what's often called corporate control of practices. Everything from private equity to other types of management companies, non physician owners. Could you give us a little update on the latest there about AMA's position in that regard?
Speaker B: And I, um, don't know one physician who's been bought up in some capacity by private equity that a year or two later has said to me, this is great. They've all had lots of challenges with it and maybe the first year is okay, but the second and third is not good. And what the AMA is clearly saying through the House of Delegates, we recognize people are putting profit above patients and that just is not acceptable to us. There's the push then to see more patients in a day decrease the amount of services that one's providing. So the AMA is standing up to that and there are people that want to be employed physicians and that's okay, but people should be able to choose to do that. The system is also set up that it's very hard to do independent practice. But the incentives are all messed up when corporations get involved in how we deliver healthcare. So we have to stand up and push back against that.
Speaker C: Homer, if, uh, I could just add to John's comments. You know, I've had the opportunity to have several conversations with physicians who are in private equity owned practices and practices that have been sold even while they're already there. And every single time there's a level of, of sadness there and regret. In these conversations I've seen mostly, of course these are, let's uh, say physicians who maybe were not senior partners and who didn't financially benefit and who are facing now the difficulties of working in that environment. Universally in these conversations it's almost the same look on their faces. And I really, I really feel for that. It's a tough um, environment in which to practice.
Speaker B: I agree and that's why we're, we're rallying against it.
Speaker A: So one of the other things I wanted to talk about is something near and dear to my heart. So I, I attend RUC as our ruck representative for Radiation Oncology, which obviously know, sits in, in your organization. Uh, uh, and one of the things we talk about a lot is payment reform. And you know over the last 20 years we've seen cut after cut after cut in uh, from CMS to the, the Medicare physician fee schedule. And a lot of this is due to um, a lot of uh, things related to uh, uh, priorities and the budget neutrality. But some of it's tied to the fact that we're not tied to inflation like the way the hospitals are. And I wanted to hear a little bit about what's AMA doing around physician payment reform. How are you guys thinking about uh, inflation?
Speaker B: This is a top priority as you know and it's truly a multi year effort. We're not going to solve this overnight. The challenge is, as you point out, one is budget neutrality. And in that setting when some people benefit, other people don't and it's a really difficult obstacle to have significant reform. And then as you point out that it's not tied to inflation, it's almost, you know, you're negotiating every year that that's a horrible process and system. You know also in the House of Medicine we, we have to become more aligned as well. And the challenges, as you point out, sometimes some people benefit more than others. And you want to think about the long term game for the House of Medicine. But we really are trying to work with CMS and they have been receptive to you know, thinking about different ways to manage the fee schedule. You know, I'm not at liberty today to talk uh, about exactly where things are, but there's been some indications that they recognize the challenges and we really have to hold their feet to the fire. But it's also been about trying to find solutions as well to this. So we're well aware of this issue and are actively working right now with both chambers and in a bipartisan way to try to get reform.
Speaker C: I uh, should uh, mention for the listener that we are recording this episode, uh, about a week before the Medicare physician fee schedule proposed rule will be released for 2027. So we don't have obviously the benefit. This will come out after that that rule is out. Um, and so certainly, uh, that will add, add greater clarity to what's happening next year. But yeah. So what Emma's talking about, for reasons of budget neutrality and other mechanisms and just to ground the listener, is basically every year physicians face a payment cut. And every year, almost m. Every year before the end of the, before the congressional session closes, there is a, is a patch that a doc fix that's, that's passed. And what I'm trying to understand is, is that the best we can get or are we actually on the cusp of, of meaningful reform of getting something, something done? You just mentioned being in touch with those chambers.
Speaker B: It's certainly not the best that we can do now. Some would argue it's better than before. Do you remember SGR and all that? Yeah. Uh, oh, yeah. So I'd say this is minimal, if any improvement. But it's also trying to educate the members of Congress and others these issues. You know, too often we focus on the elements of payment of a dollar amount and what I've been talking about on the Hill, fundamentally these are about issues of access that you want people to practice in rural areas, you have to be able to pay them to sustain practice. You want people to go into different areas of medicine, you have to pay them enough so that they can, you know, run a practice. So there are real challenges on issues of access and quality of care as well patient safety. You don't want lower level providers that don't have as much training as we do, doing services that are inherently physician focused and physician work. So part of it is continuing to educate members of Congress and then trying to find solutions. Part of the problem is also the financial situation in general in terms of dollars, where dollars come from, to address these issues. So, uh, we're working a little bit on the reframing of some of these issues, to be quite honest, and really trying to find those physician champions, which there are several in both chambers, to help advance meaningful legislation. Because you're right, what we currently have is far from even good, let alone the best that we can do. And I'm really trying, you know, to work with our team to find new ways.
Speaker C: And just as a quick follow up to that, you know, it sounds like you're working hard with Congress from your perspective. And Amar made reference to this tying physician payments to inflation. And this is often referred to inflation in this context, the Medicare Economic Index or so called MEI for from the AMA's perspective, is that an absolute must in any physician payment reform legislation? Payments tied to mei, or is there something else that's tougher. The priority, as far as the wish
Speaker B: list goes, the issue of MEI is very important to physicians, the ama, because, you know, typically it's MEI minus some percentage. Right. And there are penalties associated with that. And why should we be in this situation where there are penalties providing care? So we're also trying to recognize what is practical and realistic in the short term as well as the long term. But we can have these situations where it's MEI minus, you know, one or MEI minus two that really impacts the ability to practice medicine. So we need a better solution. But I also think we're going to have to have this pragmatic, piecemeal approach to get there and have a longer term strategy. And I think people are starting to recognize that uh, uh, many of these elements just simply don't make sense in terms of this is not how you would manage, you know, households and things like that. So I think we're making a little bit of progress. But I'm going to be honest, it's an uphill battle.
Speaker A: I was curious and feel free, John, to answer or not answer. I'm, I'm just a little curious about what's, uh. Because you were talking about different specialties and trying to get everything to work together by maybe enlarging the pot out of this existing budget neutrality where the one thing that people talk about is the concept of robbing Peter to pay Paul. You know, we do want to reward primary care more, but not at the expense of specialists. And some of the rules that came out from CMS last year kind of to a lot of specialty societies felt like that concept of robbing Peter to pay Paul. So I was wondering, maybe you can comment a little bit about that.
Speaker B: First of all, I do want to say, um, congratulate you and thank you for being on the Rock the rel Update committee. I've gone to meetings in my past life. Uh, it is the work of a saints in terms of the intensity of it, the, the detail of it and really how important it is. And all of you really serve as volunteers for the profession. So thank you for that. Uh, the big issue is you point out it's a finite pot of money and often they're not willing to significantly increase it. So you, you have to work with that pie that you have and how you divide it is going to make some people happy and some people less happy and it relates to what are the priorities of the administration. So as you point out, if they want to focus on primary care, they're going to adjust. So Primary care gets paid more and if the dollar amount is limited, that means then someone else is going to have to be paid less. And, and that inherently creates a system where we're at odds with each other and that, that doesn't make sense from a practice of medicine standpoint. So we are trying to work very hard even if we could just remove that element of budget neutrality or address some of these other issues. So it is a top priority. And that's why I'm also interested in working with the specialty societies to understand what can we all align on, what can everyone live with. That's some of the aspects as well. Absolutely.
Speaker A: We're stronger, united for sure.
Speaker C: I could move us to another area where uh, there's real heated debate and different sides going, you know, at loggerheads on something and that is prior authorization. Perhaps the most hated thing in the physician's day at dealing with, with all of that and peer to peer calls and the whole nine yards. AMA has been relentless advocating against more oppressive if you're prior authorization help our listeners understand beyond just the obvious frustration for physicians, what does prior auth actually cost for in terms of patients and in terms of physicians, what's the damage?
Speaker B: And as you know, prior auth has never been demonstrated to uh, ultimately, you know, save money for insurers. The challenges is as you know, a uh, physician tells a patient that they need something and then the insurer's like oh no, I don't know if you need it. And often it's by someone who's not even the same specialty as you are. And then when insurers say they're going to make reform to prior auth, they do for a short period of time and they go back to the practices that they were always doing. I, uh, I don't understand what the value is of priorol and, and ah, and none of our physician colleagues think that as well. If they're, they're trying to address fraud and abuse, there are other ways to do that. And guess what? Physicians are not the folks that are, that are the main proponents of fraud and abuse. It, it's other aspects of the healthcare system. So it doesn't benefit anyone. And that's why we've been so vocal about addressing prior authorization. Nobody likes it. I don't know what purpose it serves and um, I don't know how you two feel but I mean it should exist.
Speaker A: I uh, would say one person, one entity likes it, which is the insurer. Because if you think about it as a delay tactic, right, As a way to, you know, get physicians who are so busy they're not going to do those peer to peers which they like you said, would end up winning. So those claims, you know, you don't have to pay for these expensive care, you go the cheaper route and the insurance company has more money in their pocket. That's, that's the argument that physicians and patients make, right?
Speaker B: Or the patient pays for it themselves. I had a patient last year, had abdominal pain, had a um, appendectomy a couple years earlier, wanted to order a CT scan. They told the patient they had to have a KUB first. Seriously, how is that in the differential of determining what a concern would be? Where as you know, there could have been adhesions, there could have been other issues, the patient ultimately decided simply to pay for it themselves because they were in a good position. That's ridiculous as to why they have insurance. But they thought, I, uh, don't, they don't want to deal with it, they don't want to wait several days. Right. They just wanted to get the CT scan. And that's a typical tactic that they use and it is extremely problematic.
Speaker C: It's, it's been something really something to watch over the years. John, you were describing this a little bit. I'll call it the pendulum swinging between aggressive prior tactics, less aggressive. One of our guests on a recent episode of Value Help Voices podcast reminded us that one of the largest insurers, if not maybe the largest insurer in the United States today, at one point, not that long ago, maybe John, in the early part of your career, uh, abolish prior authorization altogether. They didn't do it for anything and, and I, I didn't realize that.
Speaker B: I didn't realize that either. So that's interesting.
Speaker C: Yeah, we can, we won't name them but, but yeah, they, they completely got rid of it for a time and then, and then swung back and are now sort of use it quite, quite heavily. We're coming up on this era where more and more the, you know, the public plans, both the exchange plans, the Medicare Advantage, which is of course, you know, private contracted Medicare, are being held to prior authorization standards. Do you, uh, it's DMA's view that these regulations, these rules that have come out will meaningfully, meaningfully benefit patients or maybe they haven't gone, they're not going to go far enough.
Speaker B: I don't think we know at this point in time and I'm not sure what the value is. I mean the big concern that these programs and pilots are being developed to ultimately Implement in traditional Medicare where it would be many more patients and in theory that there'd be cost savings. But we've already seen there is no demonstrable cost savings in terms of prior authorization. It's either delay or passing care on to patients or having more challenges. But this goes back to the question that we, you know, I addressed early on with AI. What's prior auth trying to solve? Right. I, uh, don't think they've ever meaningfully addressed that in a way. And I love your point about they didn't have prior auth and things were fine. This is about quality of care. And the concern is about delay is denial. And that often can adversely affect patients. We all know stories of that, that patients have waited too long.
Speaker A: Yeah, I mean, in a past life, I used to be an investment banker, so. And when I wore that hat, one of my clients was a, uh, insurer we were trying to get an IPO on. And what Wall street was looking at was these robust benefit management programs that really put a hard a, um, strong emphasis on utilization management as a way to show that they're going to be, uh, you know, high, you know, have good operating margins and everything. So I think it was just a lot of signaling to Wall street, you know, as opposed to actually showing any results, like you said, you know. But it does bring me back full circle to the beginning of this podcast when we talked about AI. I'm curious to hear your thoughts around this whole concept of the battle of the bots now that, um, these insurers are also now using AI to help scour claims that could be potentially denied. Hospitals are using AI to try to make sure all their claims are. In order to prevent those denials. Patients, we had a. Somebody on. Patients are using AI to also fight back. So I'm just curious to hear what's the AMA's position on. On the battle of the bots now?
Speaker B: No one's writing themselves anymore. Right. It started off, or we would say physicians are using generative AI, uh, to write a response to the denial letter. And then the, the bots of insurers are writing the denial to the denial letter starting to begin with. And we've all heard stories where, you know, patients have written up their own response and actually then got something covered. That's way too much work for everyone. It's really insane. It goes back to, we shouldn't be in a position where we have to battle over this with bots. That's, that's the issue. You know, there's been Some discussion around some that create this system where if physicians have kind of stepped up this gold card where 90% or 80% are typically within the standard of care, they shouldn't be subject to any prior authorization. That's something interesting to think about. Let's talk about meaningful solutions because you know, there will be outliers at times and maybe there's justification to look at those. Right. But if people meet, you know, the, the general practices, then they shouldn't be subjected to it, nor should their patients. And then that might help everyone rise as well in terms of their quality of care. Those are the kind of interesting things we'd want to talk about as well. Uh, if people feel that it has to be there.
Speaker C: I'm wondering, just thinking aloud here, you know, hopefully by the end of this, this congressional session there'll be something that gets over the line in terms of physician payment reform and other healthcare related items that are, you know, circling around that, that ah, potential package. You, you wonder if there's an opportunity there for gold carding at a, at a national level. Of course there's certain plans, types that maybe wouldn't, that still wouldn't be applicable to uh, even national legislation. But we, we're in a situation now where certain states, West Virginia is one of them. Michigan I think is another one, perhaps Texas, I may be getting that wrong, where they have the requirement of gold carding, but most of the country is still, still not. And we're just not not seeing it take real significant hold around the country.
Speaker B: Yeah, you know, I, I think it's a concept that we should talk about. You know, uh, it all depends how things are set up as well. But it goes to what's the problem that we're trying to solve. And as uh, the medical community let's kind of step up and think about what could be some interesting ways to address it. So if we can't completely get rid of prior auth, which is a, which would be a good thing to do, then what's kind of that middle ground? And that's why we should be open to solutions and we should talk about it as a profession.
Speaker C: Absolutely. John, we want to of course respect your time and thank you so much for joining us this evening. Been a great conversation. And before we leave each other, if you could make one recommendation, one piece of advice for health system leaders and for your members, for physicians, about how they can think about AI in the way that's the most helpful to them and helpful to their patients. And what would that be?
Speaker B: That that is A tall order to end with. But I, I think it really goes to this concept, and you won't be surprised by this, that these AI tools should help your physician, not replace your physician. And that means whether I'm a patient and talking about the physician that I go to or the specialist that I go to, or it's a health system that is thinking about how do I address some elements of physician work, that it's not to replace the physician, it's actually to let the physician practice at the top of their license to reduce administrative burden. So, and honestly, I don't think that AI is going to replace physicians. I think systems that don't use AI are going to be replaced by systems that use AI with their physicians. Here's the thing, we have a physician shortage. We can't automatically create a huge number of new physicians. So how do these tools become part of a care plan for the patient and for the health system, but still is overseen by a physician? Those are the important elements we should think about.
Speaker A: John, can I ask you one final question before we go then? Uh, given all the uncertainties in medicine and the consolidation by private equity and AI and physician burnout, would you still
Speaker B: go into medicine again if you had
Speaker A: to do it all over again? And what do you tell younger, you know, med school medical students who are thinking about it?
Speaker B: I would. And the reason why I say that I think each generation has had this exciting time of medicine where there's innovation, whether it's in antibiotics early on or it's in robotics, in some aspects of surgery. And I'm here in Chicago today at our AMA headquarters and we actually have archives because the AMA has been around since 1847. And when you look at some of the things in the archives each time, you know, many of the issues have been the same about fighting against insurers, you know, challenges with the government. But it's also been about exciting innovations. And I also think in, in medicine we have found more balance in a way that. You, uh, know, I trained at a time when it was still every other night call. And they'd be like, the only thing wrong with every other night call is you, you miss half the cases. Okay. People don't think like that nowadays and, and that's probably a good thing. So I do think it's such a unique profession that goes to this element of trust where maybe other than the clergy, there's not any field like that where you can have meaningful impact on patients lives. And I look at things like wearables, where I think we still have to have some advancements and, uh, some oversight. But, uh, all those things I could have never done 20 years ago and all these other elements. I think it's an exciting time to be involved in medicine. And it's different how we all trained, but how we all trained is different than if we had parents who were physicians. So it's different, but equally rewarding. So, absolutely.
Speaker C: It's a great note to end on. Thank you again.
Speaker A: All right.
Speaker B: Well, thank you.
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