It’s a simple, three-word rallying cry.
It’s the text on purple and white pins, affixed to the white coats of physicians who gathered at the U.S. House Cannon Caucus Room on Feb. 11 to meet with members of Congress, the anchoring event of the American Medical Association’s three-day National Advocacy Conference (NAC).
It’s what AMA, in part due to its Texas Delegation’s urging, is focused on: An overhaul of the Medicare physician payment system, granting physicians an annual inflationary update tied to the Medicare Economic Index (MEI) – something hospitals, nursing homes, and other health care institutions serving Medicare patients already receive.
And it’s a goal that’s uppermost on the minds of the incoming and outgoing Texas Medical Association presidents.
“It’s very disappointing we still have to come up with fixes on something that should have been fixed many years ago,” President G. Ray Callas, MD, told Texas Medicine. “We can’t continue to die by multiple different cuts. We’ve got to completely fix and overhaul the Medicare payment system to allow practice viability and especially private practices to stay viable.”
Advocacy is a year-round commitment and encompasses a range of issues. At this year’s NAC, AMA focused much of its attention on a single piece of legislation: House Resolution 879.
Even though it was not included in the stopgap funding legislation passed on March 14, the resolution sought to reverse the existing 2.83% payment cut, starting April 1 and continuing through the rest of 2025, providing physicians a 2% inflationary payment increase to partially offset an ongoing payment decline.
Jayesh B. “Jay” Shah, MD, who will be sworn in as TMA’s 160th president at TexMed in May, provides an analogy for HR 879 informed by his wound care specialty.
“I told the Congress members we met with that HR 879 will stop the bleeding,” he said. “But if you want to heal the wound, you need a long-term solution for physician payment, adjusting payments to include the [MEI]. We need comprehensive health care reform that is patient-centric, not insurance-centric. These yearly Band-Aid solutions won’t work in the long run.”
At the June 2024 Annual Meeting of the AMA House of Delegates, TMA put forth several resolutions tied to Medicare physician payment, including a call for AMA to increase media awareness about the need for Medicare physician payment reform, which received unanimous approval, as well as a push for a public relations campaign to increase awareness around the issue.
“Physicians from across the nation rallied with Texas to encourage AMA to put more money and time behind this dire issue that continues to push physicians out of the health care system,” said David Henkes, MD, in Texas Medicine Today’s coverage of the meeting (texmed.org/2024AMAMeeting).
“They’re all sympathetic,” Dr. Shah said of the U.S. representatives they met, noting the resolution picked up more than a dozen additional signers during the three days the AMA was actively advocating for it in D.C. “They understand the issue. But the challenge is figuring out which bucket the money will come from. I don’t think Congress is in the mood to increase the deficit.”
Dr. Shah believes the new administration may be open to fresh ideas for fixing health care, underscoring the importance of staying engaged and continuing to advocate for patients. He left NAC even more committed to the cause and optimistic about the future.
“When we meet colleagues who are equally passionate about being physicians and fixing health care, it inspires us,” he said. “You can’t help but feel energized just being there, surrounded by the positive energy of physicians from across the country.”
Michelle Berger, MD, chair of the Texas Delegation to the AMA, characterized February’s event as “one of the more positive ones” of the many she’s attended, thanks in large part to the Caucus Room event allowing physicians to meet with HR 879 author Rep. Greg Murphy, MD, (R-N.C.), co-sponsor Rep. Jimmy Panetta (D-Calif.), and six other U.S. House members from both sides of the aisle who have been supportive of medicine’s past legislative efforts.
“We had more than 600 physicians and students take the time away from busy practices, right in the middle of flu season,” said Melissa Garretson, MD, a Fort Worth pediatric emergency physician and AMA Board of Trustees member.
“We came together in a bipartisan way on Capitol Hill to advocate for our patients and their access to care, to address the Medicare [physician] payment problem we’re all facing, to make sure physicians can keep their doors open and take care of patients. That’s really what this is about.”
Physicians’ show of solidarity was amplified by their wearing white coats over business attire, Dr. Berger says, reminiscent of TMA’s First Tuesdays at the Capitol events in Austin – creating a striking visual underscoring the urgency of AMA’s message.
“Congress very much gets they need to do something to help physicians, because being excluded from having an update at the end of the year was unacceptable,” Dr. Berger emphasized.
Dr. Callas described the TMA delegation at NAC as “feisty,” “very loyal,” and “the loud squeaking wheel,” taking their stories to multiple legislators as part of AMA’s overall advocacy. (See “Representing Texas,” page 12.)
He reports the legislators he spoke to during his three busy days in D.C., including Sen. John Cornyn (R-Texas), Sen. Ted Cruz (R-Texas), Sen. Mark Kelly (D-Ariz.), Sen. John Kennedy (R-La.), plus 10 U.S. House members from Texas, “were shocked we got another 2.8% Medicare cut.”
“I feel confident they are going to fix this,” he said. “They want to maintain the Medicare payments appropriately to preserve access to care. The Texas legislators – they get it, they hear from their Texas physicians, and they respect what we do. They feel almost embarrassed we’ve allowed this to go on for 20-plus years with no increase in stability.”
Dr. Callas says Texas senators also are interested in addressing issues around prior authorization, considering language in the state’s landmark 2021 gold card law as a jumping-off point for federal legislation.
“As soon as I bring up prior authorization, they want to get that fixed,” he said. “And when you hear our stories about doing treatments, diagnostics, procedures, and then we don’t get paid for it, or it’s delayed in payment, or it’s just a hassle, they say, ‘No wonder y’all are frustrated,’ and they’re frustrated for us.”
The Texas Delegation to the AMA is also calling for AMA to look to Texas in pushing legislation to reform prior authorization, Dr. Berger says.
“We will try to get a federal version of the Texas gold card bill so that all the ERISA plans are covered, which is about 70% to 75% of insurance plans,” she said, referring to the Employee Retirement Income Security Act, a law setting minimum standards for most private industry health plans to protect individuals in those plans (tma.tips/ERISA). “What we did in Texas was a great, but it still is only a minority of insurance plans it applies to.”
Prior authorization has long been a focus of Dr. Shah’s advocacy, and even though the AMA is locked in on the Medicare payment issue, he’ll continue to address prior authorization on the state and federal level, as well as involving the other state medical associations in the Big Five coalition (including California, Florida, New York, and Pennsylvania) that often collaborate with Texas on shared concerns.
“The advocacy strategy moving forward is to go directly to our U.S. senators and representatives in their districts to build relationships and to do work one-on-one individually with each of them throughout the year,” Dr. Shah said. “That probably is going to be more effective.”
TMA is also calling for two key improvements to telemedicine to make patient care more viable.
First, the organization is advocating for more permanent payment parity for telehealth services, so physicians are paid for in-office and telemedicine visits at the same rate. Second, TMA is calling on Congress to permanently repeal existing geographic site restrictions so patients can continue to receive care in their own home – an idea introduced via proposed legislation in both chambers in the previous session.
In the 2025 Physician Fee Schedule final rule issued last November, the Centers for Medicare & Medicaid Services (CMS) made official the 2.83% reduction in its conversion factor, dropping it from $33.29 to $32.35 (texmed.org/2025MedicareCut).
When adjusted for inflation, Medicare physician payment rates have declined 33% from 2001 to 2025. A fifth consecutive year of cuts adds to the financial shortfalls facing physicians.
According to an AMA fact sheet prepared in advance of the 2025 NAC, the reduced payment rates are “forcing practices to operate on extremely thin margins as costs continue to rise. This directly threatens patient access to timely, high-quality care, particularly in underserved areas.”
“This has become the sole issue to focus on, because without payment reform, everything else falls apart,” Dr. Berger said.
HR 879, also known as the Medicare Patient Access and Practice Stabilization Act, is the latest effort from medicine friendly legislators to correct course from Medicare payment’s ongoing downward drift.
Given that the MEI, which gauges the annual change in the cost of running a practice, will increase by 3.5% this year, HR 879 doesn’t entirely bridge the gap, but would provide some relief for physicians (tma.tips/HR879).
“Physicians in America are facing unprecedented financial viability challenges due to continued Medicare cuts,” said Representative Murphy in a Jan. 31 press release announcing HR 879’s introduction. “Access to affordable and quality health care for millions of seniors is in severe jeopardy.
“Doctors see Medicare patients out of compassion, not for financial gain,” he added. “The cost of caring for a Medicare patient far outpaces the reimbursement physicians receive for seeing them. On top of that, the expense of providing care continues to rise due to medical inflation.”
Representative Murphy also tied the Medicare payment inadequacies to health care consolidation trends, contending the combination of medical inflation and declining payment places “enormous financial pressures on physicians,” leading some to consider selling their practices to corporate entities or retiring.
Keeping practices viable and patients healthy
Dr. Garretson says her employment contract binds her to take Medicare patients – a requirement she describes as standard for many of the 77.7% of physicians nationwide employed by a hospital, health care system, or other corporate entity, per an April 2024 Physicians Advocacy Institute study (tma.tips/PAIEmployment).(See “Tracking Texas Physicians,” Aug./Sept. 2024, page 28).
“I am immediately unemployed if I am no longer a Medicare provider,” she said. “And a lot of commercial contracts demand that you’re a Medicare provider as well, because they base the rates off of Medicare.”
Yet, she regards seeing patients who depend on Medicare to access health care as more than a contractual obligation.
“It’s just a part of your soul,” she observed. “When you’re a physician, you take care of patients. That’s why you became a physician, to help people try and maintain their health or improve their health. For the health of a community, shutting your doors is the worst thing.
“That is the rub independent practice physicians are facing right now, and I can’t blame them. It’s an incredibly difficult balance. They want to take care of patients.”
She says taking that message to legislators and their staff members in their Washington, D.C. offices is important, but she sees it as equally important to go back to those same legislators’ home offices in Texas.
“We have to make it sustainable for practices to care for patients in their community, regardless of who their insurer is, for the health of that community. And that’s a local conversation.”
Medicare payment doesn’t go directly into a physician’s pocket, but rather, “goes to the staff who answers the phone, answers your questions, helps you get appointments, helps with prior authorization when that horrible thing is needed, helps us to do the care we need to do to take care of patients,” she said.
“Medicare payment covers the entire gamut of what you need to do to care for patients in your office,” she continued, noting physicians only pay themselves after all other bills are settled. “You can ask, and you’ll get hands that are raised from physicians who are taking out private loans to pay their office staff. That still happens. It’s been going on now for 20 years and has to stop.”
As more Texas physicians become AMA members, the state has increased its delegation from 20 members last year to 22. This coincides with Dr. Berger’s first year as chair, succeeding Dr. Henkes, who led the Texas contingent for more than a decade (See “Touting Texas,” March/April 2025, page 34, texmed.org/DrHenkes2025Profile).
The Texas Delegation continues to play an integral role in the AMA’s advocacy, and physicians who have served on AMA councils and committees in recent years – including Gary Floyd, MD (Council on Legislation), and Dr. Shah (Reference Committee on Medical Practice and Facilities) made their voices heard at this year’s NAC.
In a June 2021 speech closing out her year as AMA president, Susan R. Bailey, MD, a Fort Worth allergist and immunologist who led the organization through an especially challenging year marked by the COVID-19 pandemic, praised the organization’s advocacy for medicine.
“It is impossible to know whose lives we touch when we stand up for what’s right,” Dr. Bailey said. “The same can be said for our work together at the AMA and the countless people we inspire through our leadership, our advocacy, and our action.”
With the national discussion over the high cost of health care costs sure to continue, Dr. Garretson notes AMA has an opportunity to innovatively address medicine’s myriad issues – and Texas can once again take the lead.
“The best part about the Texas Medical Association has always been its willingness to think outside the box and come up with creative solutions to solve problems, to effect change,” she said. “That’s how we got landmark liability reform. And learning that from a very young age in practice in Texas, that helped me think more creatively. I think Texas people running for the board tend to be creative, out-of-the-box thinkers.
“They’re willing to try different ways to accomplish our goals, and we need an all-hands-on deck approach. That partnership between TMA and AMA has never been more important than it is now.”