May 8, 2020
Issue SpotlightAMA fighting for IMG physicians on several fronts with many allies
The nation needs all available physicians engaged in combatting COVID-19. The AMA is working on several fronts with multiple partners to ensure that non-U.S. citizen international medical graduates (IMG) practicing in the U.S. and individuals in the Deferred Action for Childhood Arrivals (DACA) program can join the fight.
"Our health system desperately needs to deploy every physician, nurse and medical provider capable of responding," wrote AMA President Patrice A. Harris, MD, MA, in a recent Leadership Viewpoints column.
"The stakes are far too high not to take advantage of every available resource we have."
AMA advocacy efforts include:
- Sending a letter to Vice President Mike Pence strongly urging the Administration to exempt IMG physicians with J-1, H-1B and O-1 visas from any future immigration bans or limits so that these doctors can maintain their lawful non-immigrant status while practicing in the U.S. and responding to the COVID-19 pandemic.
- Joining with more than 70 other health care organizations in sending a letter to Vice President Pence and Congressional leaders urging them to take regulatory and legislative action to maintain work authorization for those with DACA status during the COVID-19 public health emergency.
- Working with health care, business, immigration and attorney organizations to support the bipartisan Healthcare Workforce Resilience Act that would capture unused visas from prior years and allocate them to doctors and nurses to alleviate the growing health care worker shortage.
"Physicians fighting COVID-19 are eager to hear these words: 'Reinforcements are on the way,'" Dr. Harris said. "Recapturing 15,000 unused immigrant visas for physicians through the Healthcare Workforce Resilience Act would ease the burden on front-line physicians who are risking their lives in understaffed hospitals."
Similarly, in the letter to Pence regarding IMG physicians with J-1, H-1B and O-1 visas, AMA CEO and Executive Vice President James L. Madara, MD, noted the vital role IMG physicians are serving during the pandemic and how they are helping alleviate the physician shortage—especially in underserved regions.
"The U.S. health care workforce relies upon health professionals and scientists from other countries to provide high-quality and accessible patient care," Dr. Madara wrote. "As such, during this pandemic, it is more critical than ever to ensure that the U.S. has a fair and efficient immigration system that strengthens the American health care system and advances the nation's health security."
The U.S. Supreme Court heard arguments on the DACA program last fall. The DACA letter urges Congress and the Administration to retain the program regardless of the court's decision and to support a bipartisan Senate bill and House of Representatives-passed legislation that would "allow undocumented young people to continue their employment, education, training and research in the health professions."
The physician shortage that existed before the pandemic continues to become more severe while the need for caregivers is growing daily during the public health emergency. Physicians and other medical professionals who are available to help must be allowed to do so.
While physicians were exempt from an April 22 presidential executive order suspending the issuance of immigration visas, Dr. Madara's letter notes that the order also called for a review of non-immigrant programs that could potentially affect physicians who hold J-1, H-1B and O-1 non-immigrant visas.
Read more here.
On May 4, the U.S. Food and Drug Administration (FDA) issued updated policy on antibody (serology) testing for COVID-19. The new policy is more restrictive on test manufacturers, after a flood of serology tests came to market, some with poor performance and fraudulent labeling. FDA will now require all commercial test manufacturers to apply for an Emergency Use Authorization (EUA) to offer their tests on the market. The FDA has also provided recommended performance criteria for these tests. Tests developed as laboratory-developed tests will still be allowed to be offered without going through the EUA process.
Importantly, FDA has noted the many limitations of serology tests currently in the marketplace, including the significant risk of false positive results where there is low disease prevalence. FDA noted that these tests should currently be used in limited circumstances, such as population-level study, to evaluate potential donors for convalescent plasma and in other well-defined testing plans in concert with other clinical information.
The AMA has ongoing concerns about the performance of many serology tests currently being marketed and does not recommend these tests be used by individuals as a determination of individual immune status. Similarly they should not be used to discontinue physical distancing and individuals should continue to follow all current public health recommendations to stop the spread of COVID-19.
On April 30 the Centers for Medicare and Medicaid Services (CMS) issued a second Interim Final Rule with comment period that gives providers additional regulatory flexibilities during the current public health emergency. Among some of these regulatory changes are a few provisions that will be especially beneficial for graduate medical education (GME) students and residents during this time.
Firstly, indirect medical education (IME) payments will not be affected by the number of available beds in a hospital and the available bed count will be "considered to be the same as it was on the day before the emergency was declared." Additionally, CMS is allowing teaching hospitals to claim the full-time equivalent (FTE) time of residents at other hospitals on its Medicare hospital cost report during the declared emergency under certain circumstances. Moreover, teaching physician supervision rules have changed. Now the list of services that may be provided through the primary care exception have been expanded, and teaching physicians may "review the services provided with the resident, during or immediately after the visit, remotely through virtual means via audio/video real time communications technology."
A bipartisan collection of 90 members of the House of Representatives sent a letter requesting that an anticipated fourth piece of legislation to address the coronavirus pandemic incorporate policies to help physicians and other health care workers cope with the mental health burdens of treating COVID-19 patients. Representative Raja Krishnamoorthi (D-IL) spearheaded the letter to House Speaker Nancy Pelosi (D-CA) and Majority Leader Kevin McCarthy (R-CA) that requests the Department of Health and Human Services (HHS) establish a grant program to allow health care employers and facilities to confidentially assess and treat the mental health of coronavirus front line health care workers. In addition to grants, the letter urges HHS to fund and complete a comprehensive study on health care worker mental health that emphasizes organizational, systemic, and occupational factors that contribute to stress and burnout, as well as ways to mitigate these issues.
The AMA worked closely with Rep. Krishnamoorthi on the specific policy proposals to highlight to House leadership and the letter was ultimately endorsed by more than 50 medical organizations. Rep. Krishnamoorthi, in conjunction with the AMA and other medical specialty organizations, are actively pursing the inclusion of these mental health policy proposals in future coronavirus legislation.
The AMA sent a letter to the Acting Secretary of the Department of Homeland Security (DHS) requesting that the department investigate reports that pregnant women seeking asylum in the United States have been denied timely access to health care by U.S. Customs and Broder Protection agents. There is still much that is unknown about the effects of COVID-19 on pregnant women and their unborn children, and the AMA recognizes the need for programs and staff training to address the distinctive health care requirements of detained women and adolescent females, including gynecological and obstetrics care for pregnant and post-partum women. AMA is urging DHS to ensure that it has appropriate medical policy surrounding maternal health and that it adequately trains its staff on the protocol and special needs of pregnant and postpartum women.
The AMA's Advocacy Resource Center (ARC) continues to support physicians by updating a suite of state-based resources to help medical societies and other stakeholders address the COVID-19 pandemic. Topics addressed include telemedicine, liability protections for physicians, Medicaid, opioid use disorder (OUD), chronic pain, elective procedures, prior authorization and more. New and recently updated documents include:
- COVID-19 policy recommendations for OUD, pain, harm reduction
- Advocating for forgotten populations during COVID-19
- The importance of safe storage and disposal during the COVID-19 pandemic
- Issue brief: Reducing barriers to vital pain medication during the COVID-19 pandemic
- Fact sheet: Elective procedures (Summary of federal and state action)
- Chart: State Telemedicine Executive Orders, legislation and regulatory activity
- State chart: Approved 1135 waivers
- AMA Opioid Task Force microsite (updated with COVID-19 specific recommendations and resources)
If you have any questions concerning these or other resources, please email ARC@ama-assn.org.
The AMA is urging parents and all those with medications in the home to remember the importance of safe storage and disposal during the COVID-19 pandemic. The reminder comes at a time in light of a new study from Vanderbilt University Medical Center finding that while 78% of Tennessee parents are concerned about their children "becoming addicted to prescription opioids," more than half of parents do not dispose of unused prescription opioids. The study surveyed 1,100 Tennessee parents to help gauge parents' opinions and actions related to prescription opioids.
"This release of the poll identified a blind spot for parents," said Stephen Patrick, MD, a neonatologist at the Monroe Carell Jr. Children's Hospital at Vanderbilt and director of the Center for Child Health Policy.
"Parents perceive that opioids are risky to children, but not their own children. This may be one reason why we found that most parents are not taking an easy step to protect their children – properly disposing of leftover opioids in their homes."
Safe storage and disposal of all medications was one of the first recommendations of the AMA Opioid Task Force.
While not specific to parents' actions during the COVID-19 pandemic, Dr. Patrick emphasized that the findings are particularly relevant given the likelihood of increased refills and fewer trips to safe disposal sites.
"Certain medications can be safely flushed, and some safely thrown away in the trash if mixed with coffee grounds, cat litter or other garbage," said Dr. Patrick, who said the FDA has disposal information that everyone can use.
Physicians have a unique opportunity to drive health equity forward by acting as a trusted voice, encouraging patients to participate in the decennial Census. Accurate statistics play a critical role in the equitable distribution of federal assets, and dedicated census officials are working to ensure complete and accurate enumeration despite the challenges posed by the COVID-19 pandemic.
Ways physicians can help include posting Census Bureau resources on their practice websites, downloading and displaying Census posters in their offices and exam rooms, and including Census messages on billing statements. Learn more in two new episodes in the AMA Moving Medicine podcast series, available on Apple Podcasts, Google Play and Spotify.
For more information on responding to the 2020 census, visit the official website at 2020census.gov.
Learn from three experts at the AMA about the financial strategies and new federal programs available to physician practices to address the unprecedented challenges facing physicians during COVID-19. Watch a recorded webinar here.
Using data from the Annual Rate Survey Issues of the Medical Liability Monitor (MLM), this report summarizes changes in medical liability premiums and provides examples of trends in premiums for select geographic areas for 2010 to 2019. The major trend in premiums has generally been one of increasing stability. The proportion of premiums that did not change from the previous year reached a high of 80.8% in 2018. Also of note, fewer premiums have been falling over time. The new data, however, marks a significant departure from prior year trends. The share of premiums that increased year-to-year went up substantially to 26.5% in 2019—the highest percentage observed since 2006. It is not yet clear, however, whether this signals a trend of increasing premiums or whether it may be just a blip.
The 2020 edition of "Medical Liability Reform – Now!" is now available.
"Medical Liability Reform – Now!" provides MLR advocates with the information they need to advocate for and defend MLR legislation. It includes background on the problems with the current system, proven solutions to improve the liability climate and a discussion of innovative reforms that could complement traditional MLR provisions.
May 20: Given the ongoing stress that COVID-19 has placed on individuals seeking care for opioid use disorder (OUD), Get Waivered, ACEP and ED-Bridge are partnering to provide the first Zoom DEA X waiver training class on May 20 from 10 a.m. to 6 p.m. Eastern time. Elevated levels of anxiety and depression caused by isolation measures are having a particularly severe impact on patients with opioid addiction. Given the realities of isolation and the increased difficulties of accessing care during the COVID-19 pandemic, many patients who struggle with addiction are having a harder time finding the treatment they need. Combined with new guidelines on telemedicine, remote waiver training will allow physicians to manage OUD in an outpatient setting while maintaining required social distancing.
Please register at getwaivered.com/remote.