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CHICAGO -- During focused committee discussions, some delegates pushed back on the American Medical Association's (AMA) plan to improve physician pay, arguing that the association's current efforts are not enough.

Speaking to a packed room at the , Virginia Hall, MD, a delegate for the Senior Physicians Section, called on the AMA to advocate more strongly for "fair reimbursement" under Medicare.

"I'm tired of the government underfunding us, over-promising that we can deliver the care... and shifting the blame to us, when it's Congress that should be blamed," Hall said.

Physicians saw a 22% drop in reimbursement rates over the last 20 years because the government refused to link Medicare payment updates to inflation, which is driving private practices out of business, Hall said.

She suggested linking annual payment updates to inflation, or to the bump hospitals, ambulatory care facilities, and medical device and pharmaceutical companies receive.

David Henkes, MD, a delegate from Texas, in a separate resolution, called on the AMA to declare Medicare payment reform the AMA's top priority, and increase federal and state advocacy budgets for the issue. The resolution also mentioned funding for "fly-ins" to Washington D.C. and a "white coat march" all focused on linking Medicare payment to inflation.

The Texas delegation, in its draft resolution, also called for the AMA to provide annual and interim meeting progress reports on achieving these goals.

In a third resolution, Cyndi Yag-Howard, MD, a delegate for the American Academy of Dermatology, similarly called on leadership to "enhance AMA's approach to the fight for fair payment, because what we are doing now simply is not working," she said.

As the owner of a solo dermatology practice that accepted Medicare patients for more than 20 years, Yag-Howard, reluctantly stopped taking care of Medicare patients, she said.

Ilse Levin, DO, who spoke on behalf of the Board of Trustees, said the AMA has already begun work on a national campaign and is engaging patients at the grassroots level, including through focus groups that started last month.

A few delegates called for colleagues to trust the Board to do its work, but that answer didn't satisfy everyone.

Scott Shapiro, MD, a delegate for Pennsylvania, who stressed his support for the Texas delegation's ideas, demanded that AMA do more.

"When we hear leadership get up and say something we're already doing, leadership is missing the point ... Our strategy has failed us," he said, and delegates are trying to put forward a better one.

Shapiro urged leaders not to "water down" the proposed policies in their own recommendations to the House.

Daniel Choi, MD, an alternate delegate for the Private Practice Physician Section, echoed Shapiro: "Prioritizing Medicare payment reform as a number one issue and officially committing a major financial investment into this issue will absolutely help us boost membership and change the false perception that AMA does not watch out for physicians," Choi said.

He also urged his fellow delegate to view the money being put toward these efforts as a "much needed investment" that would boost morale and help protect seniors' access to care, rather than an expense.

The line for those expressing support for payment reform and the draft policies snaked outside the room.

Ultimately, the reference committee's recommendations released a day or two later declared payment reform an "urgent advocacy and legislative priority."

In addition, the committees' own draft resolution integrated most of the delegates' policy ideas, including prioritizing increases to state and federal advocacy budgets, and a pledge to report back at each annual and interim meeting on the status of the AMA's goal (linking Medicare payment to the annual percentage increase in the Medicare Economic Index, at a minimum) until it is achieved. Some of the more prescriptive details regarding fly-ins and marches were omitted.

On Tuesday afternoon, the recommendations were adopted without protest, and AMA President Jack Resneck Jr., MD, thanked delegates for their ideas and energy, which bring momentum as the AMA prepares "to fight for and achieve long overdue fixes to Medicare payment," he said.

Resneck reiterated the message he shared Friday evening in what was meant to be his final speech as president: "Practices are on the brink. Our workforce is at risk. Access to care stands in the balance, and duct-taping the widening cracks of a dilapidated Medicare payment system is not sustainable ... We definitely need your help on this."

Moving forward, the AMA's is "our advocacy priority," he said, laying out specific goals tying Medicare to inflation, and fixing budget neutrality and the Merit-Based Incentive Payment System.

"We will demand it. We will fight for it. Let's get this done," he said, to a standing ovation.

Committee members responsible for the policy report also received a standing ovation.

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