AI, with potential benefits and risks, lands among top priorities in health care

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Artificial intelligence (AI) is among the top priorities that physicians, other clinicians, and administrators are dealing with in the U.S. health care system.

The Medical Group Management Association (MGMA) for the first time included AI in the association’s 2024 Advocacy Agenda. MGMA also published eight new position papers outlining the association's stances on issues.

A top priority is reversing the 3.4% cut to Medicare physician reimbursement for 2024, said Anders Gilberg, MGMA senior vice president of government affairs. Gilberg used the social media platform X, formerly Twitter, to post his statement.

“While reversing this cut is of foremost importance, permanent reform to the Medicare payment system is needed to sustainably support practices and avoid these yearly threats to their financial viability,” Gilberg said. “We urge Congress to institute changes to budget neutrality in unison with a long-needed annual inflation-based update – a holistic approach would go a long way towards establishing an appropriate reimbursement system.

“Beyond comprehensive payment reform, we call on Congress and the Administration to focus on commonsense solutions which alleviate onerous administrative burdens, improve the timeliness of clinical care delivery, and prohibit the predatory business practices of health insurers who put profits over patients,” Gilberg said.

Technology at the top

AI-enabled programs are helping in medical practice management and there is potential to do more. There also are potential risks, such as mass, rapid denials of prior authorization requests or large language models offering “hallucinations,” or inaccurate answers to queries, the MGMA paper said.

MGMA’s advocacy priorities will be:

• Medical groups should be able to easily understand the use and function of AI products, whether stand-alone or integrated with other technology.
• Policies should be aligned across agencies to avoid competing and confusing standards.
• Deployment of AI should avoid intentional exacerbation of current administrative hurdles.
• Payers must be transparent and disclose use of AI in claims processing and coverage limitations.
• Patient privacy must remain a priority.
• All attempts should be made to mitigate discrimination and bias in AI.
• Medical groups, physicians, other clinicians and providers should be protected from liability of AI pertaining to conditions of the technology developed outside the practice.

Main priorities for 2024

Along with protecting financial viability and using AI responsibly, MGMA published additional advocacy priorities for 2024:

• Reducing prior authorization burdens. Health plans need more transparency and there should be uniform national standards and increased automation.
• Advancing value-based care. Practices should have a choice to move away from fee-for service payment and toward alternative payment models (APMs) that offer support, incentives, reimbursement and flexibility. Incentive payments for APM should be reinstated and extended beyond 2025 for at least six years.
• Improving quality reporting. MGMA supports maintaining traditional Merit-based Incentive Payment System (MIPS) reporting as a reporting option under the Quality Payment Program, and encourages federal regulators to streamline other quality reporting programs to improve clinical relevance and reduce the reporting burden.
• Promoting standardization and efficiency. Inefficient and inconsistent standards increase costs and administrative burdens, so MGMA supports policies to standardize transactions, documentation requirements, claims review processes and audits.
• Telehealth. MGMA supports long-term solutions with cost-effective, high-quality care while appropriately paying practices.
• Expanding the physician workforce. Federal legislative efforts must strengthen and expand physician training programs.
• Improving the implementation of the “No Surprises Act,” (NSA) with minimal fees for independent dispute resolution so medical groups can initiate that process. Medical groups need clear implementation guidelines and more time to understand the processes and workflows to comply with NSA.

In the position papers, MGMA also is calling for congressional action to reform the Physician Self-Referral Law, known as the Stark Law, to align with value-based payment reform. Now more than 30 years old, “the law’s restrictions make it difficult for independent physician practices to coordinate care for their patients, even within their own practice.”

Congress also should act to end “predatory” fees that health plans and third-party vendors charge for receiving electronic payments. It costs money for practices and those who opt out of electronic payments get reimbursed through checks or virtual credit cards that also have fees and create an administrative burden, according to MGMA.