Clinical Care Policy and Priorities

AAMC-member teaching hospitals and faculty physicians cultivate and provide high-quality health care, especially for the most complex and vulnerable patients, many of whom are unable to receive care elsewhere. While only 5% of all inpatient, short-term, nonfederal U.S. hospitals are AAMC-member teaching hospitals, these teaching hospitals and their physicians provide a disproportionate amount of care for their communities. AAMC-member teaching hospitals also provide specialized services to their communities that often are unavailable elsewhere. 

• Medicare Support for Physician Training
• Health Care Coverage and Access
• Rural and Underserved Community’s Access to Health Care
• Maternal Health

Medicare is the primary public source of funding for Graduate Medical Education (GME). Medicare funding helps offset the stipends paid to residents, the costs of supervision, and the increased costs associated with operating teaching programs. As part of the Balanced Budget Act of 1997, a hospital-level cap was placed on Medicare support for GME which has stymied significant increases in residency training, creating a bottleneck for the physician workforce.

A broad bipartisan coalition of members of Congress representing diverse districts, states, and communities worked together at the end of 2020 to provide 1,000 new Medicare-supported GME positions in the Consolidated Appropriations Act, 2021– the first increase of its kind in nearly 25 years. This increase in residency positions was an important initial investment and first step, but more is needed to help ensure a diverse physician workforce and that patients throughout the country can access the primary and specialty care they need.

Resources

• AAMC Supports Resident Physician Shortage Reduction Act of 2023
• Senator Boozman (R-Ark.) Op-Ed: Outdated policy contributing to a worsening physician shortage
• AAMC Testimony to Senate HELP Committee Hearing on Health Care Workforce Shortages
• State-by-State Data on Graduate Medical Education
• Factsheet - Graduate Medical Education: Training the Physician Workforce
• The Role of GME Funding in Addressing the Physician Shortage
• Physician Supply and Demand - A 15-Year Outlook: Key Findings
• Bill Summary: The Resident Physician Shortage Reduction Act of 2023 (S. 1302)
• Bill Summary: The Resident Physician Shortage Reduction Act of 2023 (H.R. 2389)
• Bill summaries: The Opioid Workforce Act of 2021 (S. 1438) and The Substance Use Disorder Workforce Act of 2021 (H.R. 3441)

The AAMC is committed to ensuring that all people – regardless of their socioeconomic status –  have access to high-quality, affordable health care coverage. We strongly support policies to strengthen the Affordable Care Act and reduce the number of uninsured people throughout the country, such as expanding subsidies in the ACA marketplaces and providing incentives to ensure that all states expand Medicaid under the ACA.

The Medicare programs provides coverage for over 62 million elderly and disabled individuals, while also providing fundamental support for the critical missions and complex patient populations served by the nation’s teaching hospitals and their affiliated physician faculty. Medicare-supported graduate medical education is a cornerstone of physician training, covering a crucial share of training costs. Medicare also helps support the additional costs associated with caring for the complex Medicare patients and specialized services available at teaching hospitals.

The AAMC also strongly supports increasing access to Medicaid, which is a key source of coverage for the nation’s most vulnerable patients, many of whom have complex and costly health care needs. Major teaching hospitals and their faculty physicians provide care for a disproportionate number of these patients, despite unsustainably low Medicaid reimbursements.

For the health of all, it is essential that the nation finds ways to increase access to coverage and narrow the gap in health care felt by many communities. Without coverage, individuals often forgo routine care, which leads to more costly and complex care later.

Resources

• Virtual Congressional Briefing - Confronting the Mental Health Crisis: The Value of a Team-Based Approach
• AAMC Mental and Behavioral Health Advocacy Priorities
• AAMC Comments to Senate Finance Committee on Addressing Barriers to Mental Health Care
• AAMC Comments on Medicaid Request for Information: Access to Coverage and Care in Medicaid & CHIP
• AAMC Stakeholder Letter on Medicare Reforms
• Group Letter Supporting Proposed Prior Authorization Reforms for Medicare Advantage 
• AAMC Submits Comments on Essential Health Benefits RFI

Teaching hospitals and their faculty physicians have invested in the infrastructure necessary to provide telehealth services to enhance medical care for their patients, especially during the COVID-19 public health emergency (PHE). Telehealth provides both patients and providers with a variety of benefits and expands access to care, particularly for those in rural and other underserved areas. The AAMC supports the telehealth waivers and regulatory changes that Congress and CMS have implemented in response to the PHE.

We also support additional efforts by Congress to ensure that Medicare beneficiaries and other patients can maintain this access to telehealth services beyond the pandemic, including permanently removing patient location and rural site requirements to allow patients to access telehealth visits in any location (including in their home) and permanently allowing Medicare payment for audio-only services. Additionally, the AAMC urges Congress to continue reimbursing providers the same amount for telehealth services as in-person visits. Without sufficient reimbursement, providers may no longer be able to continue to provide the current level of telehealth services to their patients.

The AAMC is committed to increasing access to physicians, especially in rural and underserved communities. To that end, AAMC supports expanding medical schools and branch campuses in rural and underserved areas, including increasing enrollment of students from those communities; increasing related training through Rural Residency Planning and Development grants to support Rural Training Track (RTT) partnerships between rural hospitals and large academic medical centers; recruiting and training future physicians in rural areas through HRSA Title VII Area Health Education Centers (AHECs), as well as other workforce recruitment programs such as the National Health Service Corps, Public Service Loan Forgiveness, and Conrad State 30 J-1 Visa Waiver Program.

Resources

• AAMC-Supported Telehealth Extension Passes House
• AAMC Response to Healthy Futures Task Force Modernization Subcommittee RFI
• AAMC Congressional Briefing on the Future of Telehealth (Video)
• Innovations in Health Technology: Telehealth
• Investment in Teaching Hospitals Benefits All: Transfer Cases

The maternal death rate in the United States is significantly higher than other, similar, countries – and it is estimated that over 60% of pregnancy related deaths are preventable. Outcomes are even worse for Black women, who are three to four times more likely to die from pregnancy-related causes than non-Hispanic white women, and who experience the impact of these disparities regardless of education and income.

The AAMC is committed to advancing federal policy that includes a multipronged approach that avoids preventable deaths, provides patients with optimal clinical care, improves maternal health, ensures health care coverage for perinatal people, and promotes health equity, including partnership with communities and stakeholders.

Resources

• AAMC Center for Health Justice Maternal Health Incubator
• Medical Schools’ and Teaching Hospitals’ Efforts to Address the Maternal Health Crisis
• From Pregnancy to Policy: Research Brief on Maternal Health
• AAMC Contributes to White House Maternal Health Day of Action