Cite as: Tian L, Remotti E. United for change: advocating for the future of pain medicine and healthcare. ASRA Pain Medicine News 2024;49. https://doi.org/10.52211/asra080124.002.

Dear Friends and Colleagues,

It has been a privilege to serve as one of your representatives at the American Medical Association (AMA) Annual House of Delegates Meeting in Chicago (June 7-12, 2024). As I move on to the role of alternate delegate, I am thrilled to be passing on the torch to Dr. Edgar Remotti as your next Resident and Fellow Section representative to the AMA for ASRA Pain Medicine. I do not doubt that our delegation will continue to represent our society's and constituents' interests on the national level. I would also like to thank everyone who applied for this position. It is inspiring to witness such a significant interest in organized medicine efforts, even within our specialty society. I hope we can all stay involved and, together, advance the fields of regional anesthesia and pain medicine through advocacy.

In the past few years, we have made tremendous progress as a society in participation with the AMA thanks to the efforts of Dr. David Provenzano, Dr. Gary Schwartz, Dr. Richard Chou, and many others. Our presence was notably represented at the AMA’s American Society of Anesthesiologists (ASA) Section Council Meeting, Pain and Palliative Medicine Specialty Section Council, and Mobility Caucus. These specialized committees facilitate our ability to have a unified voice in the AMA through collaboration with representatives from subspecialties, including neurosurgery, orthopedics, anesthesiology, interventional pain, and physiatry, to name a few.

We are not in this alone. Many of the same issues that hamper many of our daily practices are shared throughout medicine: issues related to reimbursement, prior authorization, scope creep, and augmented reality have been brought to the forefront of these deliberations. According to the AMA, 95% of physicians report that issues with prior authorization contribute to their burnout. This is no longer an isolated burden carried by mid-career physicians or individual specialties; it is dynamic, pervasive, and damaging. The very fabric of our expertise and identity has been challenged. It is imperative that we recognize that these issues will not wait as we stand idly by. As Dr. Ehrenfeld put it, “This is why we fight.”

I hope we can all stay involved and, together, advance the fields of regional anesthesia and pain medicine through advocacy.

The AMA has long recognized the importance of involving residents and fellows in its initiatives. Society groups, such as our Resident and Fellow Section (RFS), allow our voices to be heard. Many resolutions and initiatives, such as the Pain Medicine Coalition, have been born from RFS efforts, directly influencing AMA policy. By working together, we will continue to develop, monitor, and advocate for responsible healthcare policies, improved access to care, and advancing education and research in pain management. The AMA actively develops curriculums for advocacy and engagement and provides grants for trainees to advocate for themselves. By joining the AMA, we gain access to these benefits and ensure our representation in the broader medical community.

On the legislative front, the Centers for Medicare and Medicaid Services (CMS) released the CY 2024 Medicare Physician Fee Schedule (PFS), which included a 3.4% reduction in the Medicare Physician Conversion Factor. This reduction has significant implications for our reimbursement rates. While Congress has passed short-term funding patches, the long-term resolution of this cut remains uncertain. Another critical legislation piece has been lobbying for H.R. 2474, which aims to reform the outdated payment model and strengthen our ability to care for our patients. CMS has finalized the Interoperability and Prior Authorization Rule to expedite the prior authorization process, including requiring payers to expedite requests, providing specific reasoning for denials, publicly reporting metrics, and facilitating electronic processes. These changes aim to reduce delays and improve the efficiency of our healthcare system.

Scope creep is another pressing issue we face. Over the past year, the AMA has successfully defeated over 100 pieces of legislation that threatened to expand the scope of practice for non-physician healthcare providers. For example, recent legislative efforts in several states sought to allow nurse practitioners and physician assistants to practice independently without physician oversight, which could compromise the quality of patient care. Our unified efforts through the AMA have been crucial in maintaining the integrity of physician-led care.

Moreover, integrating augmented reality (AR) into healthcare is rapidly transforming our field. The AMA actively advocates for policies supporting these technologies' ethical and effective use. One notable initiative is the AMA’s push to develop standardized guidelines for using AR in surgical training and patient care, ensuring that these innovations enhance, rather than compromise, the quality of medicine.

ASRA Pain Medicine’s involvement in the AMA House of Delegates (HOD), the Current Procedural Terminology Editorial Panel, and the Resource-Based Relative Value Scale Update Committee have significantly amplified our voice in national healthcare policy. Since joining the AMA HOD, ASRA Pain Medicine has actively participated in such committees, influencing the coding and payment policies that directly impact pain medicine services and ensuring that the work of pain medicine specialists is accurately valued.

As we celebrate our wins, we are reminded that change does not necessarily come quickly or easily, but it does come. As we continue to advocate for our patients and each other, the fruits of our efforts are being realized. Grassroots efforts to recruit young trainee physicians and their patients have been recognized as a vital catalyst of these changes. Innovations in healthcare, often born out of necessity and ingenuity, are championed by united voices. It all starts with you. Through your continued participation with ASRA Pain Medicine, ASA, AMA, and other organizations, our voices are heard throughout the halls of lawmakers. I challenge all of you to join or renew your membership in the AMA and ASRA Pain Medicine so that we can shape how medicine is practiced now and in the future. Remember, this is our fight, and our fight starts today.