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Public health and policy experts at the American Medical Association (AMA) examined the impact of the coronavirus on health equity, on physician wellness, and on practice sustainability during its second Physician Town Hall, on Sunday. The AMA's focused on the pandemic was held on April 9.

The online forum began at the end of the AMA House of Delegates "virtual special meeting," held in lieu of the regular annual meeting.

Before starting the evening's discussion, James Madara, MD, the AMA's CEO and executive vice president, reminded members of the best practices and support available through the

The questions explored by the panel (edited for brevity and clarity in the list below) had been collected over 2 weeks from delegates around the country.

Q: How has the AMA responded to the inequities in and outside of healthcare that the pandemic revealed for African American and Latinx communities?

Seeing how little data were available to explain the impact of the virus on black and brown communities, Aletha Maybank, MD, MPH, the AMA's first chief health equity officer, said the group has lobbied for more data collection and has helped to support legislation, including the to achieve that goal.

These data are important for understanding not only what happened to communities of color during the pandemic, but also specifically to who gets sick and why, Maybank said. Black and Latino workers are more likely to have to work and to be essential workers and therefore are more exposed to the virus. They also may live in overcrowded buildings and rely on public transportation. So, it is important to consider not just medical underlying conditions but also these "underlying social conditions," she said.

She noted that the AMA has also launched a survey geared towards better understanding the experiences of "marginalized and minoritized" physicians. And the organization continues to warn against racism and xenophobia.

Q: Structural inequities have been called out before; what's different this time? What needs to happen this time for the movement to succeed?

Maybank said she and others in the health equity space are excited to see the AMA and organizations like it "boldly making statements" focused on dismantling racism in healthcare. (The AMA has its own history with racism.)

"To be at this time in history where healthcare leaders and those in the profession are actually naming racism -- I think is absolutely tremendous," she said.

The test will be how well organizations and institutions hold themselves accountable for the changes that need to happen.

She urged those for whom addressing injustice is a "new space" to educate themselves and pointed to resources on the , especially those focused on developing anti-racist practices and policies.

Maybank also encouraged physicians to speak to their patients about racism and its impact on their lives.

The AMA has a lot of power and a lot of privilege and it needs to use both to effect change, she said.

Q: How is the AMA addressing the revenue losses that many of its members are facing?

The AMA has worked with the Centers for Medicare & Medicaid Services (CMS) on different programs intended to address this problem, including the , which has helped bring payroll relief to practices with under 500 employees, said Todd Askew, the AMA's senior vice president of advocacy.

The Trump administration has also made more than $8 billion of advance Medicare payments to physician practices, he noted. The House of Representatives has passed legislation that would provide certain other improvements that would make funding more accessible.

Another program, the , helps physicians by offsetting the costs of either caring for COVID-19 patients or preparing to care for them, as well as the losses in revenue to practices that had to close or stop doing elective procedures. Congress has appropriated $175 billion to the program and the administration is beginning to disperse that funding. Much of the funding in the first distribution went to practices with a higher share of Medicare than Medicaid payments.

The AMA is continuing to lobby Congress and CMS to support physicians who rely more heavily on the Medicaid program, to make funds, Askew said. "We expect in the next week or so a new opportunity for physicians who are heavily Medicaid reliant to access sums from this provider fund."

Q: In the midst of COVID-19, how is the AMA supporting physician wellness?

Physicians are under a great deal of stress -- both frontline physicians responding to the pandemic, many of who have seen patients die from lack of treatment options, and those who may have seen huge losses in revenue, been furloughed, or have had to take a pay cut because of lockdowns and social distancing policies, said Michael Tutty, PhD, the AMA's group vice president for professional satisfaction and practice sustainability.

He pointed physicians to three specific documents on the AMA's COVID-19 resource center:

• which details best practices for responding to challenges gathered from around the country aimed at leadership

• which explains actions that organizations can take to support their staff before, during, and after a crisis

• advice tailored to physicians themselves, as well as access to free meditation and mindfulness resources

For many organizations where the coronavirus surge has passed, now is a good time to assess what was learned to prepare for future crises or another wave of COVID-19, Tutty said. He recommended that institutions begin the process of debriefing by unit and by specialty. He also urged institutions to make sure that mental health resources continue to be deployed even 6-12 months following the pandemic, and encouraged institutions to leverage the to understand the kinds of challenges faced by its workforce.

Q: How long after the pandemic will the new payment parity for telemedicine be extended?

One of the challenges in expanding telemedicine has always been that payers wanted proof of its value, but, the healthcare system has "jumped 5 years in the last 5 months" in regards to telemedicine, Askew said.

He said telemedicine has demonstrated its value by enabling physicians to keep vulnerable patients out of the office, to triage patients at a distance, to perform remote monitoring, and to provide services that most thought couldn't be done over telehealth.

Payment parity is technically supposed to last until the end of the COVID-19 pandemic, "but we expect it to last a good bit longer than that," Askew added.

The AMA is petitioning CMS to try to extend that parity, including for the use of audio-only technology, and the ability to engage new patients. He said he thinks the organization has a "good deal of support in Congress" for preserving these advances.

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