2011 Accomplishments in Advocacy

The ACR will Increase its Influence with the Federal Government to Improve Policy Outcomes.

Advancing Public Policy to Advance Rheumatology
2011 was a year in which the nation's leaders slogged through historic showdowns over ballooning deficits and spending. Healthcare—especially Medicare—was identified as the major contributor to deficits. In the search for cost savings, Congressional leaders considered potential targets such as Medicare spending reductions, cuts in reimbursement for biologics, cuts in funding for research and other critical needs. Any of these would have been devastating to the rheumatology community. In response, the ACR successfully mobilized its members and volunteer leaders to maintain ongoing communication with key leaders, and cuts have currently been averted. In 2012, the ACR will work continue to work with members of Congress and with partners such as the AMA and other specialty physician organizations to protect the viability of the rheumatology subspecialty and the interests of physicians, other rheumatology health professionals and our patients.

In addition to ongoing meetings with decision makers, throughout the year the ACR presented in-person and written testimony to pivotal congressional committees and federal agencies and commissions, provided numerous letters to federal decision makers, and joined in coalition advocacy with vital partners. In the regulatory realm, the ACR held multiple meetings with leadership and staff at the Centers for Medicare and Medicaid Services, including meetings with CMS Administrator Don Berwick. The ACR will continue to assist the new leadership of CMS with recommendations for resolving issues facing rheumatologists, such as payment inequities.

A Permanent Repeal of the (Un)Sustainable Growth Rate is in Sight
The unprecedented creation of the supercommittee and its failure to come to any agreement on deficit reduction increased pressure to address the continual threats of reimbursement cuts due to the flawed SGR formula. Even though most members of Congress agreed that a 27 percent cut to Medicare reimbursements was unacceptable, Congress found itself at an impasse over how to resolve the problem. It appeared that the Medicare pay cuts would go into effect until an agreement was struck on December 23 granting a two-month reprieve. As part of the agreement reached between the House and the Senate, both chambers will select members to serve on a conference committee to negotiate extending the SGR patch up to two years. The conference will meet during the first part of the year to work on a longer-term Medicare reimbursement fix, as well as year-long solutions to extend the payroll tax holiday and unemployment benefits.

The ACR supports a permanent repeal of the SGR and will be working with members of the conference committee and other members of Congress to identify a viable solution to stabilize the Medicare program and ensure fair physician reimbursement and patient access to quality care.

Lawmakers on Capitol Hill are Increasingly Familiar with Rheumatology Issues
More than 100 ACR and ARHP members, and patient advocates, converged on Washington, D.C. in September to meet with over 200 U.S. House of Representatives and Senate offices during Advocates for Arthritis, the ACR's annual visit to Washington, D.C. The in-person meetings are critical to ensuring that good decisions are made by policy makers in areas affecting rheumatology. Participants focused on issues that affect rheumatology every day, including preserving patient access to rheumatology and to treatments, and maintaining funding levels for medical research. Advocates for Arthritis is held each year in September; tentatively mark your calendars for September 9 – 11, 2012.

In addition to Advocates for Arthritis, the ACR board of directors convened in Washington, D.C. in May. While there, board members visited Capitol Hill to support their colleagues and patients through advocacy, meeting with Congress to discuss the College's top legislative priorities.

Cognitive Specialties Coalesce to Promote More Appropriate Reimbursement Levels
While these are uncertain times for medicine generally, rheumatology faces particular challenges in continuing to attract a bright and capable physician workforce. To enhance its efforts, the ACR initiated a coalition of other cognitive specialty organizations known as the Cognitive Specialty Coalition, made up of physician specialists who primarily practice face-to-face patient care, and in 2011 built upon the growing partnerships. Other members of the coalition include the American Academy of Neurology, American Association of Clinical Endocrinologists, The Endocrine Society, Infectious Diseases Society of America, North American Neuro-Ophthalmology Society, and the American Academy of Allergy, Asthma, and Immunology.

The ACR and the coalition met with CMS and MedPAC leaders, as well as key House and Senate offices in 2011. Chief among their shared objectives is resolving imbalances in a physician fee schedule that values procedural care higher than cognitive based care. If cognitive care continues to be undervalued, a disproportionate number of medical students and internal medicine residents may choose to specialize or subspecialize in the more highly-reimbursed procedural specialties. This is problematic as rheumatology must ensure an adequate workforce of specialty physicians who are trained to provide care for a rapidly growing patient population with complex chronic conditions. While MedPAC made an initial recommendation in June 2011 that Congress consider realigning "physician payments to help ensure an adequate supply of practitioners in cognitive (or non-procedural specialties) who focus on managing patient with chronic conditions," MedPAC's later recommendation to cut all specialists' reimbursements as part a proposal to replace the SGR, and to group cognitive specialists with procedural specialists rather than with primary care providers, shows that more work must be done. The practice climate for cognitive specialists much more closely resembles that of primary care providers than proceduralists. Cognitive specialists primarily bill evaluation and management codes and share with primary care similar income levels and recruiting issues.

Support for Lawmakers Who Support Rheumatology Surpasses Goals
Goal! Through the dedicated support and commitment of its member contributors, RheumPAC exceeded its fundraising goal of $100,000 for 2011 with a year-end total of $108,587 in contributions. This outstanding support allowed RheumPAC to contribute $86,000 to select candidates, providing members with opportunities to engage influential policymakers, enhancing the ACRs presence on Capitol Hill and ensuring that champion lawmakers for rheumatology can continue to serve.

With the turmoil and uncertainty that gripped Washington, D.C., 2011 was an important time to ensure the interests of rheumatologists and patients were being heard. In addition to direct lobbying and grassroots efforts, RheumPAC played an integral part in delivering the ACR's message to policymakers. RheumPAC focused its efforts on continuing relationships with candidates who recognize the value of rheumatology and on educating key decision makers about how their decisions on health policy would impact the rheumatology community.

Through the ongoing support of the ACR and ARHP membership, RheumPAC will continue to be a vital component of the ACR's advocacy efforts and the advancement of rheumatology on Capitol Hill. 2012 is an important election year, and outcomes will have ramifications for the rheumatology community. Through the continued growth of RheumPAC, the voice of rheumatology is strengthened, and the ACR will be able to support the candidates who are dedicated to the rheumatology community and who will fight for our issues.