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Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.
H.R. 1600 is the new Patients’ Access to Treatments Act!
The new legislation was reintroduced on March 25 by its previous champions, Reps. David McKinley (R-WV) and Lois Capps (D-CA). The bipartisan bill debuted with an outstanding 50 original co-sponsors. Dr. Will Harvey, ACR Government Affairs Committee Chair, was on hand to give remarks at the press conference held at the U.S. House of Representatives, along with advocates from the Arthritis Foundation and Lupus Foundation and other members of the Coalition for Accessible Treatments.
The Patients’ Access to Treatments Act, which was developed by the ACR, will limit cost-sharing requirements for medications placed in a specialty tier and make innovative and necessary medications more accessible by reducing excessive out-of-pocket expenses. This legislation is critical for patients with chronic, disabling, and life-threatening conditions who are losing access to medications, including important biologic drugs. Placing medications on specialty tiers requires patients to pay 20–50% of the drug costs. The new H.R. 1600 is identical to the previous version, H.R. 460.
The ACR and the Coalition for Accessible Treatments are working hard to secure a Senate sponsor to introduce companion legislation and move the bill forward. Our goal is to get H.R. 1600 all the way to 1600 Pennsylvania Ave. for a signature!
(Pictured: Will Harvey, MD, MSc, ACR Government Affairs Committee Chair, joins Reps. McKinley and Capps at the PATA reintroduction on March 25, 2015.)
The basketball tournament may be over, but our own March Madness continues! We are challenging your state to take the lead with RheumPAC’s March Madness competition. From now through the end of the next ACR Board of Directors meeting, May 15, the state with the most donations to RheumPAC relative to their eligible membership will win our inaugural competition!
RheumPAC has set a goal to raise $150,000 in 2015 in order to be more active in important issues in Washington. More notably, we have set a goal to increase our participation with ACR/ARHP membership. Currently, less than 4% of eligible members participate in RheumPAC, which is among the lower end of all physician groups.
Show your state and ACR pride and donate today to this important cause! View the flyer below to learn more about the competition.
Disclaimer: You must be a U.S. citizen or permanent resident to contribute to RheumPAC. All contributions are voluntary and must be made using personal, non-corporate funds. RheumPAC contributions are not tax deductible. Federal law requires RheumPAC to collect and report the name, mailing address, occupation and employer of individuals whose contribution exceeds $200 in a calendar year. Contributions will be screened and those from persons outside the restricted class will be returned.
Exceeding last year’s attendance, more than 100 rheumatology professionals from North and South Carolina enhanced their knowledge through CME presentations featuring world-renowned physicians that included Drs. Calabrese, Reveille, and Genovese. Upon completion of these outstanding lectures, the session ended with a business meeting and an ACR update and listening session.
Reviewing reactive arthritis, CNS vasculitis, genetic basis of autoimmune diseases, and use of small molecules for RA, renowned rheumatologists shared their knowledge and expertise. In addition to their world-class presentations, neurological and pulmonary manifestations of rheumatic disease were also reviewed. A difficult panel case presentation by the members gave real-world suggestions for challenging cases.
For information about the NCRA, visit their website at https://www.ncrheum.org/. To share your state society efforts and be included in future RheumWATCH editions, please send an email to firstname.lastname@example.org.
As you are by now all aware, the U.S. House of Representatives passed a law to repeal the Sustainable Growth Rate, a plague on the House of Medicine for more than a decade. The law passed with nearly 400 votes, a true rarity these days for any bill beyond the “Let’s give each other a hug” type of bills that have little true importance. Those bills are generated by consensus. This bill was a compromise, and all stakeholders have found something to be unhappy with.
Some would say that is the definition of compromise. Though the outlook in the Senate looks good, there are some areas of concern for some Senators. Because it could not pass unanimously, Senate rules require a certain time for debate, and that has unfortunately encroached on the Spring Recess. Thus, the Senate will take up the SGR repeal upon its return April 13. This has important implications because CMS will have to administratively hold claims during the recess so they don’t pay the lower rate. If the Senate does not act quickly after the recess, either payment of claims will be further delayed or providers will be paid at -21% for dates of service from April 1 onward. Please visit the ACR Legislative Action Center to send a message to your Senators asking them to act quickly to enact this bipartisan compromise legislation. Although the vote in the Senate won’t be unanimous, it is expected to pass; however, this is a matter of getting it done quickly so as not to further impact providers. What follows is a brief summary of the key provisions of the bill that I think will be important for members.
The SGR repeal bill calls for a 0.5% yearly update through 2019, followed by flat updates. That point is when a new bonus structure kicks in (see below). This 0.5% rate is below the rate of inflation, but far above the -21% rate if the bill doesn’t pass. For reference, in only 5 years since 1992 has the annual update exceeded the inflation rate, and one of those was a 1% update in 2009 when the inflation rate was -0.4%. Since 2005, the average SGR or SGR patch update has been 0.6% and over the last 4 years was 0.35%. By definition, not a sustainable trend. While this 0.5% rate does not reflect what we believe our members’ services to be worth, it is a compromise. We get stability and predictability, but not a significant increase in payment. The ACR is actively exploring other mechanisms by which to recognize our services through increased reimbursement, and those efforts will become more important when this bill passes.
Pay for Performance
Right now, we have PQRS, Meaningful Use, and the Value-Based Payment Modifier. Maximum penalties are 4.5% in 2015 and up to 10% by 2018. The SGR repeal bill combines and harmonizes these programs into something called the Merit-based Incentive Payment System (MIPS), which will kick in for 2019. The maximum bonus and penalty in MIPS are equal and start at 4% in 2019 and go up to 9% in 2022 onward. In particular with regard to Meaningful Use, the “bonus” monies some of us are currently being paid were due to sunset around that time anyway, so ongoing MU got you nothing except avoidance of penalty. In MIPS, MU continues to contribute 25% toward your total bonus/penalty phase. There is also the opportunity to get an additional 5% in 2019 for joining an alternative payment model, including ones designed by and for physicians. The devil is in the details here. Consolidation has to mean reduced reporting burden or this doesn’t help. Much of the finer detail on how this gets implemented is left to CMS to work out over the next 4 years, and this is another area where the ACR will have to be very active to protect our members. The bill also clearly states that physician groups should play a large role in metric development, and the ACR is well positioned through our Quality of Care Committee to be there for our members in this regard as well. The bill explicitly states that quality metrics (or failure to meet them) as part of P4P may not be used in malpractice cases. This partially satisfies those of us concerned about how our own quality metrics will be used against us.
The bill requires Medicare to pay for management of patients with chronic conditions without requiring annual wellness visits. Again, more details to come, but if implemented well, this could be leveraged by our members.
Many of us have felt that IT vendors have gotten off the hook through the MU program. This bill requires that they fully support interoperability by 2018. It is time for vendors to step up.
CHIP and Physical Therapy Caps Exemptions
Both of these provisions increase access for children and those requiring PT, respectively. They are extended for two years. Many wanted four years or even permanent extensions. This may result in a few no-votes, but not enough to kill the bill. To preserve access for these vulnerable populations, the ACR will work hard at that two-year mark to renew these extensions, and we hope for a permanent repeal of the Therapy Caps, which was not included in the SGR bill.
The bill only comes up with ~$70 billion of its ~$210 billion price tag. Some say that is only appropriate, since this is a bookkeeping exercise anyway. Others will oppose the bill on this basis; however, several prominent conservatives have said they will still support the bill. One important thing is that some of that pay-for includes cuts to “providers.”Mostly, those are hospitals and post-acute facilities, who count as providers in this bill. While the 0.5% update noted above (instead of higher) does keep the price tag down, the bill does not directly cut doctors’ pay as part of the pay-for.
I encourage everyone to take a look at the comparison chart provided by the AMA for other details about this bill compared to the status quo. I want to emphasize that passage of this bill is incredibly important in terms of moving the conversation on to other things we are concerned about. But it in no way diminishes the need for ongoing advocacy around many of the provisions. The ACR, with the support of RheumPAC, Government Affairs, the Committee on Rheumatologic Care, the Insurance Subcommittee, the Quality of Care Committee, and others, will continue to work and fight on behalf of all our members to Advance Rheumatology! Please act now to let your Senators know that they need to take care of this quickly, once and for all.
Will Harvey, MD, MSc
Chair, ACR Government Affairs Committee