RheumWATCH Archives

”RheumWatch

Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.

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Legislation Would Increase DXA Access, Highlights of ACR on Capitol Hill

Help Support DXA Legislation

The ACR has endorsed newly introduced bill H.R. 2461—the Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act—sponsored by Reps. Michael Burgess (R-TX), Marsha Blackburn (R-TN), John Larson (D-CT), and Linda Sanchez (D-CA).

We need your help to advance this bill. Please visit the ACR’s Legislative Action Center to contact your members of Congress and ask that they co-sponsor this bill.

H.R. 2461 would increase access to preventative bone density screening by creating a floor reimbursement rate under Medicare for the dual-energy x-ray absorptiometry (DXA) test administered in a doctor’s office.

Congress has twice recognized the importance of this issue by including language reversing cuts to DXA reimbursement in order to increase the number of screenings and decrease the number of individuals with osteoporosis in the U.S. Despite this acknowledgment, the Medicare reimbursement rate for the DXA test administered in a doctor’s office has declined from $140 in 2007 to just $40 in 2015.

Appropriate reimbursement for tests such as DXA that measure bone mass and predict fracture risk is necessary to maintain patient access, particularly in rural or underserved settings.

Please visit the ACR’s Legislative Action Center to send a personal message to your members of Congress asking that they support and co-sponsor H.R. 2461 to increase DXA access for their constituents.

ACR Works with New York Advocates on Step Therapy Legislation

The ACR is working with the New York State Rheumatology Society and the Lupus and Allied Diseases Association, Inc. to advocate for legislation introduced by Senator Catharine Young and Assemblyman Matthew Titone. The legislation would limit the duration of step therapy or first fail protocols as well as create more transparent guidelines for providers to follow for expedited review and override processes. New York ACR and ARHP members are encouraged to contact their elected officials to support S3419-A and A2834-A.

To find your N.Y. State Assembly Member, visit NY State Assembly.

To find your N.Y. State Senate Member, visit NY Senate.

The ACR has step therapy–related legislative initiatives ongoing in several states. If you would like more information or if you have patients that would like to share their step therapy story, please contact ACR advocacy staff at advocacy@rheumatology.org.

ACR Leadership on the Hill

ACR leadership on the Hill

Last month the ACR Board of Directors, Government Affairs Committee, RheumPAC Committee, Affiliate Society Council leaders, and several other committee chairs embarked on Capitol Hill to meet with legislators and discuss issues important to Advancing Rheumatology!

In the above photo, Janet Stevens, Tamara Guastella, Dr. Gary Bryant, and Dr. Eric Matteson pose with Rep. Debbie Dingell after discussion of H.R. 1600, the Patients’ Access to Treatment Act (PATA). The ACR delegation also spent time with Rep. Dingell’s legislative director for an at-length conversation on the ins and outs of the PATA legislation.

Message from the Government Affairs Chair

Will Harvey May has been a busy month for rheumatology advocates. The ACR not only crossed a major milestone, but also hosted the Advocacy Leadership Conference (ALC) in Washington, D.C. The ALC brought together the ACR Government Affairs Committee, RheumPAC Committee, and Board of Directors, along with Affiliate Society Council leaders representing 14 state rheumatology organizations. As a complement to the fall Advocates for Arthritis program, this additional annual Hill fly-in brings together seasoned advocates and leaders from across the country to address our most pressing concerns.

Meeting Highlights

The ALC brought together 60 advocates, who attended nearly 100 Hill meetings. The group heard presentations from the Arthritis Foundation and a coalition dedicated to increasing reimbursements for evaluation and management services, as well as from our public affairs team on the best use of social media for advocacy activities. We also had presentations from two physician members of Congress. Rep. Ami Bera, MD, spoke about the importance of advocacy by physicians, the importance of malpractice reform, and his goal of ensuring the viability of small and solo practices. Rep. Michael Burgess, MD, described the process of repealing SGR and gave us some insights into where work still needs to be done to ensure that we receive fair remuneration for our services.

Hill visits included two special groups of advocates. The ACR Executive Committee met with key staff offices to press for increased reimbursement for evaluation and management services. A group of ARHP members also met with key staff to work on a permanent repeal of caps on physical and occupational therapy services for Medicare patients. The top three issues covered by the remaining advocates were the Patients’ Access to Treatment Act (H.R. 1600), which would eliminate percentage-based co-insurance; increased research funding, including support for NIH, CDC, and DOD research funds; and a new bill that would mitigate the impact of ICD-10 on our members (H.R. 2247, the ICD-TEN Act).

Major Milestone

The ACR achieved an important milestone with respect to this latter advocacy issue. For some time, the ACR has recognized the problems with implementing ICD-10 and played a role in its delay one year ago. We find ourselves this year in a situation where, despite introduction of a new bill to delay ICD-10 again, the likelihood of further delay is vanishingly small. So what can the ACR do to protect its members if there is no delay?

The ACR drafted a bill on this subject almost one year ago, and has spent that time refining it and gaining support. The bill would do two things: require more comprehensive end-to-end testing prior to Oct. 1 with certification from CMS that the system will work as well as the current system, and prevent CMS from denying payment on the basis of inaccurate subcodes (the numbers after the decimal).

The subcode specifies the subtype or location or etiology of disease, rather than the disease itself. For example, our current code for RA (714.0) translates to more than 200 codes in ICD-10. Subcodes are not needed to identify which major disease entity someone has, and thus should not be the basis for denial of payment. Further, mistakes in these subcodes are simply that: mistakes, not intentional fraud.

After a year of developing the language for this bill, we found a champion in Rep. Diane Black from Tennessee. On May 12, two days before the ALC, Rep. Black introduced our bill to the U.S. House of Representatives. For the first time, there are two bills on the floor drafted by the ACR: the Patients’ Access to Treatment Act (H.R. 1600) and the ICD-TEN Act (H.R. 2247).

We will work together toward advancing these bills or having their policies enacted via regulatory measures.

A Cure for the 21st Century

Also introduced in May was the 21st Century Cures Act. Although it has many provisions, the two main goals of this legislation are to streamline the drug approval process through the FDA and to support biomedical research. The latter is accomplished though proposed increases of about $32 billion, $33.5 billion, and $35 billion in funding for the NIH. This would be the largest increase in NIH funding since 2003, and the ACR supports these efforts.

RheumPAC Dollars at Work

During the May meeting, the ACR confirmed that nearly 100% of ACR board members have contributed to RheumPAC in 2015. This alone is a significant demonstration of the importance of our PAC to our advocacy efforts, but let me share another example.

I was fortunate enough to attend a fundraiser on behalf of RheumPAC for Rep. Marsha Blackburn, who is Vice Chair of the Energy & Commerce Committee. This committee is vitally important to our work because all legislation pertaining to healthcare and in particular to Medicare has to pass through this committee. The fundraiser was attended by Rep. Blackburn, her chief of staff, and her healthcare staff, who happens to be a pediatric geneticist. The only two other people in attendance were myself and a lobbyist representing a chemical manufacturer.

Over the course of the hour-long meeting, I was able to discuss with the congresswoman all of our issues in detail and prep her for issues that may be brought up in E&C that are of importance to rheumatologists and our patients. The other lobbyist took some time, too, but it is virtually unheard of to have such extended and direct access to a person with key influence. I am not sure she agrees with every one of our positions, but she certainly now understands and is familiar with all of them. RheumPAC strives to create opportunities with candidates on both sides of the aisle who are in positions of influence. That can only help in the difficult times ahead.

Without RheumPAC, we would not have these opportunities to tell our compelling stories to those who in many ways control our fate. Please consider donating today by visiting RheumPAC. We need your help to continue making a difference.

Weeks Ahead

As presidential campaigns start to shape up, the ACR is looking ahead at several major issues. Advancing our two bills will remain a priority. We will be tracking 21st Century Cures and the pending Supreme Court decision that could impact the Affordable Care Act. The ACR will also be engaged in an extended process to understand all of the potential implications of the replacement of SGR with a program of value-based payment that will certainly affect our members. The goal will be to understand where to focus ACR resources to best serve and protect our members from the uncertainty that lies ahead.

The ACR needs your support through donations to RheumPAC and involvement in advocacy activities to accomplish our many objectives for the remainder of 2015.

Will Harvey, MD, MSc

Chair, Government Affairs Committee

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 individual's whose contribution exceeds $200 in a calendar year.