RheumWATCH Archives


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


Report from the AMA Delegation; ACR Provides Chronic Care Recommendations to Senate

Advocates for Arthritis 2015—Application Now Open!

Attention all advocates! On October 5–6, 2015, ACR and ARHP physicians, health professionals, and patients will descend on the nation’s capital to make our voices heard for rheumatology. The program includes advocacy training, guest speakers, and visits with your senators and representatives in Congress.

Please visit Advocates for Arthritis to learn more about the program and fill out the survey application prior to July 17.

Each year, the ACR also welcomes patients to participate in Advocates for Arthritis. If you know of a patient who has a compelling story, or would be a strong advocate to communicate the importance of access to treatments, access to rheumatology, and access to care, please encourage them to apply!

The ACR covers travel and costs for participants of this important opportunity to affect health policy and the future of our subspecialty.

ACR Addresses Senate Finance Committee Chronic Care Working Group

In a letter dated June 22, the ACR responded to the U.S. Senate Finance Committee’s Chronic Care Working Group, outlining multiple policy recommendations for improving outcomes for patients with chronic diseases. ACR President Bill St.Clair, MD, praised the committee’s bipartisan effort and provided recommendations to improve access to rheumatologists and ensure better access to treatments.

In May, the U.S. Senate Finance Committee’s Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) announced that Senators Johnny Isakson (R-GA) and Mark Warner (D-VA) would lead the committee’s new Chronic Care Working Group and its efforts to find long-term solutions to improve outcomes for patients with chronic disease. The ACR provided the working group with the following recommendations:

  1. Create new evaluation and management (E&M) codes that accurately reflect the time and expertise of cognitive specialists who primarily provide E&M services.
  2. Include in any per beneficiary Medicare primary care payment all physicians regardless of specialty designation who bill at least 60 percent of charges under qualifying codes (60% or more E&M).
  3. Prohibit overly restrictive provider networks.
  4. Support better access to treatments under the Medicare Part D program.
  5. Prohibit overly restrictive drug formularies.
  6. Prohibit excessive patient cost sharing.
  7. Allow beneficiaries to accept financial co-pay assistance for specialty cost tier drugs from pharmaceutical companies, for Part B and Part D drugs.
  8. Provide fair reimbursement for Part B drugs and preventive services.
  9. Address the rising costs of prescription medications.

View the full letter >
For more information on the ACR’s response or to become involved in advocacy efforts to improve care for patients living with rheumatic disease, contact ACR government affairs staff at advocacy@rheumatology.org.

House Takes First Step Toward IPAB Repeal

In the final week before the Fourth of July recess, the House of Representatives voted 244–154 to abolish the Independent Payment Advisory Board, better known as IPAB. The Board was established as a part of the Affordable Care Act and is tasked with coming up with Medicare cuts when spending rises above a certain threshold. Most healthcare providers agree that IPAB would reduce access to care by contradictorily requiring cost-cutting measures when there is an uptick in the demand for care.

Although there have yet to be members appointed to the IPAB, passing the House is an important first step to ultimate repeal. The legislation in the House was led by Republicans, but several Democrats were also on board until the cost was offset with $8.2 billion from the Prevention and Public Health Fund.

The Senate Majority Whip, John Cornyn of Texas, has also sponsored companion legislation to repeal IPAB in the upper chamber. However, there hasn’t been any indication of a timeline for a vote. The Senate has the additional obstacle of overcoming a 60-vote threshold to prevent a filibuster. President Obama also remains committed to maintaining IPAB and has threatened to veto legislation calling for its repeal.

Finding a more reasonable cost offset that does not take away resources from patient care will go a long way in garnering consensus support. The ACR continues to work with lawmakers to repeal IPAB in a responsible manner to protect our physicians and patients.

Message from the AMA Delegation Chair

Gary BryantThe AMA House of Delegates meeting recently concluded in Chicago. I wanted to provide an update of some of the major topics discussed and actions taken by the House in which your ACR delegation was involved. I would ask that those of you who have not been members of the AMA, or have let your membership lapse, to strongly consider joining for 2015 so that rheumatology can remain involved in steering the direction of the AMA.

As I have reported before, having participated in your delegation for over a decade, I have seen major improvements in focus, prioritization of issues, transparency, collaboration, and diversity in the AMA, and we need your help to maintain rheumatology’s seat at the table. You can help by renewing your membership with or joining the AMA.

Our participation in the House of Delegates also gives us a seat at the table for the RUC and other vital decision-making and informational aspects of organized medicine.

Great work was done by my colleagues Colin Edgerton, MD (alternate delegate), Cristina Arriens, MD (Young Physician Delegate), and Erin Mary Bauer, MD, who for the first time brought an ACR voice to the Resident and Fellows Section of the AMA; all of us were assisted admirably by ACR staff members Adam Cooper and Rachel Myslinski. As you will see from the summary below, your ACR delegation took an active role in advocating for critical issues.

ICD-10: The HOD adopted policy that the AMA will ask CMS and other payers for a safe harbor "grace period" for the ICD-10 transition, based on existing policy the ACR and partners put in at previous meetings. Additionally, the AMA will aggressively promote this implementation compromise to Congress and CMS (this is new, inserted by the reference committee after testimony and the amendment offered by the ACR and others).

As you know, this is a major focus of ACR advocacy, specifically with the recent legislation introduced by Rep. Black, H.R. 2247. The House moved this up the agenda in order to start the updated advocacy campaign with letters to Congress.

There is excellent information on ICD-10 that can be found on the Key Issues page.

The ACR was successful in having the HOD adopt policy regarding the Value-Based Modifier and Flawed Drug Cost Attribution. Resolution 236 asks that our American Medical Association work with CMS to modify VBM cost attribution with regard to drug costs, to ensure the cost calculation does not unfairly disadvantage certain providers. The VBM will remain part of the future Merit-Based Incentive Payment System (MIPS) called for by the MACRA H.R. 2 legislation that repealed the SGR. Our resolution 236 was co-sponsored by the American Academy of Allergy, Asthma & Immunology (AAAAI), American Academy of Dermatology, American College of Gastroenterology, and American Society of Clinical Oncology.

The reference committee heard largely supportive testimony regarding Resolution 236. Testimony noted that disparate treatment of the costs of Part B versus Part D medications can have an unfair impact on certain physicians under the Value-Based Modifier (VBM) and result in the greater likelihood of penalties. Testimony also noted that physicians should not be forced to make drug choices that may not improve patient care because of the flawed VBM approach to drug costs. Others noted that when the Merit-Based Incentive Payment System replaces the VBM in 2019, the costs of Part D as well as Part B drugs will be included in the costs attributed to physicians, providing a more fair assessment. A minor amendment was offered to ensure that all drug costs would be considered. Your reference committee agrees with this testimony and recommends that Resolution 236 be adopted as amended to support a more balanced playing field among all physicians who face VBM penalties.

Maintenance of Certification: There were two Committee on Medical Education (CME) Reports - one dealing with MOC that is 23 pages in length, and one dealing with Maintenance of Licensure and controversy of linking this with MOC, which is 15 pages in length. In addition, there were six resolutions dealing with MOC that were extensively debated. We also participated in the internal medicine caucus, where the President and EVP of the ACP summarized their extensive ongoing dialogue with ABIM, and an open forum sponsored by the Pennsylvania Medical Society that also had a significant focus on concerns with ABIM. The CME report asks the American Board of Medical Specialties to develop “fiduciary standards” for its member boards. The policy asks the ABMS to urge full transparency related to the costs of preparing, administering, scoring, and reporting MOC exams. It also seeks to ensure MOC “doesn’t lead to unintentional economic hardships.”

Other new policies direct the AMA to work with the ABMS toward the following changes:

  • Any assessment should be used to guide physicians’ self-directed CME study.
  • Specific content-based feedback after any assessment should be provided to physicians in a timely manner.
  • Multiple options should be available for how an assessment could be structured to accommodate different learning styles.
  • Physicians need to know what their specific MOC requirements are and the timing around when they must complete those requirements. The policy directs the AMA to ask the ABMS and its member boards to develop a system to alert physicians to the due dates of the multi-stage requirements of MOC.
  • Part III of the MOC exam, typically known as the high-stakes exam, should be streamlined and improved. The policy also calls for exploring alternative formats. (Note: This, along with cost, inconvenience, lack of evidence base of recertification activities, and relevance to practice, were the most hotly debated issues.)

We also co-sponsored Resolution 235 with the American Association of Endocrinologists, AAAAI, and Endocrine Society regarding the newly launched Interstate Medical Licensure Compact commission to clarify that the intent of the compact’s model legislation requiring that a physician “holds” specialty certification refers only to initial certification and not MOC. This was passed by the HOD. Look for more information from the ACR in the near future regarding advocacy on our behalf concerning ABIM and its MOC process.

We co-sponsored Resolution 505 along with the dermatology caucus members regarding the difficulties we often face obtaining coverage for our patients for off-label use of medications. The HOD amended current policies and resolved to advocate that the FDA work to establish a process whereby the official drug labeling can be updated in a more expeditious fashion when new evidence becomes available affecting the clinical use of prescription medications and that evidence-based standards or peer-reviewed medical literature can add to legacy information contained in official drug labeling statements to guide drug administration and usage.

In another effort with the dermatology caucus, we sponsored Resolution 702 regarding Access to In-Office Administered Drugs. This strengthens AMA policy that we had previously brought forward regarding this issue.

I will be presenting a full report to the ACR Board of Directors at its August meeting. We leverage our advocacy efforts and dollars by utilizing the significant resources that the AMA brings to bear. We learned recently that the AMA membership among ACR members had declined since 2012, and as opposed to previously when our membership in the HOD was confirmed every five years, we are now measured yearly per new policy and therefore lost our second delegate.

We can Advance Rheumatology! more forcefully and serve you and our patients better by having a larger voice at the AMA. We are asking that you confirm or renew your AMA membership today by visiting www.commerce.ama-assn.org/membership.

Gary L. Bryant, MD
Chair, ACR Delegation to the AMA House of Delegates