RheumWATCH Archives

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

19

ACR RheumWATCH: November 19, 2015

Don’t Let Congress Make Decisions Without You!

No one is more qualified than you to tell lawmakers how their policies affect your ability to provide quality care and your patients’ ability to access it. Think your opinion doesn’t matter? Think again.

Your voice is an essential part of rheumatology advocacy efforts, and our new Legislative Action Center (LAC) makes contacting your legislator easier than ever before.

Thanks to our physician advocates who took the time to call, write, tweet, and email their legislators, we were able to play an integral role in the permanent repeal of the flawed SGR formula; successfully pressure CMS to institute safe harbor provisions for ICD-10 implementation; help reinstate funding to the CDC Arthritis Program; aid in passing biosimilar legislation in over 10 states; and successfully advocate to the FDA for biosimilar therapies to have distinguishable names.

All of this happened in one short year, and while much has been accomplished, there are many issues that we’re still working to address—and we need your help. Patients are struggling to avoid the high co-payments associated with specialty tiers. Funding for NIH research is nearly 25 percent less than in 2003 and continues to decline. Unfair and overly restrictive insurer practices are limiting patients’ access to critical treatments and, in some cases, prohibiting rheumatologists from being compensated for the care they provide.

Using the ACR’s new Legislative Action Center (LAC) makes contacting your legislator easier than ever before. From the homepage, you can quickly:

  • Access information on legislative initiatives the ACR currently needs your help with;
  • Find the elected officials for your district and their contact information;
  • View and search for legislation; and
  • Share your concerns with your Senator(s) and Representatives using a customizable email template.

We also recommend signing up for alerts on changes in federal and state issues that affect you and your patients. It takes less than two minutes to ensure you will be notified when new advocacy initiatives and updates are available.

Encourage your patients to have a voice in the legislative process as well. To help them make their voices heard, we have designed a special action center just for patients on the ACR’s Simple Tasks website that provides patient-centric overviews of our current issues and all of the same tools available to you for contacting their legislators.

2015 ACR Guideline for Treatment of RA Now Available

The ACR announced the availability of its 2015 guideline for the treatment of rheumatoid arthritis during the 2015 ACR/ARHP Annual Meeting in San Francisco. The guideline is designed for use by rheumatologists and other clinicians for pharmacologic treatment decisions in commonly encountered clinical situations.

See the guideline >

PQRS Update: New QRURs Released this Week

CMS has identified issues that impacted the 2014 Annual Quality and Resource Use Reports (QRURs) released on Sept. 8, 2015. There were issues with data submitted via EHR and Qualified Clinical Data Registry (QCDR), as well as a technical issue with the claims used to calculate claims-based measures. CMS has successfully corrected these issues and produced revised 2014 Annual QRURs, which are now available via the CMS Enterprise Portal.

The 2014 Annual QRURs show how groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 VBM. For groups with 10 or more eligible professionals (EPs) that are subject to the 2016 VBM, the QRUR shows how the VBM will apply to physician payments under the Medicare Physician Fee Schedule (MPFS) for physicians who bill under the group in 2016. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the MPFS in 2016.

How to Access Your TIN’s Revised 2014 Annual QRUR

Authorized representatives for a group or solo practitioner can access the 2014 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management account with the correct role. For more information on how to access the 2014 Annual QRURs, visit How to Obtain a QRUR.

For groups with 10 or more EPs that are subject to the 2016 VBM, CMS established an informal review period to request a correction of a perceived error in their 2016 VBM calculation. The informal review period for the 2016 VBM is open now through November 23, 2015 at 11:59 PM EST; therefore, we strongly encourage that you access and review your TIN’s QRUR as soon as possible.

Additional information about the 2014 Annual QRURs, and how to request an informal review, is available on the 2014 QRUR website and through the QRUR Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3).

Message from the Government Affairs Chair

Will HarveyAdvocates,

The Annual Meeting in San Francisco is over and was quite an event—our largest ever! The range of scientific and educational opportunities seemed overwhelming, as it always does, and none of us ever has time to attend every session we want. Of course, some of you stayed home with your practices and patients, so I wanted to take a few moments to provide this virtual guided tour of some of the wide range of advocacy sessions that took place at the meeting, many of which are available on SessionSelect.

On Sunday, November 8, we had our annual Legislative Update session. I started by giving an overview of the problem of rising drug prices and our patients’ inability to afford them. This included an update on the ACR-drafted Patients’ Access to Treatment Act (H.R. 1600), which would eliminate specialty tiers with a percentage cost-sharing model. We are up to 95 co-sponsors in the House and have had a number of fruitful meetings to advance the bill over the next year. We also had a wonderful speaker, Assemblyman David Chiu, who represents much of San Francisco in the California State Assembly. He spoke about a number of issues that need to be addressed in healthcare. He also provided some details about a bill he has introduced in California to require some elements of transparency around how pharmaceutical manufacturers derive their pricing, and called on organized medicine to get into the debate about the rising cost of medications. He told us that our voice was missing in the conversation in terms of how cost affects our ability to treat patients. We ended the session with a brief review of other ACR advocacy activities, including progress on dealing with unfair insurance practices and shortages of pediatric subspecialists, and strong prospects for increased NIH funding.

From SGR repeal to a safe harbor period for the implementation of ICD-10, ACR/ARHP members have made a huge difference both on Capitol Hill and in local constituencies. You can view a handy infographic showing everything our advocates have done in 2015.

Perhaps the most pressing part of the update was in relation to the Medicare Access and CHIP Reauthorization Act (MACRA), which replaced the failed SGR. As I have discussed in prior columns, there are many parts of this plan that still need to be implemented by regulators, who have not always understood to a sufficient degree how their choices impact doctors and patients. We will be spending a large amount of time and resources engaging with the regulators to proactively address our concerns. To this end, the ACR has contracted additional regulatory lobbying support.

Our other advocacy session included two presentations. First, former U.S. Senator Tim Hutchinson gave another exciting presentation about the importance of advocacy. He emphasized the need to personalize our messages with members of Congress and the need to engage at both state and local levels. He told the story of a physician constituent of his who never once came to D.C., but who invited Sen. Hutchinson to his practice back home. Sen. Hutchinson got to know him to the point that when he had a question about something that would affect healthcare, the Senator would call this constituent and ask for his thoughts. This physician became a Key Contact for the Senator whenever he needed it.

The ACR has launched a Key Contacts program to fill this very need. Many of you already have personal relationships with members of Congress, perhaps in areas outside of medicine. Others lack the resources and know-how to establish that contact. The ACR wants to help.

The second speaker, an expert in social media, shared her thoughts about using Facebook and Twitter to reach Congress. She discussed a surprising survey result among Hill staff, revealing that only a relatively small number of tweets or Facebook posts about an issue is enough for them to explore an issue. She also demonstrated our new outreach platform, VoterVoice. Either through the ACR website or through a downloadable app for iPhone and Android, you can connect with the ACR to learn about the issues we’re working on, send messages to your elected officials, and register for our Key Contacts program. You can also sign up to receive action alerts (not too many, I promise!) about important issues when we need you to act.

This year has already seen its share of political fireworks. From Speaker Boehner’s resignation to the averted debt ceiling crisis, it’s been a busy fall. As we head in to what promises to be an exciting election year, we cannot lose sight of our objectives, or stop pressing for changes that have to happen to our healthcare system. In years like this it is sometimes difficult to engage in controversial discussions with our government officials. Sometimes it’s easy because those debates happen in front of a primetime TV audience, as commentary about drug pricing has in the last two presidential debates.

Regardless, we need to double our efforts. We have to maintain our will to fight for what is in the best interest of our profession and our patients. I look forward to another 365 days of continuous advocacy until we gather for the next ACR/ARHP Annual Meeting in Washington, D.C., barely a week after the Presidential election. Please reach out to me if you have issues for us to address and get involved by signing up with VoterVoice. I certainly have the drive to carry on the fight and hope you will join me.

Will Harvey, MD
Chair, ACR Government Affairs Committee
Twitter: @TheresAWillMD