RheumWATCH Archives


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


ACR RheumWATCH: December 17, 2015

ACR Advances Interests of Rheumatologists at AMA Meeting

Rheumatology’s AMA delegation represented the ACR at the House of Delegates meeting in Atlanta last month, and was able to bring advocacy priorities to the AMA that will move these important issues forward with the help of AMA resources.

The topic of drug pricing and patient access to care was a major topic of concern. The ACR authored and submitted Resolution 817, which drew several cosponsoring specialties, and which requested the following additions to AMA policy:

  • RESOLVED, That our American Medical Association work diligently and actively with Congress to advance legislation that would allow the Department of Health and Human Services to negotiate with pharmaceutical manufacturers the prices that may be charged for covered Medicare Part D drugs (Directive to Take Action); and be it further
  • RESOLVED, That our AMA seek and actively support measures that would increase transparency in how pharmaceutical companies, pharmacy benefit managers, and health insurance companies determine the costs of prescription medications, including increasing transparency related to any incentives given by drug companies to pharmacy benefit managers or health insurance companies related to the dispensing or promotion of their manufactured drugs (Directive to Take Action).

In addition, the ACR cosponsored Resolution 814 with several other specialty societies. Resolution 814 asked that our AMA convene a task force of all of the relevant stakeholders in the development, approval, and cost of prescription drugs, which should include representation from physicians, physician researchers, the pharmaceutical industry, pharmacy benefit managers, insurance payers, the Centers for Medicare & 19 Medicaid Services, the U.S. Food and Drug Administration, hospitals, and patient advocates; generate a grassroots effort to engage physicians and patients in local and national advocacy initiatives that bring attention to the rising price of prescription drugs and helps to put forward solutions to make prescription drugs more affordable for all patients; and report back to the HOD regarding the progress of the drug pricing task force and grassroots effort at the 2016 Interim Meeting.

I am happy to report that these two resolutions and their recommendations were incorporated into a comprehensive report and set of recommendations from the Council on Medical Services. In addition, you may have seen reports from the AMA meeting highlighting the decision by the HOD creating new policy calling for a ban on advertising directly to patients (DTC advertising).

Another Council on Medical Services report was approved by the HOD that supported our resolution from last year’s Interim Meeting asking for national medical specialty societies and other stakeholders to submit a request to Medicare for a national coverage determination directing Medicare Administrative Contractors to consider all biologics as complex injections or infusions. This success highlighted the importance of working within the AMA coalition with other interested societies on issues important to the ACR and our patients in order to effect change.

The ACR also supported successful Resolution 807, which will have the AMA advocate in support of specific criteria governing the adoption and reconsideration of Local Coverage Determinations (LCDs) by Medicare Administrative Contractors (MACs)—specifically that the AMA will advocate that when LCDs are proposed, the CAC meetings must be conducted in public with minutes recorded and posted to the Contractor’s website, and that the MAC would have to disclose the rationale for any LCD, including the evidence upon which it is based. The AMA will also now advocate that CMS adopt a new LCD reconsideration process that allows for an independent review of a MAC’s payment policies by a third party empowered to make recommendations to affirm, withdraw, or revise said policies to the Secretary of HHS; and that MACs be prohibited from adopting another MAC’s LCD without first undertaking a full and independent review of the underlying science and necessity of such LCD in their jurisdiction.

Other topics with new policy or AMA advocacy attention that significantly impacts rheumatologists and rheumatology health professionals included issues surrounding electronic medical records and the burden of meaningful use, ongoing insurance consolidation and its impact on local health markets, and the STEPS Forward program developed by the AMA to assist physician practices in navigating the complex environment we face and improving the care of our patients and our satisfaction in the practice of medicine .

For a more complete summary of the meeting, please visit the AMA Wire page.

As we approach 2016, I want to encourage all rheumatologists to join or renew their AMA membership. As reviewed in the October issue of RheumWATCH, it is of critical importance that the voice of our specialty be heard at the AMA and we keep our seat at important venues that impact our profession and our practice. You may access AMA membership, sign up, or renew at the AMA website.

We need your help now to keep rheumatology’s seat at the table. Please renew your membership in the AMA or join the AMA.

We also need your help to continue to grow the ACR delegation and the voice of rheumatology in the House of Delegates. If you are already an AMA member, it is very important that you review your information and cast your ballot for the ACR to represent you.

Yours in Advancing Rheumatology!
Gary L. Bryant, MD

Still Need to Report PQRS Data for 2015?

The Rheumatology Clinical Registry (RCR) is open for registration and data entry until January 31, 2016.

The RCR consists of the RA measures group with 8 measures, and the cost is just $249 per provider. In order to successfully report, providers must meet the following criteria: report on 20 patients (at least 11 Medicare), report on all 8 measures, and meet the measure in at least 1 patient (greater than 0%).

For more information, please visit the RCR page or email us at rcr@rheumatology.org.

AMA and ONC EHR Survey

The AMA has collaborated with the Office of the National Coordinator (ONC) to create a short survey intended to collect information regarding EHRs and interoperability. The purpose of the survey is to gather information in order to improve the summary of care document that is produced to meet the Transfer of Care objective in Stage 2 of Meaningful Use.

With the information collected, the ONC aims to create a new standard that will reduce the number of pages in the summary of care document, thus making it easier to find relevant information. Please access the survey. This survey will close on December 23, 2015.

Message from a RheumPAC Contributor

Rudy Molina, MDThere are two governing bodies that have a direct impact on the practice of medicine. One is our College, the American College of Rheumatology, which, among many other things, provides guidelines, process and outcome measures, and updates on basic and clinical information that help us with our treatment options. The second body that has a direct influence on our practice is our government. Our U.S. Congress provides laws/policies that impact us and our patients profoundly. We as physicians and members of the College can bring our issues to the various committees of the ACR and actually participate in the process as part of the volunteer workforce. This is and will remain a very important avenue for us as practicing physicians to provide an appropriate dialogue to the College. But it's the second body, our government, I would like to discuss, as it is just as important and arguably more impactful.

First, ask yourself: when was the last time you spoke with your Congressman? If you never have and feel you just don't have the time to invest in such an endeavor, I kindly ask you to reconsider. If you already have a relationship with your Congressmen/Congresswomen, then you are the choir and do not need to read any further. For those of you who are reading the rest of this message, please keep an open mind on why this topic is so important to us all.

The first time I spoke with Congressman Henry Cuellar (D-TX), I was surprised at how much he knew about the woes of healthcare, and equally surprised at how much he didn't know about the specifics of how we struggle with overbearing administrative burdens. I've met him at fundraisers in town, including one in my own home, and I've met him at his office as part of a "fly in" to Washington, D.C., sponsored by the ACR. (By the way, if you haven't participated in our annual fly in, it's a blast and you should put it on your to-do list.)

Now, after a number of years of meeting with Congressman Cuellar , we are on a first name basis—he calls me Rudy and I call him Congressman. I'm kidding, of course. More importantly, he asks for my opinion on healthcare issues and has my cell phone number. At our last fundraiser for him, he singled me out and we spent a lot of time discussing various issues and how they stack up as priorities in Congress. My message to the Congressman is clear and concise: RheumPAC can help with the message and with donations (if you wish). It’s part of what the ACR does for our membership.

Congressman Cuellar and group

Congressman Cuellar

Congressman Cuellar

I have a feeling that if we all had relationships with our Congressmen and Congresswomen, Congress would be hearing a similar, if not the same, message from the rheumatology community. It may sound idealistic, but it is actually doable. Building relationships with our representatives is part of the democratic process. We are a highly educated segment of our community, and therefore, by default, we are looked upon as leaders. Once you establish a relationship with your Congressman/Congresswoman, he/she will seek your input. Having a voice that is being heard is the first step in making a difference.

To learn more about how to get involved, visit the Advocacy page and please make a donation to RheumPAC to help us reach our goal for the year and continue to voice rheumatology’s issues in 2016.

Rudy Molina, MD
RheumPAC Leadership Circle Contributor