RheumWATCH Archives


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


ACR RheumWATCH: January 7, 2016

ACR, Coalition Secures Expanded Access to MU Hardship Exemptions

The ACR, AMA and other groups have been successful in our coalition efforts to allow an expedited hardship exemption process for Meaningful Use. In the last few days of 2015, Congress adopted the “Patient Access and Medicare Protection Act” (S. 2425), which included a provision granting CMS the authority to expedite applications for exemptions from Meaningful Use Stage 2 requirements for the 2015 calendar year. Last week President Obama signed the legislation.

In order to avoid a penalty under the meaningful use program, you must attest that you met the requirements for Meaningful Use Stage 2 for 90 consecutive days during calendar year 2015.

However, CMS did not publish the Modifications Rule for Stage 2 of meaningful use until Oct. 16. As a result, eligible professionals were not informed of the revised program requirements with less than 90 days remaining in the calendar year.

CMS has previously stated that it will grant hardship exemptions for 2015 if eligible providers are unable to attest due to the lateness of the rule. However, under current law, CMS can only grant such exemptions on a case-by-case basis. This means that many eligible professions will be required to apply for exemptions and that CMS will have to act on each application individually.

A provision of the legislation adopted by Congress would grant CMS the authority to process requests for hardship exemptions to physicians through a more streamlined process, alleviating burdensome administrative issues for both providers and the agency.

CMS is implementing these changes and information should be posted to the CMS website soon. The deadline for eligible professionals to submit hardship applications for the 2017 payment adjustment (based on the 2015 EHR reporting period) will be Friday, July 1, 2016.

ACR Comments on Improving ACA Qualified Health Plans

On December 21, 2015, the ACR submitted a letter to CMS in response to its notice of proposed rulemaking (NPRM) for the 2017 Benefit and Payment Parameters (BPP). This annual rule sets policy related to the Affordable Care Act and determines key requirements for qualified health plans (QHPs) in the federally-facilitated Marketplace and how they will operate.

The ACR recommended improvements to the qualified health plan requirements, such as:

  1. Greater transparency of plan options and information so that patients can make better comparisons and have a clearer understanding of provider networks, benefit plan options, drug formularies, and out-of-pocket costs
  2. Expanded access to rheumatologists to improve patient outcomes and prevent costly procedures and/or disability; and
  3. Protected access to prescription drugs by prohibiting overly restrictive drug formularies with excessive cost sharing and by prohibiting prescription drugs from being subject to deductibles.

Read the ACR letter >

Advocates Score $2 Billion Funding Increase for NIH

Rheumatologists, health professionals and patients conducted hundreds of Hill meetings advocating for increased NIH funding, and our efforts are continuing to pay off. Before Congress adjourned for the holidays, it passed the $1.1 trillion FY2016 omnibus appropriations package that will fund the federal government through September 30, 2016. One of the major victories reflected in this package was a $2 billion increase in federal funding for the National Institutes of Health (NIH). The new budget of $32.08 billion nationally represents a 6.64 percent increase over the last year.

Other top priorities in 2015 included stopping unfair insurer practices that restrict access to rheumatologists and limit patient access to care and reigning in excessive patient cost sharing. You can help in our continued effort to address these issues by going to the Legislative Action Center and contacting your legislator today.

Message from the Government Affairs Chair

Will HarveyAdvocates,

I wanted to take the opportunity to thank everyone for some of the things we have been able to accomplish together for rheumatology and our patients in 2015, take a look at what’s coming in 2016, and to ask for your continued efforts.

The ACR was part of the coalition that altered the MU requirements for 2015 to make it easier to get incentives or harder to get penalized. We weren't able to stop ICD-10, but when most other organizations had given up, we were on the Hill talking about safe harbors and testing. We even got the AMA to finally focus a large effort on this.

More on practice killing mandates
For 18 months we shopped ACR-drafted language at Hill meetings, and that language eventually became the bill (the ICD-TEN Act) that was used by the AMA and CMS to draft and enact a 1-year safe harbor for Medicare claims. Only a couple other national groups and a handful of state groups kept on fighting, and ACR lead the way.

The NIH got a $2 billion bump this year. No, I'm not trying to claim all the credit for that, but we conducted hundreds of Hill meetings this year telling the important story of how NIH helped get drugs like TNF inhibitors and IL-1 inhibitors from basic science to industry darlings. When lawmakers have to make tough decisions they will think about these kinds of stories, and we contributed to the drumbeat that got this done.

These are but a couple of examples - find out more about what we did in 2015.

What's next?
Holy MACRA! It should take you about 35 seconds after getting to the office this morning to think about a dozen things that need to change. There is a tremendous amount of work to do. Top of the list is implementing changes to the new pay-for-performance parts of the SGR replacement bill called MACRA. If we're not part of the solution on this one, we'll be in big trouble - all of us – academics, employed docs and small business owners alike.

The ACR thanks all the rheumatologists and rheumatology health professionals who took the time out to engage in advocacy and help produce these legislative victories. Please help get us continue the efforts in 2016. Many thanks and best wishes for a prosperous year!

Will Harvey, MD
Chair, Government Affairs
American College of Rheumatology