ACR Advocacy: 2021 Midyear Update

Andrei Medvedev / SHUTTERSTOCK.COM

Beginning in the late 1800s, Eliza Ruhamah Scidmore, U.S. diplomat and writer, spent 24 years advocating for sakura, or Japanese cherry trees, to be planted in Washington, D.C. After unsuccessfully petitioning every U.S. Army Superintendent of Public Buildings and Grounds for over two decades, she wrote a letter to First Lady Helen Herron Taft about the trees.

First Lady Taft had been to Japan and understood the cherry blossoms’ significance and beauty. Together, they secured a gift from the mayor of Tokyo, Yukio Ozaki. Ms. Scidmore’s persistence had paid off.

In March 1912, 3,020 cherry trees of 12 varieties were shipped to Washington, D.C. The National Cherry Blossom Festival grew from a simple ceremony of planting a tree with First Lady Taft and Viscountess Chinda, wife of the Japanese ambassador.¹

As the cherry blossoms have come and gone in D.C. this spring, the ACR government affairs team has been hard at work engaging with a new administration and the 117th Congress.² This diverse group was ready to consider and debate legislation after a challenging year dealing with the pandemic, a major vaccination effort and social injustice.

I hope you’ve had a chance to breathe and can take a break to consider what is happening in Washington, D.C., and around the country. In just five short months, we have had important federal legislation introduced in both houses of Congress.³ States have signed into law legislation on utilization management, copay accumulators and loan repayments (https://www.rheumatology.org/Advocacy/State-Advocacy). And several large pieces of legislation, such as the COVID-19 relief packages and the infrastructure bill, include attached bills that are important for the practice of medicine.

A midyear review provides an opportunity to assess progress on these fronts and ensure you know how you can help.

Physician Fee Schedule & Sequester

The Centers for Medicare & Medicaid Services (CMS) finalized the 2021 Physician Fee Schedule (PFS) Final Rule, with rheumatologists receiving an estimated average boost in reimbursement of 14–15% (https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/1131). This was the second-largest increase among all medical specialties. However, to maintain budget neutrality, this boost was somewhat offset by a drop in the conversion factor.

This summer, the CMS will release new proposed rules on physician reimbursement. The American Medical Association’s (AMA’s) Relative Value Scale Update Committee (RUC) will provide input to the CMS to guide decisions on how to pay physicians from a single pot of money. In this zero-sum game, other specialties were less fortunate than rheuma­tology, with losses in procedural practices and physical therapy. With many practices struggling due to the pandemic, COVID-19 legislation helped offset cuts by increasing Physician Fee Schedule payments across the board by 3.75% through Dec. 31.

Sequester is an automatic reduction in federal spending.⁴ Due to large spending packages by the government for COVID-19, additional sequester cuts—separate from the PFS—will begin Dec. 31 if not addressed (https://budget.house.gov/publications/report/FAQs-on-Sequester-An-Update-for-2020). Expiration of a moratorium on a sequester that has been on pause through 2020 and 2021 will result in 2% cuts to reimbursement, and a new sequester, called PAYGO, will add across-the-board 4% cuts.

How you can help: Watch for calls to action on the ACR’s Legislative Action Center in support of suspending or repealing cuts.