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One thing that became clear very quickly this past year was that the COVID-19 pandemic would change the way we deliver care to patients. What has not changed amid an evolving healthcare landscape is our driving focus to ensure our patients’ access to rheumatology care and the availability of state-of-the-art treatments. We know you share that drive. By speaking with a unified voice for our patients, we can seize new opportunities presented by this unique moment.
COVID-19
The COVID-19 pandemic has highlighted new challenges and opportunities to improve our patients’ health and well-being. An example of this is in our work for vaccine access for patients.
In the weeks following our advocacy efforts, many states opened vaccinations to immunosuppressed patients. Thankfully, today, all adult patients have access to COVID-19 vaccination, and access for children is expanding. However, the effort to increase rheumatology patient vaccination rates continues as we work with our federal partners, such as the Centers for Disease Control and Prevention (CDC), to build vaccine confidence.
In May, the ACR held a town hall on this topic, providing resources and best practices for talking with your patients about COVID-19 vaccination. You can view the town hall on our YouTube channel.
Priorities
The ACR’s membership is broad and represents all of those in the rheumatology profession who treat patients, manage rheumatology practices, do the research to discover new scientific breakthroughs, and train the rheumatologists and other professionals who will join our workforce. For each of these aspects of our community, the ACR is focused on priorities that will make a difference in the professional lives of members and, ultimately, help patients receive better care. Our advocacy priorities are focused on reducing administrative burdens, drug pricing, appropriate reimbursement, access to care and expanding research funding.
We know the frustrations caused by the increasing requirements and delays to get therapies approved for our patients. We are proud the ACR is a lead advocate for better guardrails in the use of step therapy protocols and prior authorization.
At the federal level, the ACR is advocating for passage of the Safe Step Act (S. 464/H.R. 2163), which would implement common sense reforms and guidelines for the use of step therapy, as well as the Improving Seniors’ Timely Access to Care Act, which would streamline documentation requirements for prior authorization in Medicare Advantage, ensure an electronic option and minimize prior authorizations for routinely approved medications.
At the state level, the ACR and state and local rheumatology societies are actively promoting legislation to rein in inappropriate prior authorization and step therapy rules, prohibit non-medical switching of treatments so that providers and patients can choose patients’ medications, and eliminate copay accumulator policies that make it more difficult for patients to receive treatment.
The high cost of medicines, particularly biologics, continues to be a focus of policy makers. As drug pricing legislation is considered in Congress and in state legislatures this year, the ACR is working to ensure proposals are focused on expanding patient access to treatments by addressing the underlying causes of high pharmaceutical costs to patients without hindering the provider’s ability to administer necessary treatments or the patient’s access to medications. Additionally, the ACR has been working to increase transparency of drug pricing and pharmacy benefit manager activities by supporting proposals with robust reporting requirements for rebates and drug price increases.
The ACR also continues to advocate for recognition and appropriate reimbursement for rheumatology. Our major win for rheumatology last year was the culmination of years of work to have the Medicare physician fee schedule more appropriately recognize the importance and value of rheumatology care and cognitive care specialties. We are working to protect major evaluation and management (E/M) payment updates for cognitive specialists that were implemented in January this year. The ACR is also advocating on behalf of all members of the rheumatology care team to protect our members from cuts to reimbursements for rehabilitation services.
Because of the opportunities for broadened access that telemedicine can now provide, we have pushed for expansion of telemedicine as a supplemental tool to ensure access to rheumatologic care. The ACR is pressing for greater telemedicine access and continued appropriate reimbursement for telehealth visits, including preserving payment parity for audio-only visits, and working to resolve licensing issues arising from telemedicine across state lines, as well as allowance of continued flexibilities for site-of-service requirements.
The ACR is also developing opportunities to share best practices in how providers and patients can approach the use of telemedicine post-pandemic.
Workforce Issues
To aid those who have a focus on training the next generation of rheumatologists and expanding the rheumatology pipeline, the ACR continues its advocacy to expand the rheumatology workforce.
At the federal level, we are working for expanded loan repayment opportunities—particularly for pediatric rheumatology—increased Graduate Medical Education funding, a permanent repeal of the cap on Medicare funding for training slots and support for International Medical Graduates (IMGs) seeking to join the U.S. medical workforce.
At the state level, we are encouraging states to include rheumatology professionals in loan repayment programs, talent retention programs and other workforce initiatives. Just this year, we saw the progress of a loan repayment program for cognitive specialists in Washington state and reintroduction of a similar loan repayment program in Georgia.
Educators and fellows in training can join the ACR’s work to expand training slots, add incentives for rheumatology providers serving in underserved areas, and fund new loan repayment or forgiveness programs for pediatric and adult rheumatologists.
Research Funding
As always, the ACR is committed to supporting those members who seek to find the causes and cures for rheumatic and musculoskeletal diseases. We are continuing to advocate for increased targeted research funding for the conditions we treat.
We are working with partner groups, such as the Arthritis Foundation, to add arthritis to the diseases specified to receive funding through the U.S. Department of Defense’s Congressionally Directed Medical Research Program and pushing for increased targeted funding through the CDC.
We are working with Dr. Lindsey Criswell, a rheumatologist and the new director of NIAMS, to increase the impact of NIH funding in rheumatology. You can join us in this advocacy to advance the research enterprise and bring more available funding for rheumatology research.
In May, leaders of the ACR and ARP, including many committee members, joined together in productive virtual meetings with their representatives in Congress to urge action to address step therapy protocols and improve pediatric rheumatology access.
The general ACR/ARP membership—and your patients—can apply to represent the rheumatology community in our September Advocates for Arthritis Capitol Hill fly-in event, which will also take place virtually, via phone and video conferences.
The Advocates for Arthritis application period for ACR/ARP members and patients opens in July. You can sign up to receive the latest updates and to be notified when the application period opens at www.rheumatology.org/Advocacy/Advocates-
for-Arthritis.
In Sum
ACR and ARP members are unified in our mission to expand patient access and improve our patients’ lives. We are asking you to join the advocacy work to make this possible. Develop the mindset of educating policy makers about rheumatology and your patients’ needs. No one knows more about our field or the needs of our patients than rheumatologists and rheumatology team members, so we are uniquely qualified to educate policy makers about these needs. We have a duty to advocate and educate. See the box below for a few things you can do to stand with your colleagues as a unified voice for better patient access.
We should all be proud of the strides we have made for the rheumatology community through our advocacy together. Our thanks go to all ACR/ARP members who are working to improve patients’ lives every day, including in their advocacy for their patients. Let us each make a personal commitment to be more involved, especially in these consequential times, and to get our colleagues more involved on behalf of all our patients.
David R. Karp, MD, PhD, is chief of the Division of Rheumatic Diseases and the Harold C. Simmons Chair in Arthritis Research at UT Southwestern Medical Center, Dallas, and the ACR’s 84th president.
Christine Stamatos, DNP, ANP-C, directs the Fibromyalgia Wellness Center within the Division of Rheumatology at Northwell Health, Huntington, N.Y. She is also assistant professor at Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies, Hempstead, N.Y. She became the ARP’s 52nd president in November 2020.
