SAN DIEGO—During the past year, ACR advocacy staff and volunteer leaders have been working on a range of pressing rheumatology issues. In an advocacy update session at ACR Convergence 2023, panelists described progress in multiple areas, including access to care and workforce issues.
The presentations conveyed how full the ACR’s slate of advocacy efforts has been and how important it is for rheumatologists and rheumatology health professionals to become more involved in those efforts. The ACR’s advocacy efforts include several volunteer committees: the Government Affairs Committee, the primary advocacy committee that determines the ACR’s policy priorities; the Committee on Rheumatologic Care (CORC), which works on policies specifically related to the practice of rheumatology and provides resources for practices; CORC’s Insurance Subcommittee, which directly interacts with payers on behalf of the ACR and members of the College; the Affiliate Society Council, a group of representatives of state and local rheumatology societies that tracks what is happening legislatively at the state level; and RheumPAC, the ACR’s political action committee, which focuses on fundraising.
A Personal Touch
ACR staffers attended 120 Congressional meetings and sent 36 letters to Congress in the past year, said Lennie Shewmaker McDaniel, JD, the ACR’s director of congressional affairs. The ACR is smaller than the American Medical Association and other specialty societies and organizations, she said, but it can make more of an impact politically than organizations that don’t represent voters in legislators’ districts.
The ACR represents community practitioners, she noted, providers who may sponsor a local baseball team or have kids in the same schools or activities as children of the Congressional representatives the ACR is interacting with. “We actually represent human beings that they interface with in their communities,” she said.
The policy priorities for 2023 included Medicare reimbursement, barriers to care access, the rheumatology workforce shortage, drug pricing, and telehealth and research funding, said Ms. McDaniel.
She encouraged ACR members to send letters to Congress about issues they feel are important, saying such contacts lay the groundwork for future ACR meetings with legislators. “All of this loosens the ground,” she said. “So don’t think your letters just go into some black box.”
She described an environment in Congress that makes it especially challenging to get legislation passed. For example, an ostensibly non-contentious appropriations bill in the House was held up when a small group of lawmakers wanted to include language to interfere with implementation of a law regarding the use of family planning benefits that had already been passed in Washington, D.C.
“That’s what we’re talking about,” she said. “This bill that has absolutely nothing to do with the District of Columbia and absolutely nothing to do with workforce.”
She also reminded the audience that ACR@Work email newsletters are the best way to keep up on the ACR’s advocacy efforts on issues that are important to members.
Access to Care
Amanda Grimm Wiegrefe, MScHSRA, the ACR’s director of regulatory affairs, said the biggest issue she works on in the regulatory sphere is access to care, which includes Medicare reimbursement.
“We know at the ACR how much of an issue this is for you, your practices and your patients,” Ms. Wiegrefe said.
The new Medicare Physician Fee Schedule includes a conversion factor—part of the equation used to determine final reimbursement for services—that represents a decrease of 3.4%. The good news, she said, is that the new G2211 complexity add-on code—which should better reflect the resources needed to treat patients with complex conditions and will boost reimbursement in these cases—has been finalized and is expected to go into effect in January. The ACR has been at the forefront of efforts advocating for creation and implementation of this long-needed code.
Also, telehealth flexibility has been extended through 2024, allowing the Centers for Medicare & Medicaid Services (CMS) to better determine how to reimburse for telehealth in the future.
“The toothpaste is already out of the tube,” Ms. Wiegrefe said. “I don’t think we’re ever going back to what it was before.” There are discussions regarding cross-state licensing to better accommodate telehealth, she said, but for now, “we’re kind of in the wild, wild West” on that issue.
Drug Prices
Another major policy development is that Medicare now has the ability to negotiate with manufacturers on prices of some drugs, including rheumatology drugs etanercept and ustekinumab. The initial list includes 10 Part D medications, with more expected to be added to the list each year, eventually expanding to include Part B medications as well.
Biosimilars have also raised hopes for controlling drug prices. This year was a “huge year for biosimilars,” Ms. Wiegrefe noted, and there are now a staggering nine biosimilars for adalimumab. But pharmacy benefit managers (PBMs) have tended to price biologics the same as the originating drugs or are requiring that biologics be tried before patients are treated with biosimilars, so far undercutting the goal of reducing drug costs.
Ultimately, she said, “we hope it means less expensive drugs for treatment for your patients. What does it actually mean? We don’t know.”
PBMs have been a major legislative focus and will likely continue to be a top issue in the next legislative year, Ms. McDaniel said. They represent a “common ground” between the pharmaceutical industry’s priorities and physicians’ priorities, she said.
The way PBMs have priced biosimilars underscores the need for reform, she said. “What it does do is negate yet another argument that PBMs make, which is that they are a good influence on the market and that they have this benefit to patients.”
Positive Change
Christina Downey, MD, chair of the ACR Government Affairs Committee and associate professor of medicine in rheumatology at Loma Linda University, California, said the importance of advocacy efforts is greater than ever because “it’s getting really tough to be a physician” due to reimbursement concerns, medical accessibility and other challenges.
The committee and ACR staff have made strides in a variety of areas, she said. The Safe Step Act reduces barriers to access by codifying medical exceptions to step therapy protocols. Workforce struggles prompted the Resident Physician Shortage Reduction Act, which adds 14,000 Medicare-funded graduate medical education positions. And the Pharmacy Benefit Manager Transparency Act aims to address high drug costs.
She urged ACR members to get involved in the efforts.
“We do have a way to make positive change,” Dr. Downey said. “We still have a say in what happens to our profession. But we only have a say when enough of us get loud enough to be heard.”
Thomas Collins is a freelance medical writer based in Florida.
