CHICAGO—ACR leaders described a series of looming legislative and regulatory threats to rheumatologists and their patients—including the proposed collapsing of evaluation and management (E/M) coding and potential changes to step therapy rules—and urged everyone in the field to make their voices heard to quash the proposals.
They also recounted recent victories in the policy realm by the ACR—among them, changes to reimbursement for biosimilars and the easing of cuts to imaging reimbursement—which they say show that stepping into an advocacy role can bring results that matter.
The call to action came in a session here at the 2018 ACR/ARHP Annual Meeting.
The changes to the E/M codes are ostensibly meant to simplify documentation, by blending E/M levels 2 through 5 into a single payment, requiring documentation only at level 2, which is less onerous. But the ACR and other medical organizations say it will lower reimbursement for more complex cases.
“What it ends up meaning—and may be an unintended consequence—is reducing access to care for our patients to see us, because it reduces reimbursement pretty severely for rheumatologists,” said Angus Worthing, MD, chair of the ACR’s Government Affairs Committee. “Medicare anticipates a 3% reduction in reimbursement, which translates into a 10% pay cut.” That calculation assumes 70% overhead and 30% take-home, he said.
The ACR has led the national response to this proposal in partnership with other specialty societies, such as the American Academy of Neurology, including facilitating meetings on Capitol Hill and, with the agency, writing and coordinating a stakeholder letter from more than 130 physician and patient organizations to the CMS, and letters from members of the U.S. House of Representatives and the U.S. Senate expressing concerns.
Another threat, he said, is the proposal to allow step therapy policies—requiring physicians first try therapies they believed are doomed to fail—in Medicare Advantage Part B.
Among many legislative achievements over the past year, he said, three were spearheaded by the ACR. One was to get the federal government to restart premium processing for physicians needing an H1-B visa, which applies mostly to foreign-trained physicians practicing or finishing their training and wanting to practice in the U.S.
Also, proposed musculoskeletal ultrasound reimbursement cuts were significantly eased after the ACR argued that it is useful and safe—and often more effective than more expensive imaging.
Another success, he said, was the start of unique coding for biosimilars, which he said makes prescribing the drugs a “more provider-friendly environment.” Under the new coding, biosimilar reimbursements will no longer be pooled—lumping less and more expensive drugs together—but will be individualized.
