TR: What insights from your own practice do you bring to CORC?
Dr. Phillips: As a small business owner and rheumatologist, I wear the same two hats many of our members do. With my business-owner hat on, I look at the bottom line—watching with concern when I see Medicare reimbursement rates not only failing to keep up with inflation, but actually being cut. These cuts, combined with the increasing cost of supplies and paying our staff, significantly tighten our margins. CORC supports the practice of rheumatology for our employed and academic members as well, but we know that especially for our independent members, we must remain highly active in advocacy with payers and the government for adequate reimbursement. This is important both for our evaluation and management codes and infusions, where lower administration fee reimbursement and an unstable market of biosimilar pricing have created increasing challenges in the last few years.
With my clinical practice hat on, I battle step therapy and prior authorizations, as well as burdensome documentation requirements, MIPS requirements and various other hurdles to providing my patients the care they deserve. These are the same pain points all of our members experience, of course—these are among the issues we seek to impact through CORC advocacy efforts.
TR: Can you share your plans and goals for CORC over the next couple of years?
Dr. Phillips: While our members are increasingly comfortable using biosimilars, we are finding on the buy-and-bill side that the economics are challenging. For example, several biosimilar versions of infliximab are reimbursed at rates below acquisition cost and are at the same time mandated for use by some payers. As we see more versions of more drugs, this issue may grow. This concern is closely wedded to the importance of supporting the buy-and-bill model of drug acquisition, which is critical to the survival of many of our members’ practices. These are issues that CORC, along with ISC, has been addressing aggressively for the last few years. I forecast our advocacy in these areas will need to further intensify.
I am excited by the formation of the Community Practice Council (CPC), and I anticipate CORC will increasingly work with this expert group of community rheumatologists to identify emerging concerns that warrant CORC’s focus. The more we connect with passionate members, the better pulse we have on the health of community rheumatology. I am hopeful we can work in tandem with the CPC and like-minded community practice groups outside of the ACR. I want to see CORC provide the best possible educational resources and support for members who are in the thick of dealing with the business of medicine and for those just starting out who need guidance on how to do this!
