Reimbursement: Medicare cuts are looming. We expect a 2.75% cut, plus possibly a PAYGO 4% cut to go live on Jan. 1, 2023, unless Congress legislates a fix to avoid those cuts. One such solution is the Supporting Medicare Providers Act of 2022. You can easily tell your legislators to support this legislation from our Legislative Action Center.
The 2023 proposed rule for the Medicare Physician Fee Schedule (PFS) included major cuts to ultrasound reimbursement, but intact valuation of evaluation and management services (E/M). Unfortunately, although not unexpectedly, additional cuts to reimbursement were proposed. We have sent letters to the Centers for Medicare & Medicaid Services and are fighting back with other coalitions and the American Medical Association (AMA). We are shifting our advocacy focus to reform the PFS in line with the AMA and other specialties. Read more in my recent op-ed in The Hill.
Utilization management: This may be the ultimate pain, requiring at times a very fine donut fix! Prior authorization and step therapy legislation is in both the Senate and the House, and we are hoping to get the bills across the finish line. The prior authorization bill passed in the House, so we are hopeful.
We are monitoring the FTC investigation into pharmacy benefit manager (PBM) practices closely. We have been working on Medicare downcoding with the ACR Insurance Subcommittee of the Committee on Rheumatologic Care. Robust activity at the state level targeting these issues has been ongoing.
Research funding: Arthritis research funding from the Department of Defense was stalled this year due to budget and administrative hurdles. We are closer to this resource than before and hope that next year we can inch closer.
Pandemic: The public health emergency (PHE) was extended yet again, although we expect this to be the last time. We have supported telehealth provisions in the PFS, and legislation has extended flexibilities well into 2023. Further advocacy will be needed to maintain this resource for patients.
Reproductive healthcare: The Supreme Court ruling on Dobbs overturning Roe v. Wade has had profound impacts on our delivery of patient care. The ACR government affairs team is tracking federal, administrative (HHS, FDA) and state conversations around these substantial impacts and the next steps for rheumatology physicians and interprofessional team members.
Drug pricing: The passed Inflation Reduction Act includes provisions that allow Medicare to negotiate drug pricing for the most expensive medications. This is an enormous shift in policy that can impact the cost of drugs in the U.S.
