Advocacy in a COVID-19 America

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These are truly extraordinary times. The COVID-19 pandemic has affected the rheumatology community, both providers and patients, in many ways, and our advocacy efforts are now more important than ever to ensure policymakers hear us and help address the issues facing our community. As with so many things during this pandemic, we are reimagining advocacy and finding new ways to be effective in Washington, D.C.

Our dedicated professional staff and volunteers in D.C. have continued to advocate for us in a virtual environment without missing a beat. In addition, we needed to find a way for individual ACR/ARP members to bring their concerns and recommendations directly to federal lawmakers during the pandemic—without traveling to Capitol Hill. Each year for many years, the ACR has held two major fly-in events in D.C. to meet directly with decision makers on challenges that face our specialty. Many of you have joined us in our nation’s capital for these important visits through the years, and you know the value of direct contact from you, a constituent, sharing your experiences and recommendations with lawmakers. How could this be accomplished in this period when travel is severely limited or banned?

As it became clear that in-person visits to D.C. for our usual May Advocacy Leadership Conference would be impossible, the ACR organized its first-ever Virtual Hill Day, involving leaders on our board of directors, as well as committee chairs and volunteer members of the Government Affairs Committee (GAC), Committee on Rheumatologic Care (CORC), RheumPAC, the Insurance Subcommittee and the Affiliate Society Council. Live training webinars were held in place of the typical in-person training in preparation for the visits, and telephone meetings took the place of in-person visits to congressional offices on the Hill.

I am grateful to the nearly 80 ACR volunteer leaders who held 139 teleconference meetings with representatives, senators and staff in Hill offices on May 22 to discuss the difficulties we currently face in our field and to share their experiences during the COVID-19 pandemic. I want to thank the Government Affairs Committee for planning these impactful virtual visits, GAC Chair Blair Solow, MD, and our professional advocacy staff, who made all of this happen seamlessly. I also want to thank the many ACR/ARP members and patients who added their voices from home through our Legislative Action Center, the ACR’s online platform providing advocates the ability to directly email their lawmakers with policy messages. Each one of these touch points with legislators makes a difference and helps move our concerns to the forefront.

Talking Points

This year, these important meetings focused on the many challenges practices and patients are facing in the new reality of life during the COVID-19 pandemic. Advocates discussed issues affecting patient access to care, including maintaining provider solvency so rheuma­tologists and rheumatology interprofessional team members can continue to care for the estimated 91 million Americans suffering from rheumatic disease.

Advocates highlighted the fact that a shortage of rheumatologists existed pre-COVID-19 and patients have already had difficulty accessing rheumatologic care.

They discussed provider solvency as a key issue during the pandemic, making it clear that practices are financially challenged due to the need for social distancing for patients, decreasing the number of patients seen and often requiring extended office hours to enhance patient safety. In addition, costs incurred for overtime payments and for the purchase of additional personal protective equipment increase the concern that practices may lose the ability to continue to provide adequate payment to staff.

Advocacy for the rheumatology community continues in these challenging times, & I hope you will add your voice as we continue this journey together.

Recognizing that many rheumatology providers and practices are suffering financially, advocates asked that additional financial assistance to providers to be included in the next Congressional package for COVID-19 relief. Although the funds designated for practices and institutions in the CARES Act were immensely helpful, these funds will clearly be inadequate to ensure patient access and provider solvency through the duration of the pandemic.

Hill offices were encouraged to press for the passage of healthcare provider-specific grant and loan programs, and support the American Medical Association’s request for an emergency, one-time grant for providers equal to their total payroll and overhead costs from Jan. 1–April 1, 2019.

For employed physicians, advocates also discussed the need for funds to be specif­ically directed to maintain provider and staff salaries, to prevent further job losses, furloughs and salary cuts.

Other advocacy issues raised with legislators included asking for universal parity for reimbursement of audio-only and audiovisual telehealth, and continued support for the evaluation and management (E/M) payment improvements set to go into effect in January 2021.

Offices on Capitol Hill heard from rheumatology advocates about their experiences with telehealth during the pandemic and the crucial need for flexibility in telehealth options to maintain access for patients. Rheumatology practices are relying on traditional telehealth, as well as telephone visits, to treat patients safely while in-person evaluation and treatment may be restricted.

A few months ago, we saw the Centers for Medicare & Medicare Services (CMS) respond to our advocacy efforts by acknowledging the importance of this access, including reimbursement for not only audiovisual telehealth, but also audio-only telephone visits for those patients who may not have access to the necessary technology to allow for traditional audiovisual visits. Lawmakers were asked to request the CMS have Medicare Administrative Contractors (MACs) issue blanket adjustments of payments for all audio-only CMS claims back to March 1, so individual providers don’t have to take time away from patient care to do the arduous resubmission of claims already filed.

Advocates also promoted H.R. 6644, the Healthcare at Home Act, which would have employer-based health plans also expand parity in reimbursement to audio-only telehealth visits, following the lead of the CMS.

Finally, advocates discussed the importance of the updates to E/M coding, finalized by the CMS and scheduled to go into effect in January 2021. These updates are estimated to result in an average 15% raise in pay, an important win for rheumatologists. These improvements are critical to ensure an adequate workforce of providers treating rheumatic diseases and the chronic illnesses that often ensue in our patients most in need of care.

What’s Next

This first-ever Virtual Hill Day held by the ACR is just the beginning. It represents a new avenue for our advocacy efforts, and I encourage all members to consider joining in upcoming virtual visits to Capitol Hill. In addition to accessing your lawmakers directly at the ACR’s Legislative Action Center, you can apply to join us in September for our Advocates for Arthritis conference, where you can continue to lend your voices and important perspectives to those legislators who are making decisions for our healthcare system and for the nation.

For the past several months the ACR has been tackling the many challenges posed by the COVID-19 pandemic through our Practice & Advocacy COVID-19 Task Force, which has provided rapid responses to many issues. This task force has also worked in concert with many of our dedicated volunteer leaders on our committees.

Visit our COVID-19 pages, where you will find resources and guidance to assist you in keeping up with the many issues posed by this pandemic. In addition, advocacy issues unique to the current times can be found on our advocacy page.

My sincere thanks to all of the rheumatologists and interprofessional team members who are providing care to patients in these unprecedented times and, especially, to everyone who took the time to weigh in virtually on advocacy issues and help us all with the challenges we are facing. Advocacy for the rheumatology community continues in these challenging times, and I hope you will add your voice as we continue this journey together.

Ellen M. Gravallese, MD, is chief of the Division of Rheumatology, Inflammation and Immunity at Brigham and Women’s Hospital, Harvard Medical School, Boston. She is the 83rd president of the ACR.