The Medicare Payment Advisory Commission (MedPAC) makes recommendations to Congress on Medicare policy including physician payments and patient access issues. These recommendations can directly impact rheumatology care coverage and rheumatologist reimbursement. Representatives of the ACR and partners recently met with new MedPAC Executive Director James E. Mathews, PhD, to discuss appropriate recognition of rheumatology care and other cognitive specialty concerns, workforce development and other key issues.
Even if Congress doesn’t move forward with MedPAC recommendations, this commission publishes annual reports that others, such as the CMS and the Center for Medicare & Medicaid Innovation (CMMI), may take ideas from.
That’s why ACR government affairs advocates, led by Timothy Laing, MD, and ACR Regulatory Affairs Director Kayla Amodeo, PhD, made a trip to Washington, D.C., to meet with Dr. Mathews.
“Maintaining a good relationship and communication with MedPAC [allows us to provide them] the perspective of rheumatologists and rheumatology health professionals. With a new executive director [at MedPAC’s helm], we thought it was a great time to go in and discuss our thoughts on several key issues,” Dr. Amodeo says.
Bringing Important Issues to the Table
The issues critical to rheumatology that were discussed during the meeting include:
- Cognitive care issues;
- Payment reflecting the value and expertise of rheumatologists;
- Workforce development issues;
- Loan repayment; and
- Graduate medical education (GME) funding.
“Because MedPAC exerts a lot of influence on policymakers in Congress, it’s critical for the ACR to communicate our ideas to MedPAC about solutions for our projected workforce shortage, such as loan repayment programs, boosting GME slots and funding, and improving how cognitive care is valued in billing codes,” explains Angus Worthing, MD, chair of the ACR’s Government Affairs Committee (GAC).
“Because rheumatology is a small specialty, working with influencers like MedPAC helps us leverage our voice,” he adds. “Our hope is that meetings like this will help create victories on Capitol Hill on behalf of ACR members, our profession and our patients.”
Dr. Worthing suggests that one important victory with MedPAC would be a focus on making changes to address the projected workforce shortage for rheumatologists, including reforming reimbursement of cognitive specialists who experience the same recruiting problems as primary care providers. “Rheumatologists and cognitive specialists bill with the same evaluation and management [E/M] codes, so efforts to improve coding and reimbursement solely for primary care are unfair and will lead to further shortages in cognitive specialties.”
Timothy Laing, MD, a rheumatologist in Ann Arbor, Mich., and the ACR’s adviser at the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) and Current Procedural Terminology (CPT) advisor, agrees.
Dr. Laing points to data from a recently published workforce study showing that over the next several years the rheumatology profession will suffer an increasing shortage of practitioners, and further suggest that compensation differentials vis-a-vis other procedure-based specialties may be responsible, in part.
“It makes eminent sense to discuss the issue with MedPAC,” Dr. Laing says. “The ACR participates with the Cognitive Care Alliance [CCA] in advocating for a large-scale study to be conducted under the auspices of CMS. [This study would] examine the family of [E/M] codes, with the goal of extensively revising them to more accurately recognize the value of cognitive care services. Thus, these two efforts can be seen as complementary.”
Making Headway
Dr. Amodeo is encouraged by the dialogue between the ACR and MedPAC on these issues.
“Dr. Matthews and the other MedPAC leaders we met with shared with us that they are considering the landscape and certain policies around loan repayment and GME funding. There are no additional specifics on these topics yet, but we look forward to engaging with MedPAC along the way,” Dr. Amodeo says.
She also notes that MedPAC leadership was receptive to including a focus on cognitive specialists, not just primary care, when it comes to such reforms as changing billing codes.
“These issues are critical for those of us in clinical practice, including private practice and academic medical center clinics,” Dr. Worthing notes.
He explains that it is increasingly difficult to recruit and retain rheumatologists to join a practice. “Increasing GME slots and funding, and having a set of billing codes that values rheumatology care would help attract more residents to choose rheumatology and strengthen our workforce pool. Also, improving reimbursement is critical to maintain viability of practices, especially in rural and underserved areas where rheumatologists are needed.”
Based on discussion during the meeting, Dr. Amodeo shares that MedPAC welcomes more discussion on issues facing rheumatologists, and the ACR is glad to have open lines of communication with them as the College looks forward to future meetings that support “a working relationship that allows us to engage on issues and provide feedback along the way. Stakeholder engagement is very important when making sweeping policy change recommendations.”
The ACR is planning a follow-up meeting with MedPAC and the CCA to talk in more depth about E/M code recommendations.
Additional Resources
Learn more about the ACR’s federal advocacy efforts with the U.S. Congress and federal agencies.
Catch up on the latest ACR wins and new threats on the advocacy front.
Carina Stanton is a freelance science writer in Denver.
