Updated 9/1/2022 with legislation status.
With more than 800 members, the California Rheumatology Alliance (CRA) is one of the largest and most active state rheumatology organizations. The CRA comprises rheumatologists and rheumatology professionals from community practices and medical centers throughout California.
“Our membership encompasses all health professionals within the field of rheumatology—physicians, nurses, nurse practitioners (NPs), physician assistants (PAs), fellows currently enrolled in a California-based rheumatology training program, office managers, researchers and medical science liaisons,” says Shanna Castro, the CRA’s executive director.
Ms. Castro
After a two-year hiatus, the CRA held its first in-person conference since the start of the pandemic in May in San Francisco.
“Given the situation at the time of planning, we prioritized the health and safety of our faculty, attendees and exhibit partners and reduced the number of in-person attendees by 50% to ensure participants were able to reconnect with their colleagues while learning in a safer environment,” Ms. Castro says.
The CRA holds a practice manager track that runs concurrently with the annual meeting, says Ms. Castro. It provides an opportunity for practice managers, supervisors and billers to network with their peers and share ideas on how to efficiently and effectively oversee a rheumatology practice.
At this year’s conference, the CRA bestowed its Lifetime Achievement Award on Michael Stevens, MD, FACR, a rheumatologist at San Mateo Rheumatology. Dr. Stevens founded CRA in 2004 and served as president of the organization from 2004–10.
Overcoming Challenges
Like many states, California is experiencing a shortage of rheumatology professionals, says current CRA president Samy Metyas, MD, MSc, FACR, FACP, a rheumatologist at the Covina Arthritis Clinic.
Dr. Metyas
“We see most physicians and rheumatology staff, including NPs, PAs and others, going to work in big healthcare organizations and hospitals that can offer more money than private practices,” Dr. Metyas says. “Private rheumatology practices are shrinking because of a shortage of rheumatology fellowships and training.”
These shortages have also resulted in increased waiting times for patients to see a rheumatologist, he notes. “Community rheumatologists need additional help in seeing patients and running their practices efficiently.”
During the pandemic, telemedicine became a popular option among rheumatologists in California, Dr. Metyas says, but it’s not a replacement for traditional office visits.
“Rheumatology is based on clinical examination,” Dr. Metyas says. “While telemedicine helped us to continue seeing patients during the peak of the pandemic, these visits don’t replace clinical exams. In addition, some insurers aren’t reimbursing telemedicine visits at the same rate as in-person visits.”
Dr. Dore
Robin Dore, MD, immediate past president of CRA and a rheumatologist in private practice in Tustin, agrees.
“For some patients who are stable, telemedicine visits are fine, but in-patient appointments are vital for rheumatoid arthritis and lupus patients to determine if they’re responding to therapy,” Dr. Dore says.
To help increase the number of practicing rheumatologists in the state, the CRA (along with the Coalition of State Rheumatology Organizations) has given funds to the Children’s Hospital Los Angeles in support of the hospital’s Pediatric Rheumatology Fellowship Program. This gift is intended to serve the needs of the hospital and provide financial support to encourage physicians to practice in the field of pediatric rheumatology.
Rheumatology, like many other specialties, has faced shortages of supplies as well as people, due to supply chain issues. “We’ve seen a shortage of many medical supplies and medications, including steroid injections and saline which we use for infusions,” Dr. Metyas says.
Continuing to Advocate for Patients
The CRA has an active advocacy committee that works to ensure patient access to rheumatology care.
“CRA also received positive news when the California Assembly passed AB 1880 to ensure that an appeal of a step therapy or prior authorization request must be reviewed by a clinical peer, such as a rheumatologist reviewing for a rheumatology colleague,” says Tim Madden, partner at Madden Quiñonez Advocacy, who works with the CRA. “The bill is now being reviewed by the Senate. If the bill passes the Senate, it will then go to the governor in September.”
Some of the current bills the CRA is actively advocating for include:
- SB 958: Medication & Patient Safety Act of 2022. The CRA supports this bill, which opposes the practice of white-bagging, or requiring physicians to acquire provider-administered drugs through specialty pharmacies designated by a payer or pharmacy benefit manager. The bill prevents health plans from refusing to cover infused or injected medications the health provider has in stock if use is provided for patient safety, integrity or timely care. This was passed by the State Senate in May but has not yet been taken up by the Assembly.
- SB 853: Medication Access Act. The CRA supports this bill to improve patient access to medication. The bill requires health plans to cover a patient’s previously prescribed drug, dose or dosage form through the duration of an appeals process in the event their health plan denies coverage. It also strengthens California’s prohibition on non-medical switching, which is when a health plan forces a patient to switch from a prescribed medication to a different one for non-medical reasons. This was held by committee in the Assembly in August.
- AB 2352: Prescription Drug Coverage. The CRA supports this bill, which would require health plans or insurers that provide prescription drug benefits and maintain one or more drug formularies to furnish specified information about a prescription drug upon request by an enrollee or insured, or their prescribing provider. This was passed by the Assembly in May and the State Senate in August. As we go to press, it awaits concurrence.
For information about connecting with your state or local rheumatology society, visit the ACR’s state societies webpage.
Linda Childers is a health writer located in the San Francisco Bay Area.
