Keep Your Practice Solvent
Mr. Haberkern
The first speaker, Charles Haberkern, MBA, is an entrepreneurial healthcare executive and the CEO of Arthritis, Rheumatic & Bone Disease Associates. In his presentation, Cash Flow Considerations, Mr. Haberkern shared tips from his 25 years of financial experience, advising, “You have to take care of patients first, but if you’re losing money, you can’t take care of patients.”
Mr. Haberkern advised his audience to set aside money to pay invoices when they come due—rather than right away—so the funds can accrue interest while in the bank.
Nehad Soloman, MD, FACR, is a Phoenix-based rheumatologist, a recipient of multiple awards for research and academic excellence and a public speaker for the Arthritis Foundation. In his presentation, Dr. Soloman brought the perspective of both administrator and physician to his analysis of the buy-and-bill model used by infusion centers. Under the buy-and-bill model, healthcare providers purchase certain medicines that require special handling and storage and store them at their practices until they are needed by a patient. Medicare then reimburses physicians for these therapies.
Dr. Soloman
Dr. Soloman emphasized the utility of observing metrics to understand the roles of every person on a team and ensure each person is responsible for their own role. He underscored the importance of resource and inventory management in infusion clinics and advised practices to keep track of drugs by doctor and by quarter to ensure resources are distributed without disparities.
Christopher Phillips, MD, the final speaker of the first session, is a rheumatologist affiliated with Mercy Health-Lourdes Hospital, Paducah, Ky. He delivered a presentation on how to operate a successful infusion clinic. He cautioned against making “bad assumptions”—for example, assuming that a practice’s infusion nurse will never leave that practice. “If you only have one person you rely upon, that person is … more of a key employee than you are to your practice’s survival,” so make sure your pay is competitive and your employees’ needs are met, Dr. Phillips advised.
Dr. Phillips
Additionally, he recommended delegating tasks to nurse practitioners within the parameters of what is legal in each state, as well as insuring drugs in case of a power outage or other emergency. Dr. Phillips emphasized the necessity of being prepared for contingencies and never infusing without a clinician on site.
As with the two preceding speakers, Dr. Phillips recommended keeping a close watch on drug prices, to buy in bulk when prices are low and not to hesitate to negotiate or switch vendors.
Optimize Patient Access to Treatment
Colin Edgerton, MD, RhMSUS, opened the second session with a presentation about biosimilars. Dr. Edgerton is a founding member of Articularis Healthcare, one of the largest rheumatology practices in the U.S., spanning the states of South Carolina and Georgia. Biosimilars can be a great option for patients and can make treatment more financially accessible, he said. In his experience, patients adhere to their medication regimens equally regardless of whether the drug is the originator or a biosimilar, and the efficacy of the drug itself is not reduced.
Dr. Edgerton identified some challenges related to the use of biosimilars, such as complications with prior authorization and clinical concern regarding multiple prescription switches.
“We don’t want a patient getting changed to another adalimumab every quarter or two,” said Dr. Edgerton. Multiple switches in medications may even cause a nocebo effect for patients, who may be understandably confused or anxious about having to adjust to a new drug.
Mr. Turkas
Nicholas Turkas, MS, is the senior director of patient education and community connections for the Arthritis Foundation. Mr. Turkas’s presentation explored the pros and cons of original Medicare vs. Medicare Advantage plans. Original Medicare is a fee-for-service program, which means there is a set, non-negotiable price for any given procedure. Medicare Advantage, however, is managed care, which requires patients to use a limited network of providers and has stricter rules around prior authorization. When patients near age 65, Mr. Turkas recommends having a discussion with them about switching to Medicare, which has “huge implications in terms of access to care.”
Patients may be drawn to Medicare Advantage plans because of the lower up-front cost and such benefits as gym memberships. Medicare Advantage plans may also offer coverage for some care that original Medicare does not, such as vision, dental or hearing. However, the limitations of Medicare Advantage may make care much more expensive for patients switching from original Medicare, and because plan coverage specifics change from year to year, patients may not always be able to see the same doctor.
“It’s important to understand that covered doesn’t mean affordable,” said Mr. Turkas. He also warned that once a patient has switched from original Medicare to a Medicare Advantage plan, it is “almost impossible” to switch back.
Ms. Owen
Michelle Owen, a rheumatology office manager in Portland, Maine, with 15 years of experience, delivered the final presentation, addressing prior authorization. “I am the person who sits across from the patient to try to explain why their particular drug is not approved,” she said.
Ms. Owen strongly advised providers to have a designated person in the office to handle all prior authorizations and to institute a process for automatic appeal for every prior authorization request that is denied.
She reminded the audience that physicians must write a detailed note on behalf of their patient for a prior authorization to go through. “If you’re willing to fight for it, I can get it … but I can’t get it if you don’t give me a good note,” said Ms. Owen.
Conclusion
Speakers at the ACR/ARP Access in Rheumatology meeting presented expert guidance on how to avoid or mitigate some of the field’s significant barriers to access, with information on biosimilars, navigating prior authorization, the buy-and-bill model and more.
Glen K. Rodman is the assistant editor of The Rheumatologist.
