I Will Be the Squeaky Wheel

On the walls of my examining rooms, I have the ACR flyer forewarning visitors about the decreased access Medicare patients will have to rheumatologists, other physicians, and a variety of medical services if the sustainable growth rate (SGR) is not modified by the end of 2011. The interest in this flyer has only intensified in the past few weeks as patients have raised concerns about the debt ceiling talks and what is going to happen with Medicare. One of my elderly female patients explained that she relies on Medicare for her insurance and without it she wouldn’t be able to afford her medical care. I had another patient who needed a colchicine prescription, where the cost of the medicine has skyrocketed from pennies to hundreds of dollars because they were in the Medicare Part D “doughnut hole.” Other patients have concerns about their potential costs of and access to Medicare Part B infusion drugs in their rheumatologist’s outpatient office if the new reimbursement formula of the average sales price plus 4% is instituted in 2012.

Whenever I get together with colleagues, the future of reimbursement inevitably becomes the topic of conversation. Initially, we discuss problems that affect our patients. The give and take is helpful when we are discussing complex patients and trying to brainstorm a diagnosis or treatment plan. Unfortunately, in the last few years the more common themes that take over our mental energy have been the topics of insurance burdens, Medicare issues, etc. The final common pathway of all these issues is access to care. We all know that patients need access to rheumatologists, access to testing, and access to treatment options. We need to help our patients overcome these barriers by advocating on their behalf and teaching them how to be their own advocates.

No Excuses

I know what you are going to say: “But Dr. Borenstein, I don’t have the time to advocate. I am too busy seeing patients and doing all of the busy administrative work that insurers and Medicare keep piling on.” That is precisely why it is important for Congress to hear your concerns. Members of Congress are dealing with thousands of issues, so it literally comes down to the squeaky wheel. It is now time for rheumatology health professionals to make noise and have our voices heard. Make a call. Send an e-mail. Visit a congressional office.

For 10 years, the physician community has battled to repeal the SGR, the formula that determines physician Medicare reimbursement. Last year alone, we faced four separate cuts and now face a 29.5% cut in 2012. How can we, whether in private or academic practice, plan for the future if we are unsure of our revenue? Congress recognizes the problem and the cost, but continually responds that they don’t know how to fix it. Frankly, we cannot afford a 29.5% cut. Patients cannot afford for us to lose our reimbursement. It is essential that we are there for our patients. Congress needs to deliver a solution for us, for our patients, for their families, and for the future.

I Have a Story to Tell, and So Do You

I am a rheumatologist and I have a story to tell. I have a story to tell about patients needing care. I have a story about a distressed patient being rolled into my office but leaving my office walking. I have a story about a patient who had seen several other physicians before coming to me and being properly diagnosed and appropriately treated. How many times, as rheumatologists, have we heard the statement, “You are my last hope because you can figure out my problem?” Congress needs to hear who we are and the services we provide. They need to hear it from me. They need to hear it from you. They need to hear it from our staff. They need to hear it from our patients.

Years ago, while visiting Capitol Hill, the reaction to “I am a rheumatologist” was a blank stare. We are beginning to see a change. This month, the ACR will be on Capitol Hill for Advocates for Arthritis, a yearly opportunity for rheumatologists, health professionals, and patients to join forces and share our message with Congress. This year, we will have more than 125 attendees from across the country spreading the word. Together, we will walk the halls of Congress educating our legislators on what rheumatology is and why patients need access to rheumatologists.

In addition to our efforts on The Hill, the ACR will launch its new public relations initiative, Simple Tasks. The initiative has a strong focus on ensuring that influencers, such as members of Congress, understand the problems affecting our patients and how rheumatologists help manage those problems. Simple Tasks aims to elevate the importance of rheumatology, increase understanding of the work of rheumatologists, and lay a foundation of awareness and understanding. The campaign focuses on the simple tasks such as brushing teeth or tying shoes that can become impossible because of inflammatory rheumatic diseases. As rheumatologists and rheumatology health professionals, we know that these diseases are more than aches and pains and more than a part of getting older. Simple Tasks will help lawmakers and administration officials (as well as other influencers) better understand the hardships our patients face.

Rheumatology’s Progress

We have made progress. Now, on congressional visits when I say I am a rheumatologist, the first response isn’t a quizzical look. Through frequent meetings with Congress, grassroots action from the members such as yourself, and RheumPAC’s ability to open doors to key members of Congress, the ACR’s presence in Washington is recognized.

Since I became president last November, the ACR has met with Donald Berwick, MD, the administrator for the Centers for Medicare and Medicaid Services (CMS) Medicare Payment Advisory Committee that recommends payment policy for this Federal program, and CMS Director of Medicare Management Jonathon Blum. Tim Laing, MD, chair of the Government Affairs Committee, and I, along with the presidents of other medical societies and executive officers of major medical centers, attended a meeting with Ezekiel Emanuel, MD, head of the Department of Bioethics at the Clinical Center of the National Institutes of Health, and Dr. Berwirk to discuss the organization of medical practices in light of the new health care reform law.

We have had key discussions with Energy and Commerce Committee Chair Fred Upton (R-MI) and Ways and Means Committee Chairman Dave Camp (R-MI). We have been addressed by Sen. Ron Wyden (D-OR) about the status of healthcare reform and SGR. I’ve had small group dinners with Speaker John Boehner (R-OH), Sen. Olympia Snowe (R-ME), and Sen. Orrin Hatch (R-UT). While supporting Sen. Sherrod Brown (D-OH), we met Sen. Charles Schumer (D-NY) discussing healthcare issues. And it turns out that Rep. Ed Towns (D-NY) works downstairs from a current Government Affairs Committee member.

With the combined efforts of our members, the ACR, and our patients, we can influence the influencers who make decisions that affect rheumatology. We can enjoy more conversations that start with, “I have a patient who is feeling much better about the future of rheumatology care.” The ACR’s advocacy efforts have come a long way since we began this voyage two decades ago. Washington has certainly changed, but one thing remains the same and critically important: members of Congress are elected to represent their constituents (you), and they want to know your issues and how they can help you. It isn’t scary. They are not going to quiz you or ask you to solve the nation’s debt problem. You just need to tell your story. Tell them about your patients. Tell them about rheumatology.

You have a story to tell. Now is the time to tell it. Be the squeaky wheel.

Dr. Borenstein is clinical professor of medicine in the division of rheumatology at George Washington University Medical Center, in Washington, D.C., and in private practice at Arthritis and Rheumatism Associates there. Contact him via e-mail at [email protected].