Dozens of rheumatology leaders met with more than 100 politicos on Capitol Hill in mid-May, per the ACR’s annual Advocacy Leadership Conference. Armed with research and advocacy training concerning a handful of important issues, rheumatologists, researchers, government affairs specialists and others met with federal lawmakers, legislative aides and correspondents.
The two-day conference, which featured the May 16 Hill meetings, is one of two major organized events when rheumatology leaders descend on Washington to meet with federal lawmakers. Unlike September’s Advocates for Arthritis event, this event did not include patients; instead it fell to rheumatology leaders to advocate on patients’ behalf for the following key issues.
Issue 1: Support the Safe Step Act to Counter Step Therapy
Create a clear and transparent process for many patients to get exceptions to step therapy (or fail first), require insurers to consult with patient medical histories and providers before denying medically necessary treatments, and establish a clear and reasonable timeframe for over-ride decisions. This Act would build on reforms already passed in 22 states.
Issue 2: Stabilize the Long-Term Rheumatology Workforce
Provide loan repayment for pediatric subspecialists (including in rheumatology), and address pediatric public health disparities in children’s hospitals graduate medical education programs. These initiatives would help counter a trend that shows the projected demand for rheumatologists far exceeding the supply over the next dozen years. This workforce is severely limited by the lack of substantial funding for fellowship training, while many programs rely on private funding to sustain their training. (A House bill calling for the strengthening of the pediatric workforce at large was introduced in March.)
Issue 3: Reform Prior Authorization
Improve the transparency and efficiency of this process, helping patients access care without facing delays that could jeopardize their health. Congress should require prior authorization be standardized and allow for electronic options, force insurance companies to reveal coverage restrictions levied at the point of care, and eliminate prior authorization altogether for most approved therapies.
Issue 4: Improve Access to Osteoporosis Testing in Medicare
Issue a sustainable payment for dual-energy X-ray absorptiometry (DXA) bone density scans conducted in physicians’ offices, and preserve current access to osteoporosis testing, prevention and treatment. Medicare reimbursements for DXA scans have dropped by 70% over the past decade, and active payment rates don’t cover physicians’ costs to provide this service. (A Senate bill was introduced in January and a House bill in May.)
Issue 5: Invest in Arthritis Research at the Department of Defense (DoD)
Submit an appropriations request for a dedicated $20 million line item in a DoD research program’s budget. That program lacks funding earmarked for arthritis research, despite listing similar dedicated budgets for other diseases—and despite arthritis being a major condition afflicting U.S. service members. Funding for arthritis and clinical care research overall is also significantly limited.
Meeting Outcomes
Participants converged on D.C. May 15 to meet each other, as well as ACR staff, discuss these issues and undergo a few hours of advocacy training at a hotel just north of the Congressional buildings. Many also attended an advocacy dinner featuring a speech by Sen. Susan Collins (R-Maine).
After a brisk breakfast Thursday morning, they split into small groups divided by delegation, hailed rideshares or taxis and headed to the Hill. Most groups met with staff or leaders of at least a few Congressional offices over the next few hours; the final tally: 67 rheumatology leaders spoke with a combined 110 Congressional personnel. The ACR leaders represented the ACR’s Board of Directors, Affiliate Society Council, Government Affairs Committee, Committee on Rheumatologic Care, RheumPAC and Insurance Subcommittee; they came from 31 states and D.C.
The ACR is far from finished lobbying Congress regarding these issues and others. While some rheumatology leaders may have felt cynical before meeting with Hill personnel, they emerged from the meetings content and optimistic their voices had at least been heard and they had achieved some momentum for advancing the key issues through Congress. This is not a rapid process, and the ACR is in it for the long haul. Participants in September’s event also advocated for Congress to address step therapy, the decline in DXA scans and dedicated arthritis research funding at the DoD. In April, the ACR led 25 patient and provider organizations in urging the Centers for Disease Control and Prevention to address an issue with step therapy.
“Our ability to show support and interest in legislators through conversations and through financial contributions is key to advancing our advocacy efforts,” Gary Bryant, MD, former RheumPAC chair, former ACR Board member, and chair of the ACR’s delegation to the AMA House of Delegates, told the ACR recently. “It is important to participate in advocacy both through contributions and by keeping abreast of ACR issues.”
RYAN BASEN is a journalist in the Washington, D.C., area.
