“We’ll see what emerges,” he adds.
ACR representatives recently met with Congressional staff to share concerns and ideas, and Dr. Adams says the feedback they received was “encouraging.”
However, the cost to rheumatologists, particularly those in small or solo practices, must be taken into account, Drs. Herzig and Adams both say.
“Some doctors will look at their Medicare income, see what percentage of Medicare they have in their practice and decide whether a 4% cut is worth it or not,” Dr. Herzig says. “What doctors need to know is they need to have real control of their budget. If they know what their budget is and look at what percentage of Medicare is their budget, they can figure out what that means to them.”
For example, starting in 2019, if a practitioner receives $300,000 a year in Medicare reimbursements, a 4% loss is $12,000. “That cost might be absorbed,” Dr. Herzig says. “However, the penalty rises each year.
“Doctors have to get moving now,” he adds. “There is no time to waste.”
Looking Forward
In addition to knowing their budget, rheumatologists should look for ways to work together, Drs. Adams, Herzig, White and Kazi all say.
“We’re not going to survive as lone rangers, independently putting out every brush fire that comes along,” Dr. Adams says. “This movement toward quality and cost control in medicine is too big for any one doctor or small group of doctors to deal with. I think the ACR’s efforts are vitally important, and members really need to support and contribute to it in terms of leadership.”
On June 24, 2016, the ACR submitted a letter to the CMS lauding the promise of MACRA while also expressing deep concerns over some aspects of the reimbursement overhaul.3 The comments reflect many of those shared by Drs. Adams, Herzig, White and Kazi. In particular, the ACR believes the benchmark timeline for MACRA measurement to be “daunting,” and would like to see additional exceptions and consideration made for small and solo practices.
The key issues, the ACR wrote to the CMS, concern timing and complexity of the requirements, the lack of APMs for which rheumatologists appear to be qualified and the exclusion of Part D medication costs from resource use calculations.
“We are pleased to provide comments on a number of the complex issues raised within the rule,” wrote Dr. Von Feldt in the letter to the CMS. “As a general principle, we encourage CMS to be mindful of our ability to treat and care for patients with chronic and rheumatic diseases.”
