More than 90 rheumatologists and rheumatology professionals and 30 patients met virtually with 149 legislators in Washington, D.C., on Sept. 15 to advocate for telehealth and other ways to ensure access to care through the pandemic and beyond during the ACR’s annual Advocates for Arthritis event.
The participants included 20 rheumatology fellows, program directors and ARP members who participated in the ACR’s Advocacy 101 training on Sept. 13. They used their training to give legislators direct insights into rheumatology and the unique challenges providers and patients must manage during the pandemic.
Training Advocates
Advocacy 101 participants learned about federal and regulatory advocacy and worked in small groups to explore ways to implement the training.
“This program has promoted volunteerism in the ACR and trains enthusiastic advocates who speak up for their patients and profession,” says Blair Solow, MD, chair of the ACR’s Government Affairs Committee (GAC). “In our first virtual Advocacy 101, I was thrilled with the transition made to a virtual platform by Bharat Kumar, MD. He thoughtfully created teaching modules to lay the foundation for the event.” Dr. Kumar is an Advocacy 101 coordinator and a GAC member.
Many of the Advocacy 101 talks were led by members of the GAC and covered key practice and legislative issues, ways to get involved, being an effective advocate and state advocacy.
GAC member Amanda Schnell, MD, spoke about personalized advocacy, how energized advocates can stay involved year-round and encourage others to participate, and why it is important to advocate for patients.
“I love this quote from Margaret Mead that was presented at Advocacy 101 when I participated as a first-year rheumatology fellow … ‘Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that has.’ Her words continue to inspire me today because it reminds me that it is important to take time away from my rheumatology practice to support effective advocacy of issues paramount to rheumatology,” Dr. Schnell says.
For Manjeet Singh Bhamra, MD, a second-year clinical rheumatology fellow at SUNY Upstate Medical University, Syracuse, N.Y., participating in Advocacy 101 helped him learn how to be concise and clear in meetings with congressional staffers. “The staffers certainly appreciate it, and it forces you to understand and distill the issues to layman terms.”
Eric Dein, MD, a rheumatology fellow in Baltimore, and a participant in Advocates for Arthritis for the first time through Advocacy 101, learned it is essential to not only clearly deliver your message, but emphasize its direct impact on the field.
“I was more effective when I spoke less about the details of the bills and spent more time talking about how my experience in rheumatology is directly affected daily by COVID-19, telemedicine and workforce shortages,” Dr. Dein notes. “This impact on my life, as well as on the life of our patient advocates, were the most demonstrable examples of how congressional support can produce effective change in the field of rheumatology.”
He also gained new appreciation for the importance of getting involved. “Over the course of my medical training, I have noticed many inefficacies and disparities in our healthcare system. Today, I had the opportunity to directly work on enacting changes to this system,” Dr. Dein says.
Focus on Access to Care
In meetings with legislators and their staff, “We addressed protections for and access to telehealth moving forward, and communicated our shared experience using this tool,” says Blair Solow, MD, GAC chair. As physical distancing requirements have significantly impacted access to in-person evaluations, telemedicine has bridged the gap in patient care during the pandemic, especially in light of concerns for immune-suppressed or aging patients.
For Amy Barron, a patient advocate living with rheumatoid arthritis, participating in Advocates for Arthritis gave her the chance to share how telehealth has proved an invaluable connection to her rheumatology providers through the pandemic to maintain uninterrupted care for her rheumatoid arthritis.
“It’s imperative to maintain consistent care with an established provider, especially during unfavorable situations, such as what ’we’ve been faced with during the pandemic—the lines of communication must remain open,” Ms. Barron stressed. “There are times a patient might trivialize a new or changing symptom, yet a physician deems it necessary to have an in-person exam, or even lab work or X-rays. Follow-up situations such as these can be lifesaving.”
During her virtual meeting with a legislator on Sept. 15, Ms. Barron asked for support of legislation that will allow telehealth to be sustained through the pandemic and after to ensure long-term access to care, particularly in rural areas and those that lack rheumatologists.
Extending Telehealth
The ACR’s advocacy for telehealth to preserve and expand patient access to care supported a major point of discussion during the event, according to Lennie Shewmaker, JD, the ACR’s director of congressional affairs. Despite financial strains experienced through the pandemic, rheumatology providers have been able to continue patient care through the rapid adoption of telehealth, including audio and video appointments, she says.
Flexibilities for telehealth treatments of Medicare patients through the Centers for Medicare & Medicaid Services (CMS) will remain in place for the duration of the public health emergency (PHE), which is currently set to expire on Oct. 25. Legislation that would make permanent many of the telehealth expansion parameters, including evaluation and management (E/M) visits for established patients, would allow providers to shift appropriate care to this platform and expand patient access, Ms. Shewmaker explains, echoing similar discussion from an issue brief the ACR created to guide conversation with legislators during the event. “Our member advocates stressed appreciation for the agency’s recognition of the value of telehealth for our patients and the recognition that action is necessary to preserve telehealth as a valuable platform after the public health emergency ends.”
Advocates also stressed that further support for rheumatology telehealth during and after the PHE will require two important solutions proposed through current legislation:
- Parity for telehealth under ERISA plans, which asks Congress to follow CMS’s lead and reimburse for audio-only E/M visits at the same rate as audio-video and in-person evaluations through the PHE to deliver efficient healthcare and support broader access for those in rural and underserved areas. This reimbursement is outlined in the Health Care at Home Act (H.R. 6644/S. 3741).
- Update telehealth delivery restrictions to improve health outcomes by applying lessons learned through telehealth delivery during the PHE permanently to telehealth services through Medicare. This would make it easier for patients to connect with their providers while creating cost savings for patients and providers. These updates are covered in the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (H.R. 4932/S. 2741).
Workforce Demands
“During the COVID-19 pandemic, ongoing concerns with workforce shortages among rheumatologists and rheumatology health professionals have become a more pressing issue, and congressional action is critical to address the workforce needs,” says Dr. Solow.
Several pieces of active legislation to address workforce shortages were discussed during the event and shared through an issue brief left with legislators. For example, the ACR supports actions to raise the cap on funding for graduate medical education slots as outlined in the Resident Physician Shortage Reduction Act (H.R. 1763/S. 348).
Advocates also spoke out in support of funding the Pediatric Subspecialty Loan Repayment Program, based on estimates from the ACR’s 2015 Rheumatology Workforce Study suggesting nearly 300,000 American children have juvenile arthritis, but fewer than 400 board-certified pediatric rheumatologists are practicing in the U.S.1
Federal action to secure J-1 visas for foreign medical professionals serving American patients through the Healthcare Workforce Resilience Act (H.R. 6788/S. 3599) was also discussed during the event to help legislators understand that nearly 21 million Americans live in areas where foreign-trained physicians account for at least half of all physicians.
Making Virtual Connections
The virtual format for this year’s advocacy events reduced the required time commitment and allowed more providers and patients to participate, according to Dan Redinger, ACR’s manager of advocacy and political affairs. “Legislators and their staff have had to transition to virtual visits with constituents, so advocates were still able to have meaningful discussions on providing better access to care and build relationships with their members of Congress.”
The event’s success illustrates that effective advocacy is not limited to Washington, D.C. “Our hope is that attendees found that legislators and their staff are readily available to hear from their constituents, and interactions about issues important to rheumatology can occur year-round,” Mr. Redinger adds.
Get Involved
Learn how you can add your voice to the ACR’s work to ensure patient access to care through telehealth and workforce support in the Legislative Action Center.
Read the ACR’s correspondence to federal agencies regarding telehealth, workforce support and pediatric rheumatology provider support.
Carina Stanton is a freelance science journalist based in Denver.
Reference
- 2015 Workforce Study of Rheumatology Specialists in the United States. American College of Rheumatology, 2016.
