The ACR and its delegation to the American Medical Association (AMA) House of Delegates (HOD) capped a busy and highly successful annual HOD meeting June 7–12 in Chicago with the passage of a resolution supporting higher pediatric specialist compensation. The ACR’s resolution at this meeting—addressing Medicaid payment parity for pediatric specialists—was successfully passed, with some amendments, in the HOD and will be adopted by the AMA.
Gary Bryant, MD, chair of the ACR’s delegation, notes the dire and continuing workforce shortage in pediatric rheumatology, similar to the situation in some other specialties. “There are barely more than 300 pediatric rheumatologists nationwide to care for more than 300,000 children in the U.S. with rheumatic disease,” he says. “Medicaid is typically the lowest payer for physician services, so raising Medicaid payment to at least be on par with Medicare is an important step to incentivize career entry into pediatric specialty medicine.”
Hundreds of delegates from medical specialty societies and state medical associations gather at two AMA HOD meetings each year—in June and November—to set policy and direction for the nation’s largest and most powerful physician organization. A detailed rundown of the AMA’s policy development process can be found here.
The ACR delegation also worked to shape policy discussions in a number of other areas affecting members. Topics addressed at the HOD meeting included updates to Medicare Physician Fee Schedule payments, budget cuts and budget neutrality issues, approaches to sustaining community practices, biosimilar policies, artificial intelligence in healthcare, prior authorization and many more.
The new resolution adds to a long list of ACR-developed policies and directives passed by the AMA. Previous efforts have addressed copay accumulator policy, third-party pharmacy benefit administrators, stakeholder engagement with Medicare Administrative Contractors, payer financial incentives to switch treatments, selective application of prior authorization, step therapy in Medicare Advantage, biosimilar interchangeability pathways, ensuring an effective H-1B visa program to enhance the rheumatology workforce, drug pricing, drug cost attribution in quality payment programs, pharmacy benefit manager reform, opposing the previous Medicare Part B drug payment demonstration and more.
Pediatric Specialty Medicaid Reimbursement
Resolution 249, which addresses Medicaid reimbursement for pediatric specialists, was developed by the ACR in conjunction with five other specialty societies.
Joining the ACR’s resolution as cosponsors and calling for AMA involvement on this issue were the American Academy of Allergy, Asthma and Immunology; American Academy of Neurology; American Urological Association; Association for Clinical Oncology; and American Academy of Ophthalmology. Resolution 249 also gained support in many caucuses and section councils and support was expressed by the American Academy of Pediatrics, PacWest Healthcare and the AMA’s California Medical Association delegation, among others.
As a result of the resolution’s passage, the AMA will now work with professional organizations and Congress in support of payment parity for pediatric specialists when treating Medicaid patients.
This AMA policy advancement would not have happened without the ACR’s initiative to develop relevant and cohesive policy and convene a coalition of stakeholder specialty societies with similar concerns, nor without partnering societies’ help and substantial support at the meeting. This success was also possible because ACR members join and maintain memberships in the AMA, allowing the delegation representation at the meeting. Join now to not only access benefits for yourself, but to also support this work to elevate rheumatology issues at the national level.
Resolutions are also introduced by other specialty societies and considered by the ACR based on its positions and policies and the work of ACR committees and the Board of Directors. The ACR cosponsored the following resolutions at this meeting.
Medicare Advantage Part B Drug Coverage
The HOD passed Resolution 232, authored by the Association for Clinical Oncology with the ACR as a cosponsor. This resolution requires that Medicare Advantage plans cover physician-administered drugs and biologics in such a way that the patient out-of-pocket cost is the same as or less than the cost to a patient with traditional Medicare plus a Medigap plan.
Prohibiting Mandatory White Bagging
The HOD passed Resolution 233, authored by the Association for Clinical Oncology with the ACR as a cosponsor. It will have the AMA urge state and federal policymakers to enact legislation to prohibit the mandatory use of white bagging.
State Prescription Drug Affordability Boards—Study
The HOD passed Resolution 233, authored by the Association for Clinical Oncology with cosponsors that included the ACR, American Academy of Dermatology Association, American College of Mohs Surgery, and American Contact Dermatitis Society. It will have the AMA conduct a study to determine how upper payment limits (UPLs) established by state prescription drug affordability boards will impact reimbursement for physician-administered drugs and what impact state UPLs will have on patient access to care. The AMA will report the results of this study to the AMA HOD in 2025.
Alternative Funding Programs
The HOD passed Resolution 707, authored by the Association for Clinical Oncology with the ACR as a cosponsor. It will have the AMA educate employers, benefits administrators and patients on alternative funding programs (AFPs) and their negative impacts on patient access to treatment. The AMA will advocate for legislative and regulatory policies that would address negative impacts of AFPs.
Support the ACR’s Delegation
The ACR’s delegation to the AMA House of Delegates consists of Gary Bryant, MD (delegate and delegation chair), Eileen Moynihan, MD (delegate), Cristina Arriens, MD (alternate delegate), Colin Edgerton, MD (alternate delegate), Luke Barre, MD (Young Physician Section representative), and Christina Downey, MD (Young Physician Section representative).
The ACR asks rheumatologists to join or renew membership in the AMA so this work may continue. Rheumatology’s voice at the House of Delegates meeting is determined based on the number of ACR members who are also members of the AMA, so every single person who is a member of both the ACR and the AMA adds to the strength of this effort. Visit the AMA’s membership site to join or renew your AMA membership and receive valuable membership benefits along with helping to advance rheumatology.
Input on the AMA delegation’s work on behalf of the rheumatology community—along with questions or suggestions for this House of Delegates meeting—can be directed to [email protected]. If you are experiencing specific issues with payers or have other practice concerns, the ACR offers individualized assistance to members of ACR and ARP. Write to [email protected] with your insurance, coding, billing and other practice issues.
