The Health Buzz

The ACR list serve is abuzz with opinions regarding the state of our nation’s healthcare systems and the plans to reform them. Debate about what should, versus what can, be done to reform healthcare—and at what cost—rages in laboratories, boardrooms, and physician waiting areas. While the ACR’s leaders, being reflective of its membership, hold differing personal opinions, it is incumbent upon us as stewards of the organization to represent the rheumatology community and serve its interests.

In the fall of 2008, in response to the potential for healthcare reform, the ACR Government Affairs Committee established a task force on the future of healthcare in the United States. The task force was established to address healthcare priorities of the rheumatology community that would increase the value and improve the delivery of care and the quality of life for people with arthritis and rheumatic and musculoskeletal diseases. The goal of this task force was the development of a position paper outlining the ACR’s vision and its recommendations regarding healthcare reform.

Our Goals

Chronic musculoskeletal conditions are the leading cause of disability in the United States and, according to an article by Edward Yelin, PhD, entitled, “Health care utilization and economic cost of musculoskeletal diseases,” various forms of arthritis were responsible for $37 billion in medical care expenditures between 2002 and 2007.1 With the aging population, the number of people affected by chronic musculoskeletal disease, as well as the cost of caring for them, is expected to grow exponentially. With that in mind, the ACR’s position paper includes the following goals for healthcare reform:

• Ensuring access to affordable health coverage;
• Ensuring an adequate workforce for arthritis and rheumatic and musculoskeletal diseases;
• Fixing the flawed sustainable growth rate formula;
• Ensuring access to quality care for arthritis and rheumatic and musculoskeletal diseases;
• Ensuring cost-effectiveness without reduction in quality healthcare; and
• Expediting an end to the practice of denying coverage for pre-existing conditions.

The ACR’s position paper can be viewed online at www.rheumatology.org/advocacy/acr_future_of_health_care_usa.asp.

Advocacy

Over the last year, the ACR has been focused in its efforts to influence the debate on healthcare. In September, members of ACR leadership and the Government Affairs Committee met with Nick Rathod and Kavita Patel, MD, MSHS, two members of the White House staff, to discuss issues relating to healthcare reform. The White House meeting followed earlier meetings in July with Meena Seshamani, MD, PhD, at the Department of Health and Human Services; several staff from Centers for Medicare & Medicaid Services (CMS); and several staff at the Agency for Healthcare Research and Quality. The CMS meeting was particularly important because it allowed us to voice our concerns over the removal of consultation codes, which could potentially have a major impact on delivery of care to Medicare patients. In addition to attending these meetings, members of the ACR have participated in organized lobbying efforts on Capitol Hill over the last year. Utilizing ACR staff and Patton Boggs, a Washington, D.C.–based lobbying firm, the ACR has closely monitored the evolving healthcare plans and attended hearings and committee meetings. It is important to have a consistent level of activity to keep the ACR fresh in the minds of members of Congress because it familiarizes them with the important subtleties of our specialty and allows them to have a better understanding of our goals.

What the Future May Bring

There is uncertainty about what the future may bring as the political parties continue to debate healthcare reform. The ACR needs to remain vigilant to address issues that could affect the wellbeing of patients. Congress may continue to question the necessity of specialty and subspecialty care. I would caution that the true cost of specialty care should be investigated before decisions are made in haste. It has been documented that rheumatologists achieve better outcomes in the treatment of arthritis and rheumatic and musculoskeletal conditions compared with primary care providers and other specialists—and this care is provided at a potentially lower cost to the healthcare system. We all frequently see patients who have been misdiagnosed for months and have gone through extensive, often repeat, testing that would have been unnecessary if they had seen a rheumatologist earlier. Earlier and more aggressive treatment of rheumatoid arthritis can reduce the need for hospitalizations or joint replacements, reducing overall healthcare expenditures. Those who treat arthritis patients daily know this. Unfortunately, the data supporting the advantages of early aggressive treatment are limited and it is necessary that additional studies be conducted examining these issues. In the future healthcare arena, the burden will be on us to provide data to prove that we are more cost efficient in managing chronic musculoskeletal diseases or we will be an afterthought in the new system.

Where We Stand

The ACR strongly supports the opportunity for all patients to have access to healthcare. In fact, many of us have seen patients we knew we could help if they had the benefit of coverage, which would allow proper treatment. As part of healthcare reform, we urge Congress to permanently fix the sustainable growth rate formula presently used to calculate Medicare reimbursement. It is clear to all that the formula is flawed and needs to be replaced with a formula that accurately reflects the increases in the cost of healthcare delivery.

We applaud the efforts to promote the integration of electronic health records that have the promise of interoperability and should result in improved quality of care. Financial support by the government will speed the process, and the resulting reduction in redundancy may save money in the long term.

We encourage quality standards to raise the level of care provided, with the caveat that they must be developed by medical experts with experience in patient care. We support and promote comparative effectiveness research to determine practices that provide quality care efficiently. Additionally, we would like a seat at the table to assist in setting the agenda for care of chronic musculoskeletal disease.

The devil is in the details. President Barack Obama believes there is an approximate savings of $500 billion dollars to be found in the existing Medicare programs. Further proposed cuts to rheumatologists to increase reimbursement for primary care or to penalize physicians who perform more tests than the average are problematic and could reduce access to the sickest patients who need care. Stories from our colleagues who have been subjected to Medicare audits by Recovery Audit Contractors have been sobering, and we hope that a better mechanism to determine cost efficiency can be developed. We all agree that the growth in healthcare expenditures needs to be controlled but it must be acknowledged that the incoming influx of graying baby boomers into the Medicare system will make it improbable that savings will result without negatively affecting care.

Be Heard

To ensure we continue to have a seat at the table and a voice in the discussion, the ACR supports the efforts of RheumPAC, the ACR’s nonpartisan political action committee. Formed in 2007 to assist the ACR in its legislative advocacy efforts, RheumPAC supports candidates for U.S. Congress who have demonstrated a willingness to fight for the issues most important to the rheumatology community and provides the ACR with improved access to legislators. To learn more about RheumPAC, please visit www.rheumatology.org/rheumpac.

Insurance companies are spending millions of dollars on marketing for healthcare reform on a constant basis. Physicians and healthcare providers need to contact their members of Congress to make their voice heard. It is easy to contact Congress by sending an e-mail or picking up a telephone. Contact ACR staff or visit www.rheumatology.org/advocacy to have your voice heard. We may not agree on all of the details, but we all should have an opportunity for our voice to be heard. We need to be the voice for our patients, and we need to advocate for appropriate reimbursement for the care we provide.

Dr. Cohen is president of the ACR. Contact him via e-mail at [email protected].

Reference

1. Yelin E. Health care utilization and economic cost of musculoskeletal diseases. In: The Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal, and Economic Cost. Rosemont, Illinois: American Academy or Orthopedic Surgeons, 2008.