Workforce
Workforce advances came on multiple fronts. The Resident Physician Shortage Reduction Act (H.R. 2256/S. 834), which would fund 14,000 slots over several years, has 154 cosponsors in the House. The House-passed Build Back Better Act (BBB) added 5,000 graduate medical education (GME) positions; however, the BBB Act is currently stalled in the Senate.
Pediatric rheumatology fellowship slots are filled around 50% of the time, while adult rheumatology fellowship slots must turn away applicants. The cap on Medicare support for GME included in the Balanced Budget Act of 1997 was repealed in the final COVID-19 relief package of 2020, which added 1,000 new Medicare-funded GME full-time equivalent residency positions beginning in fiscal year 2023. The Pediatric Subspecialty Loan Repayment Program (PSLRP) was authorized by the CARES Act, and both the House and the Senate passed appropriations for $25-30 million to fund it. Alas, Congress has been funding the government through a series of continuing resolutions, which extend the previous budget agreement that did not include this funding, so we are waiting on the passage of the budget omnibus (i.e., the government’s funding package) for the program to start helping residents. The PSLRP legislation addresses the pediatric workforce shortage by providing funds for loan forgiveness when certain metrics are met.
Progress has also been made at the state level on workforce issues. In 2021, Washington became the first state to allow pediatric rheumatologists to participate in its state-administered loan forgiveness programs. Georgia reintroduced the ACR-supported bill that would establish a state-based loan repayment program for all cognitive specialists; that bill will carry over into 2022.
Telehealth: Parity & Access
Prior to the pandemic, telehealth was practiced only by a few providers, primarily due to low reimbursement and geographic and originating site restrictions. With the easing of these constraints during the pandemic, we have now learned and implemented virtual options to continue to care for patients. The CMS recognizes that telehealth is here to stay. The 2022 PFS addresses elements of telehealth to facilitate patient access to care. We are tracking two pieces of legislation, the Telehealth Modernization Act (S. 368/H.R. 1332) and the Protecting Access to Post COVID-19 Telehealth Act (H.R. 366), which eliminate restrictions impacting access to telehealth care.
Utilization Management
Regarding step therapy, the Safe Step Act (S. 464/H.R. 2163) has 108 bipartisan cosponsors in the House and would create a clear process for patients who have Employee Retirement Income Security Act (ERISA) health plans to seek exceptions to step therapy. The prior authorization bill (H.R. 3173/S. 3018), with 252 House cosponsors, streamlines prior authorization processes, including using electronic formats and minimizing use for routine treatments. The prior authorization legislation will protect patients in Medicare Advantage plans and supports reporting back to the CMS how often Medicare Advantage plans approve or deny medications and services.
