Last month, the ACR’s delegation to the American Medical Association (AMA) House of Delegates gathered at the Gaylord National Harbor, Md., for the 2023 Interim Meeting of the AMA House of Delegates.
The AMA House of Delegates meets each June and November, and each meeting brings its own set of urgent and novel issues. At these meetings, the ACR and other specialty societies, along with state medical associations, debate issues and advance resolutions and reports that become official policy and directives for action for the nation’s most prominent and influential medical association. At this November’s Interim meeting, the ACR’s delegation considered more than 100 resolutions and reports and helped shape policy in areas including healthcare workforce and patient access to care and treatment.
On behalf of its members and the rheumatology community, the ACR is able to leverage its representation in the AMA House of Delegates by introducing for consideration new AMA policies and directives to take action. The ACR’s delegation is already beginning to consider potential resolution topics to introduce at the June 2024 House of Delegates Annual Meeting. The ACR and its delegation have taken a leading role in authoring or cosponsoring resolutions over the past several years, including driving resolutions on:
- In-office specialty drug dispensing;
- Copay accumulator policies;
- Complex treatment administration and reimbursement;
- Payer financial incentives to patients for switching treatments;
- Mandatory payment models from CMMI;
- The NIH Public Access Plan;
- Home infusion issues;
- Biosimilar interchangeability;
- Drug pricing issues;
- Private payers and consultation codes;
- Prior authorization and Medicare Advantage; and
- Step therapy reform.
Members of the ACR can reach the delegation and propose topics to advance in resolutions on behalf of the rheumatology community by emailing [email protected].
Advancing Solutions to Pediatric Workforce Challenges
November’s Interim HOD Meeting included resolutions addressing Medicare payments and payment reform, PBMs and other access to treatment issues. Another area of focus was solutions to address the nation’s medical workforce shortages. Of special note were resolutions focused on the need to improve Medicaid payment rates to attract more practitioners into the pediatric subspecialty workforce and the need to improve the path to practice for international medical graduate physicians.
One of the major resolutions supported by the ACR’s delegation during the meeting was Resolution 817, “Expanding AMA Payment Reform Work and Advocacy to Medicaid and Other Non-Medicare Payment Models for Pediatric Health Care and Specialty Populations,” introduced by the American Academy of Pediatrics. The pediatric rheumatology workforce, like other cognitive pediatric subspecialties, continues to experience severe shortages nationally as well as difficulty attracting new physicians. These challenges stem in part from reimbursement rates that are below those for non-specialized pediatricians, which are a focus of the ACR’s workforce efforts. Among other strategies, the ACR will be working with other specialties concerned with pediatric subspecialty workforce shortages and with the AMA to identify and develop approaches to address these challenges. These may include state-level pilot projects and other efforts to improve Medicaid payment rates and incentivize pediatric subspecialists to locate in areas of the most need.
The resolution supported by ACR and passed by the HOD will have the AMA prioritize improving Medicaid payment rates due to their critical impact on patient care and patient access to care. Additionally, it 1) adds to AMA policy new support for demonstration projects, carve outs and adjustments for pediatric patients and services provided to pediatric patients within the payment reform arena; 2) calls for the AMA to work with societies on payment models and to call for related payment models to be developed by the Center for Medicare & Medicaid Innovation (CMMI); 3) will have the AMA support appropriate demonstration projects, carve outs and adjustments for pediatric patients and services provided to pediatric patients within the payment reform arena; and 4) will have the AMA support and collaborate with state and national medical specialty societies and other interested parties on the development and adoption of physician-developed alternative payment models for pediatric health care that address the distinct prevention and health needs of children.
Smoothing the Path for International Physicians
As with many other specialties experiencing workforce shortages in the United States, patients with rheumatic diseases depend in part on visa-holding physicians to provide high-quality care. For the 2023 application cycle, about one third of applicants to pediatric rheumatology fellowship programs and over one half of applicants to adult rheumatology fellowship programs were graduates of non-U.S. medical schools, many of whom rely on a J-1 visa for their fellowship training years. Providing a viable path for practice in the U.S. for these highly qualified physicians will be crucial to ensuring future quality care for patients across the country.
These issues were addressed in Resolution 217, “Addressing Work Requirements for J-1 Visa Waiver Physicians,” which was introduced by the International Medical Graduates Section and strongly supported during the meeting by the ACR’s delegation. This resolution would have the AMA advocate for a revision in the J-1 waiver physician’s requirement, proposing a transition to a comprehensive 40-hour work requirement that encompasses both direct clinical responsibilities and other professional activities, acknowledging the reality of clinical practice. This resolution will move forward through referral to the AMA Board of Trustees, which will report back with recommendations at a future HOD meeting.
The ACR thanks all members who contribute to these efforts by joining or maintaining membership in the AMA. This allows the ACR to retain representation in the AMA House of Delegates and related critical policy bodies, including the AMA Relative Value Scale Update Committee (RUC) and AMA Current Procedural Terminology (CPT) policy groups. Maintain your AMA membership each year to take advantage of AMA member benefits and sustain rheumatology’s continued representation.
The ACR considers and introduces resolutions based on its positions and policies and the work of ACR committees and the Board of Directors. 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 Barré, MD (Young Physician Section representative), Christina Downey, MD (Young Physician Section representative) and Rami Diab, MD (Resident and Fellows Section representative). Input for the AMA delegation’s work on behalf of the rheumatology community 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.
