“Setting unique billing codes for biosimilars was a huge step in promoting their use in rheumatology,” notes Dr. Huston. “This allows better monitoring of these products over time, as well as improved financial confidence for practices wanting to administer biosimilars.” He also says, recognizing this potential practice issue, the ACR first established a position statement on biosimilars in 2016, before the first biosimilar was approved by the FDA; the College will soon publish a white paper on the topic.
This work addressing biosimilars continues to be a focus, as outlined in the ACR’s upcoming 2018 Policy Statement, Dr. Edgerton adds.
Identifying the Importance of Diagnostic MSUS
Late last year, the CMS proposed significant payment cuts for diagnostic musculoskeletal ultrasound (MSUS) studies based on survey data that office-based specialists, instead of hospital-based specialists, were performing a majority of studies. The ACR warned the CMS that cuts would reduce utilization and training for this innovative, safe and cost-effective diagnostic technique. Within weeks, the CMS reversed course and avoided the drastic cuts, while also increasing reimbursement for more limited, diagnostic ultrasound studies, Dr. Worthing shares.
“The ACR was instrumental in working with other stakeholders to identify the importance of MSUS and communicating with CMS on the issue,” Dr. Edgerton says. “As a result, the reimbursement cuts were significantly reduced, helping protect access to this point-of-care diagnostic tool.” From his practice viewpoint, Dr. Edgerton says “the ACR work in reducing cuts to musculoskeletal ultrasound has had a profound impact in allowing my practice to continue to offer this inexpensive and critical point-of-care diagnostic tool to patients.”
Offering Support via the RISE Registry
Under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, physicians and practices who do not choose the APM for reimbursement of Medicare patients must participate in the Merit-Based Incentive Payment System (MIPS). To support members in meeting MIPS requirements, the ACR launched the Rheumatology Informatics System for Effectiveness (RISE) qualified clinical data registry, which members can access free of charge so they can submit measures for all three necessary domains while tracking and maximizing their MACRA performance.
RISE has significantly helped rheumatology practices meet MIPS requirements, according to Salahuddin Kazi, MD, vice chair of education and director of residency training in the Department of Internal Medicine’s Division of Rheumatic Diseases at the University of Texas Southwestern Medical Center in Dallas. “Our process in connecting with RISE has acted as a catalyst for us to standardize workflows to ensure that we collect the relevant data to meet quality measures. In doing so, we have already improved documentation, efficiency, and patient and provider satisfaction.”
