Ask any rheumatologist why he or she chose to pursue a career in rheumatology and the answers will be as unique as the individual. Dig deeper, though, and you tend to find that at the heart of this choice, rheumatologists are attracted to this field because of the challenging diseases we treat and caring for patients who have them.
From that initial attraction, rheumatologists can choose to pursue a career in any number of settings, with the majority choosing private practice (although many in other settings still continue to see patients). At the end of the day, though, we are all rheumatologists trying to improve the lives of patients with rheumatic diseases. To that end, all practicing rheumatologists—regardless of workplace setting—should care about practice advocacy efforts for rheumatologists.
Practice Advocacy Defined
I’m often asked what, exactly, practice advocacy is. Practice advocacy is an umbrella term for organized activism related to issues that affect a physician’s practice. This can include representing the specialty for coding valuation, lobbying Congress for favorable legislation, working with CMS to address reimbursement issues, advocating policy change with an insurance company, assisting members with coding compliance issues, and developing and delivering quality education on practice management issues—just to name a few examples.
The ACR does all this and more for all practicing rheumatologists in the United States. Through volunteer groups such as the Committees on Rheumatologic Care and Government Affairs and the Regional Advisory Council, as well as through advocacy and professional coding staff, we assiduously work on issues that directly affect your professional practice life.
ACR Advocacy Activities
Private practitioners face a myriad of little questions that can have a big impact on practice. How do you know you’re accurately coding a procedure and receiving appropriate reimbursement? How is pending or recently enacted legislation going to affect you and your patients? What’s the latest information on electronic health records? Do you have the tools you need to assess the Medicare fee schedule and Part B versus Part D, and their effects on your practice? Are your documentation aids up to date? It is easy to get caught up in the routine of our day-to-day professional lives, but when you have an issue in your practice, do you know where to turn?
Turn to the ACR. We offer a wide range of resources and tools to help you run a successful practice. Here’s just a glimpse of our offerings:
Coding compliance: The ACR employs two certified professional coders, Melesia Collins and Resaee Freeman, who are available to answer coding questions and address insurance problems. If you have a problem receiving reimbursement for imaging studies or medications, contact our coders. Sometimes the problem can be handled by adjusting your coding; other times, a letter may need to be sent from the ACR requesting that the insurance company change their policy. The coders have assisted hundreds of members with proper coding and have saved members thousands of dollars.
The ACR coders also attend state and local rheumatology society meetings and provide CME coding presentations. In 2006, the ACR coders gave 17 coding presentations throughout the country; they hope to attend even more of these meetings in 2007.
One-on-one assistance: If you have a question related to your practice and want to talk directly with another physician, start with your regional advisor. The ACR Regional Advisory Committee is made up of regional advisors who are available to discuss insurance and practice management issues related to a specific region or state. If you feel your issue is broader in scope, feel free to contact any member of the ACR Committee on Rheumatologic Care (CORC). During the past year, the ACR CORC and regional advisors have successfully changed some insurance company policies to assist practicing physicians. Selected achievements include:
- Convincing an insurance company to change its policy that patients on anti-TNF medications must also be on methotrexate;
- Changing a non-coverage decision by an insurance committee that would not allow patients to receive IV ibandronate sodium if they were unable to take the oral version;
- Reopening a comment period for an insurance company trying to restrict the number of c-reactive proteins that can be reimbursed during a year; and
- Convincing an insurance company to change its policy requesting additional documentation when reporting modifier -25.
The regional advisors also attend state and local rheumatology meetings to review relevant ACR activities, discuss the issues faced by members in your area, and gather feedback on what services and resources the ACR can offer to better assist you in your practice.
Practice tools: At Rheumatology.org, we offer nearly two dozen practice management tools for use with documentation (including academic tools for teaching physicians and pediatric-specific tools), HIPAA compliance, and fee schedule and coding assistance. In our “Patients & Public” section we offer more than 50 complimentary patient education pieces on diseases and related issues, medications, and the role of caregivers. I encourage you to refer patients to these resources or—better yet—print them and make them available in your office or clinic. Also available online is the 2006 ACR Coding in Rheumatology manual, the rheumatology-specific adjunct to the AMA’s CPT manual.
Networking with colleagues: One of the best ways to get tuned in to clinical issues and coding issues is by joining a regional list serve. Members from every region have subscribed to one or more of the ACR’s list serves, which were launched in July 2006. Recent discussions include crystal analysis and laboratories, DXA reimbursement, acute anterior uveitis, ONJ and bisphosphonates and numerous coding and reimbursement issues. Encourage your staff to sign up for the coding and practice management list serve.
Legislative advocacy: The ACR Government Affairs Committee undertakes activities regarding pending and proposed legislation that may have an effect on our members and their patients. We issue legislative alerts, facilitate and conduct Hill visits between ACR leaders and members and key Congressional leaders and their staffs, host legislative receptions, and initiate letter-writing campaigns to influence the outcome of legislation. We have an outstanding online Legislative Action Center where you can learn more about the prevailing issues affecting our profession, locate and communicate with your House and Senate representatives, and learn more about how you can become involved in legislative advocacy efforts.
Courses: The Committee on Rheumatologic Care develops educational sessions for the ACR State-of-the-Art meeting in April and the annual meeting each year. These sessions focus on coding, compliance, electronic medical records and more. Interested in seeing a specific topic? Let us know.
Let Us Know What You Think
If you want to see additional services, or if you have suggestions for how to improve our efforts, please contact us. We are constantly looking at ways to improve the practice environment for every one of our practicing members. Additionally, if something has worked well for you—a particular letter or program in your office—let the staff know or post it on the list serve. As rheumatologists, our best outcomes will occur when we work together to improve the practice environment of rheumatology.
Dr. Birnbaum is president of ACR. Contact him via e-mail at [email protected].