ACR President David Daikh, MD, PhD, and American Academy of Ophthalmology President Cynthia Bradford, MD, published a strong opinion piece in the influential beltway publication, The Hill, last month. We helped organize a broad coalition of physician societies and patient groups to fight this. We have also been engaged in a series of meetings with key Congressional offices, and it’s critical they hear your voice, too. Tell your elected officials to protect access to Part B therapies (currently the second advocacy campaign in the ACR’s Legislative Action Center). Patients and families of Medicare beneficiaries can send a letter. Do it now!
Medicare Rehabilitation Therapy Caps
Our Medicare patients who need physical, occupational and speech therapy face self-rationing due to the $2,010/year hard cap that was instituted on Jan. 1. Soon, patients will start hitting that cap and will not be able to receive more rehab benefits in 2018 without paying out of pocket. Luckily, with key Congressional committees supporting active legislation that permanently repeals the therapy cap, there’s momentum right now. Thirty groups, including the ACR, are campaigning to #StopTheCap by Jan. 19. Tell lawmakers: Therapy Can’t Wait! Patients and families can also send emails.
Regulations
As the Trump administration works to reduce and simplify regulation across agencies, the ACR advocated for continuing the FDA’s critical scientific vigilance in developing a biosimilars marketplace. Specifically, the ACR’s wish list for the FDA regarding biosimilars includes finalizing the robust plan to require three-switch studies for biosimilars to be designated as interchangeable, and creating memorable, distinct names for biosimilars (in the form of memorable suffixes). It is quite unfortunate that despite the approval of biosimilars in the U.S., prices are being kept high and competition is being held back by dealings between pharmaceutical companies and intermediaries in the drug distribution system, like PBMs. The ACR, through ATAP, is working to fix that.
Cognitive Codes
Frustrated by documentation? Confused about whether to bill a level 3 or 4? The ACR continued its work this fall to create a new set of billing codes that recognize cognitive work, instead of emphasizing procedures as the current evaluation and management (E/M) codes do. Your team, together with a coalition of cognitive specialties, met with Congressional offices and policymakers at the CMS to communicate the importance of new codes in our efforts to both incentivize physicians to go into cognitive specialties and also to more easily take part in value-based payment models, which are not set up for cognitive work. Stay tuned!
