“That’s what we’re talking about,” she said. “This bill that has absolutely nothing to do with the District of Columbia and absolutely nothing to do with workforce.”
She also reminded the audience that ACR@Work email newsletters are the best way to keep up on the ACR’s advocacy efforts on issues that are important to members.
Access to Care
Amanda Grimm Wiegrefe, MScHSRA, the ACR’s director of regulatory affairs, said the biggest issue she works on in the regulatory sphere is access to care, which includes Medicare reimbursement.
“We know at the ACR how much of an issue this is for you, your practices and your patients,” Ms. Wiegrefe said.
The new Medicare Physician Fee Schedule includes a conversion factor—part of the equation used to determine final reimbursement for services—that represents a decrease of 3.4%. The good news, she said, is that the new G2211 complexity add-on code—which should better reflect the resources needed to treat patients with complex conditions and will boost reimbursement in these cases—has been finalized and is expected to go into effect in January. The ACR has been at the forefront of efforts advocating for creation and implementation of this long-needed code.
Also, telehealth flexibility has been extended through 2024, allowing the Centers for Medicare & Medicaid Services (CMS) to better determine how to reimburse for telehealth in the future.
“The toothpaste is already out of the tube,” Ms. Wiegrefe said. “I don’t think we’re ever going back to what it was before.” There are discussions regarding cross-state licensing to better accommodate telehealth, she said, but for now, “we’re kind of in the wild, wild West” on that issue.
Drug Prices
Another major policy development is that Medicare now has the ability to negotiate with manufacturers on prices of some drugs, including rheumatology drugs etanercept and ustekinumab. The initial list includes 10 Part D medications, with more expected to be added to the list each year, eventually expanding to include Part B medications as well.
Biosimilars have also raised hopes for controlling drug prices. This year was a “huge year for biosimilars,” Ms. Wiegrefe noted, and there are now a staggering nine biosimilars for adalimumab. But pharmacy benefit managers (PBMs) have tended to price biologics the same as the originating drugs or are requiring that biologics be tried before patients are treated with biosimilars, so far undercutting the goal of reducing drug costs.
