Rheumatology practices have faced unique challenges this year, from navigating underwater biosimilars and new twists and turns with reimbursements to taking a closer look at complex treatments and enhancing data-driven patient care. With so much to discuss, the business of rheumatology will be a lively track at ACR Convergence 2024.
The ACR’s annual meeting is taking place Nov. 14–19 at the Walter E. Washington Convention Center in Washington, D.C. The conference will be hosted in-person and on-demand with select livestreamed sessions.
Dr. Shepherd
One major business focus will be to address payer challenges to which the ACR is currently responding, and which rheumatology practices are having to endure. These include insurance requirements for therapies with biosimilars, according to Rebecca Shepherd, MD, MBA, a session moderator and chair of the ACR’s Insurance Subcommittee of the Committee on Rheumatologic Care (CORC). “The more rheumatologists know, the more we can influence decision making and educate other stakeholders including patients, employers and government officials who create policy.”
Dr. Niemer
Rheumatology practices are also “keen to learn how colleagues are finding success caring for rheumatoid arthritis (RA) patients with complicated treatment regimens, including combination therapies and biologic response modifiers,” notes Mark Niemer, MD, who is moderating a session that will highlight best practices for coding and tools to improve patient workflows.
What to Expect from the Business Track
The business of rheumatology track will cover a wide range of topics targeted toward improving business operations for any rheumatology practice. Sessions will cover coding, payer changes, clinical workflows, conducting research, advocacy, staffing, and technologies in practice such as using artificial intelligence (AI) for documentation.
Two sessions on Saturday, Nov. 16, will help attendees understand payer challenges and learn strategies to handle these and other workflow issues:
- Facing Payer Challenges: Biosimilars, Closed Formularies, and Telehealth (Nov. 16, 9–10 a.m. EST)
- RA Toolkit: A Turnkey Workflow for RA Patients in Your Clinic (Nov. 16, 1–2 p.m. EST)
Two sessions on Sunday, Nov. 17, will help you make your rheumatology practice more efficient, from using AI to working with advanced practice providers. Also, be sure to check the networking lounge program for opportunities to talk with peers and ACR staff about topics including work-life balance, handling practice challenges and more.
Facing Payer Challenges
“Rheumatology professionals are critical advocates for their patients, and access to medications is equally critical in treating rheumatologic diseases,” says Dr. Shepherd. In a session she is co-moderating with Louisa Ziglar, MD, attendees will learn more about the evolving access to and reimbursement for biosimilars, as well as the reasons behind formulary restrictions that often limit access to medications essential for disease management.
In the session, Ashley Beall, MD, managing director of Arthritis and Rheumatism Associates, P.C., will share her experience and knowledge across critical payer issues. In her role, she has to understand the fine details of economic and financial decisions made by payers in the rheumatology realm.
Dr. Beall will be followed by Chris Phillips, MD, who will present strategies and understanding on the payer front through his joint clinical and business roles as founder of Paducah Rheumatology, Ky., and as CORC chair.
“The greatest challenges our members currently face concerning biosimilars include the economic challenges of underwater biosimilars and the myriad adalimumab biosimilars and varying insurer mandates and prior authorization requirements on the pharmacy side,” Dr. Phillips shares. “Because commercial and MA payers increasingly have chosen one or two versions of each bio-originator they will allow, this frequently leads to forced switches from one version to another of a given drug.” He will discuss approaches to these mandates, including best practices for interacting with payers and patients, and will review ACR advocacy on these topics.
The RA Toolkit
For patients with complex disease requiring advanced treatments, payers are frequently looking for outcomes data or measures of disease activity, Dr. Niemer says. Often, data embedded in a patient’s medical record can help expedite this process on many fronts.
Dr. Yazdany
To help practices meet these data requirements and streamline workflow for high-quality care with fewer disruptions, the ACR launched the RA Measures Toolkit in 2023. The toolkit’s lead creator, Jinoos Yazdany, MD, MPH, professor of medicine at University of California San Francisco and chief of rheumatology at San Francisco General Hospital, will present ways the toolkit can help optimize patient care.
“Insights we gathered from the RISE registry revealed a fascinating trend—some practices were consistently performing at a high level,” Dr. Yazdany says. “This curiosity sparked the development of the toolkit through extensive interviews with dozens of individuals from practices across the country, uncovering both their innovations and the barriers they faced.”
One pain point she will discuss is the challenge of continually training staff when there is a high rate of staff turnover. To ease this burden, the toolkit includes dedicated training materials for nursing and support staff to make onboarding smoother and more consistent. She’ll also discuss patient-reported outcome forms created in several languages to make data collection easier for all patients.
Ms. Ellis
The second portion of the session will be with Nancy Ellis, MBA, MHA, CHE, CRHC, CRMS, CPMA, practice administrator for Piedmont Arthritis Clinic and past president of the National Organization of Rheumatology Management. She will share her perspectives on coding for accurate reimbursement, especially to alert practices to coding errors that could be impacting their practice, such as defaulting to unspecified codes. “This may seem harmless, but more and more payers are putting billing edits in place to possibly deny those claims,” Ms. Ellis cautions.
She will also discuss how a practice can invest in ongoing training and certifications for their coders. “There are so many changes that can happen, it is imperative to have up-to-date information and well-seasoned coders.”
Start Planning Now
With only one month until ACR Convergence 2024, now is a good time to build your schedule to make sure you can capture as much knowledge as possible at the meeting. Both sessions discussed here are offered in person and on-demand. Explore these and other sessions in the business of rheumatology track and start planning your schedule for the meeting. View the full schedule to learn more about the education offered at ACR Convergence 2024.
Carina Stanton is a freelance science journalist based in Denver.
