The ACR’s delegation worked hard to influence deliberations on behalf of rheumatology in many other areas as well. Topics addressed at the HOD meeting included the politicization of biomedical research, vaccine misinformation, workforce reductions at federal healthcare agencies, access to prescription drugs and many more.
The ACR’s delegation to the AMA (left to right): Gary Bryant, MD; Adam Cooper, MS; Christina Downey, MD; Cristina Arriens, MD; Luke Barre, MD; Eileen Moynihan, MD; and Colin Edgerton, MD.
The ACR is fortunate to have an experienced and influential delegation to the AMA House of Delegates, consisting of Gary Bryant, MD (delegate and delegation chair), Eileen Moynihan, MD (delegate), Cristina Arriens, MD (alternate delegate), Colin Edgerton, MD (alternate delegate), Luke Barre, MD (Young Physician Section representative) and Christina Downey, MD (Young Physician Section representative). Resolutions are introduced and considered by the ACR based on its positions and policies and the work of ACR committees and the Board of Directors.
Many ACR-developed policies and directives have been previously passed by the AMA and shaped the direction of AMA policy and advocacy, addressing copay accumulator policy, third-party pharmacy benefit administrators, stakeholder engagement with Medicare Administrative Contractors, payer financial incentives to switch treatments, selective application of prior authorization, step therapy in Medicare Advantage, biosimilar interchangeability pathways, ensuring an effective H-1B visa program to enhance the rheumatology workforce, drug pricing, drug cost attribution in quality payment programs, pharmacy benefit manager (PBM) reform, opposing the previous Medicare Part B drug payment demonstration and more. ACR/ARP members are encouraged to suggest topics of focus for future ACR resolutions by writing to [email protected].
NIH Grant Funding for Medical Research
The ACR spearheaded Resolution 502, which called for the protection of biomedical researchers’ ability to negotiate indirect costs for NIH grants. It attracted many cosponsors and significant vocal support at the meeting from like-minded societies and was adopted by the HOD. The resolution’s adoption ensures that the largest physician advocacy organization in the U.S. will join the ACR in leading the opposition against caps on indirect costs for NIH grants.
Gary Bryant, MD, chair of the ACR’s delegation, addresses the HOD on the importance of supporting biomedical research and public health infrastructure.
Earlier this year, the NIH implemented a policy to cap indirect costs for research grants at 15%. This policy change, announced in February, applies to both current and future NIH grants. The policy has faced legal challenges, with a court temporarily blocking its implementation in some cases.
The cap on indirect costs is one part of a bigger Trump administration push to reduce federal funding for healthcare research. For example, as part of the administration’s strategy to restructure the Department of Health & Human Services (HHS), research programs dedicated specifically to rheumatic diseases—such as the Lupus Program at the Centers for Disease Control & Prevention (CDC Lupus Program) and the National Lupus Outreach & Clinical Trial Education Program at the HHS Office of Minority Health (OMH Lupus Program)—have been consolidated or cut. The ACR is working with partners, including the Lupus Foundation of America and Arthritis Foundation, to oppose cuts and communicate the value of federal funding for rheumatic disease research by engaging in a comprehensive letter-writing campaign to HHS.
The ACR’s HOD resolution continues this charge. Though it is specific to the 15% cap on indirect costs for NIH grants, the resolution is an extension of the ACR’s overall work to protect public health infrastructure and research. The ACR will continue its drive to develop these policies and others based on the priorities of rheumatologists and coalesce around the support of other concerned stakeholder specialty societies.
This advocacy and coalition-building is made possible because ACR members join and maintain memberships in the AMA, allowing the delegation representation at the meeting. Join now to not only access AMA member benefits for yourself, but also to support this work to elevate rheumatology issues at the national level.
Inadequate Reimbursement for Biosimilars
Resolution 103, submitted by the American Society of Gastrointestinal Endoscopy (ASGE) and cosponsored by the ACR, called for the AMA to work with stakeholders to advocate for legislation that will amend Section 1847A(c)(3) of the Social Security Act to permanently remove manufacturer rebates from the average sales price (ASP) methodology for biologics.
Colin Edgerton, MD, testifies in reference committee.
The HOD voted to send the resolution to the Council on Medical Service to work with the ACR and other groups to further explore challenges surrounding biosimilar implementation and payment and to identify recommended solutions to the problem, to be reported at the interim HOD meeting in November.
On this issue, the ACR is currently co-leading with the Coalition of State Rheumatology Organizations (CSRO) the Underwater Biosimilars Coalition, of which the ASGE is a member. The Coalition began in summer 2024 after members approached the ACR with concerns about reimbursement for infusing certain biosimilars—infliximab and rituximab—being much lower than the costs for procuring them. This discrepancy is primarily due to the rebates negotiated between PBMs and drug manufacturers, which the manufacturers must report to the CMS. The CMS then includes the rebates in the ASP methodology for setting reimbursement rates to providers for infusing these biosimilars. The Coalition thus far has met with the CMS, MedPAC and the Office of Management & Budget and is currently engaging Congress through a comprehensive letter-writing campaign.
With Resolution 103, the ACR and ASGE hope to ensure that patients have unimpeded access to biosimilars and that providers are reimbursed adequately for their infusion. We also hope to broaden this advocacy by appealing to the AMA and additional specialty societies that may have a stake in ensuring providers are no longer negatively impacted by suboptimal reimbursement for infusing biosimilars.
CMS Payment Monitoring Following Government Staff Reductions; Access to Important & Essential Drugs
For many years, the ACR has closely engaged the Association for Clinical Oncology on an array of advocacy priorities. At this meeting, the ACR cosponsored two resolutions submitted by the association, both of which were adopted by the HOD.
Resolution 235, CMS Payment Monitoring Following Government Staff Reductions, called for the AMA to actively monitor the reductions in force implemented at the CMS and to provide a method whereby providers can report associated CMS payment delays to the AMA.
Resolution 522, Access to Important and Essential Drugs, called for comprehensive legislation to mitigate existing drug shortages and prevent future shortages of lifesaving and life-prolonging drugs.
Both issues highlight common priorities for our respective organizations and emphasize the ACR’s coalescence with other organizations when our respective priorities are aligned.
Physician-Performed Microscopy Procedure (PPMP) Designation for Synovial Fluid Crystal Exam
The HOD recommended for adoption Resolution 504, led by the Georgia Society of Rheumatology’s delegation and cosponsored by the ACR. This called for the modification of the Clinical Laboratory Improvement Amendments (CLIA) of 1988 to categorize synovial fluid crystal analysis as a provider-performed microscopy procedure (PPMP), to be performed by appropriately trained physicians.
Luke Barre, MD, testifies before reference committee at the AMA House of Delegates annual meeting.
As ACR members know, synovial fluid crystal analysis is a vital procedure used by rheumatologists to assist in diagnosis of gout and other diseases. The CMS requires that a laboratory be CLIA–certified to perform the test; however, the process for certifying and re-certifying can be onerous and costly. The CMS currently allows special exceptions for nine PPMPs, including the evaluation of urinary sediment and qualitative semen analysis.
In 2018, the ACR unsuccessfully sought an exemption for synovial fluid crystal analysis. Based on a recent survey of ACR members, the issue is now impacting more rheumatologists. As such, the ACR has taken the lead to find ways to get synovial fluid crystal analysis is categorized as a PPMP. Resolution 504 ensures that the AMA will follow the ACR’s lead in actively calling for CLIA to be modified to allow synovial fluid crystal analysis to be performed by appropriately trained physicians.
Advisory Committee on Immunization Practices
While the HOD meeting was underway, HHS Secretary Robert Kennedy fired all 17 members of the CDC’s Advisory Committee on Immunization Practices (ACIP), a committee that provides advice and guidance on effective control of vaccine-preventable diseases in the U.S. civilian population.
In response, the HOD adopted an emergency resolution, supported by the ACR delegation and an overwhelming number of societies, calling for a Senate investigation into Secretary Kennedy’s actions and advocating for alternative vaccine advice from other sources.
Protecting Evidence-based Medicine, Public Health Infrastructure & Biomedical Research
The HOD passed Resolution 242, led by the Infectious Diseases Society of America (IDSA) and cosponsored by the ACR and 10 other specialty societies, which called for the AMA to affirm that protecting science, clinical integrity and the patient-physician relationship is central to the organization’s mission. It also called for the AMA to assertively and publicly lead the House of Medicine in collective, sustained advocacy for federal and state policies, proposals and actions that safeguard public health infrastructure, advance biomedical research, improve vaccine confidence and maintain the integrity of evidence-based medicine and decision-making processes.
Other Actions
The HOD also adopted policies from the following ACR-supported resolutions:
- Resolution 219, which called for opposition to NIH restructuring when it jeopardizes public health.
- Resolution 221, which called for opposition to federal and state efforts to restrict eligibility, coverage, access and funding for Medicaid and the Children’s Health Insurance Program.
- Resolution 222, which called for an expedited H-1B visa application and renewal process for International Medical Graduate physicians.
- Resolution 308, which called for the creation of reciprocity programs that allow physicians to receive credit for compliance training completed at one healthcare entity toward requirements at other facilities.
- Resolution 411, which called for protections for use, research and development of mRNA vaccines for infectious diseases and cancer treatment.
- Resolution 706, which called for more transparency in Medicare Advantage plans.
- Resolution 707, which called for the simplification of correspondence from health insurers.
- Resolution 708, which called for the removal of prior authorization requirements for in-person visits.
- Resolution 716, which called for minimum payer communication quality standards.
- Resolution 717, which called for medication continuity and reducing prior authorization burdens.
The ACR asks rheumatologists to continue to join or renew membership in the AMA so this work may continue. Rheumatology’s voice at the House of Delegates meeting is determined based on the number of ACR members who are also members of the AMA, so every single person who is a member of both the ACR and the AMA adds to the strength of this effort. Visit the AMA’s membership site to join or renew your AMA membership and receive valuable membership benefits along with helping to advance rheumatology.
Input on the AMA delegation’s work on behalf of the rheumatology community can be directed to [email protected]. If you are experiencing specific issues with payers or have other practice concerns, the ACR offers individualized assistance to members of ACR and ARP. Write to [email protected] with your insurance, coding, billing and other practice issues.
