Douglas Graham, MD, a rheumatologist at DuPage Medical Group, a successful accountable care organization in Illinois, recently began his two-year term on the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC).
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The committee guides the CMS on specific clinical topics. Its responsibilities mainly include reviewing and evaluating medical literature, reviewing technology assessments, offering public testimony and examining data and information on the benefits, harms and appropriateness of medical items and services either covered or that may be eligible for coverage under Medicare.
“I’ll represent rheumatologists and physicians on this panel,” says Dr. Graham, who also served on the ACR’s Government Affairs Committee between 2014 and 2017. He was motivated by a disagreement about treatment coverage made by a local contractor. “I didn’t understand the mechanisms about how you deal with this. The ACR addressed it, which impressed me, so I joined the committee.”
Since then, he was involved in two more local determination coverage issues and has become knowledgeable about how the system works. He served on the ACR’s Quality of Care Committee between 2011 and 2014, where he was exposed to guideline development and evidence-based medicine concepts.
He explains that local determinations are generally made by nonrheumatologists. Unless people work in rheumatology, he says, they may not recognize the value of what treatments or diagnostic testing can reveal or accomplish. He’s hoping to be directly involved in such discussions so that others have a better understanding of what rheumatologists need to take care of their patients.
Dr. Graham adds that his role will involve examining the strength, quality and grade of evidence-based medicine and explaining how new treatments or technology may improve the lives of beneficiaries and help rheumatologists continue to evaluate and treat patients.
“I want to advocate for rheumatology so decision makers understand that there are the things that help us do what we need to do and the consequences of when things are changed drastically,” he says. “I’ve been interested in this area for years and am curious about how national health policy is created.”
Carol Patton is a freelance writer based in Las Vegas.