We have met with legislators and have communicated with letters and visits to the Centers for Medicare & Medicaid Services (CMS), identifying problems with MACRA and the Part B project for rheumatologists in practice, both in the timing of the rollout and other key concerns expressed by ACR Committees. ACR/ARHP members have sent thousands of messages to lawmakers on these issues through the Legislative Action Center.
The Committee on Rheumatology Care (CORC), the Committee on Government Affairs (GAC) and the RheumPAC Committee have been tireless in their rapid response to these challenges, and I want to personally acknowledge the time and effort by Will Harvey, MD, MSc, Angus Worthing, MD, Doug White, MD, PhD, and Harry Gewanter, MD, who have helped us make sure that we manage these issues effectively. Most especially, I want to thank Adam Cooper (ACR staff), whose gentle but determined efforts have accomplished more than one person can possibly do.
These efforts have paid off: The CMS recently announced some flexibility in options for rheumatologists around MACRA requirements.
The ACR has also sent letters to the FDA, has communicated directly with Janet Woodcock, MD, and has published a position paper on biosimilars that emphasizes that the naming of drugs, switching of biologics and the tracking of any safety signals of the new drugs need to ensure patient safety and patient flexibility. These efforts have been effective in getting the FDA to change some of its initial plans for the naming of biosimilars.
Additional GAC activities include ACR Advocacy 101. In collaboration with the Committee on Rheumatology Training and Workforce Issues (COTW), rheumatology fellows are invited to join ACR/ARHP volunteers and their patients on Capitol Hill each September for the Advocates for Arthritis fly-in. This has been a resounding success and has been an opportunity to recruit new volunteers into ACR activities. The ACR’s advocacy efforts are active at the state level as well, through partnerships with coalitions and with 40 active affiliate societies. This state-by-state advocacy is critical, because biosimilar substitution is state regulated, as are insurance policies, which are usually state or region specific.
Practice Management
Because most of the new government policies and legislation have a direct impact on clinical practice, much of the work of the GAC has been in collaboration with CORC. In addition to the aforementioned activities, CORC has issued position papers on Complementary and Alternative Medicine for Rheumatic Diseases and Screening for Hydroxychloroquine Retinopathy. CORC’s position papers are a treasure trove of gems on up-to-date medical care that can help fight insurance company denials, etc. I urge you to review these when you are deliberating on care for your patients or the CARE package for Maintenance of Certification (MOC). Speaking of MOC …
Education
The ACR, through the Committee on Education, has been in deliberations with other internal medicine societies and has been vocal in expressing concern about the current ABIM Maintenance of Certification (MOC) program requirements. Our volunteers have been in meetings with ABIM leadership to convey the burden that the current MOC program has on rheumatologists, and the threat to our workforce. As a result, the ABIM has announced plans to replace the 10-year secure exam with more frequent, at-home testing options, although the high-stakes nature of the testing remains. We are expecting details of the alternative assessments to be announced late November 2016. I want to especially think Carol Langford, MD, for her many years of expertise managing MOC issues.
Training & Workforce Issues
The COTW is a nexus for many important College initiatives, including workforce assessment. The results of the ACR 2015 Workforce Study will be presented at the ACR/ARHP Annual Meeting in Washington, D.C. By any measure, the conclusions from the study are alarming.
