“Because rheumatologists generally see patients that are more complex than average, and engage in cognitive services instead of procedures, rheumatologists will likely face reimbursement cuts if this proposal goes into effect, “he says. “Since even small reimbursement cuts are magnified after overhead expenses are paid, rheumatologists may face pressure not to participate in Medicare.”
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To put this into numbers, the CMS estimates a 3% cut in reimbursement for E/M services. Such a cut, says Dr. Worthing, could be magnified by a multiple of 2 or 3 because of fixed and rising business overhead costs. For a rheumatologist with an overhead of 70%, he says, a 3% reimbursement cut may actually look more like a 10% salary cut once overhead costs are figured in.
Colin Edgerton, MD, chair of the ACR committee on Rheumatologic Care, highlighted the impact this type of financial strain will have on patient care. “Patients will suffer; they may see reduced access to rheumatologists, shorter appointments and a focus on treating fewer complaints during each appointment,” he says.
Both Drs. Worthing and Edgerton also worry about the effect this reduction in reimbursement will have on attracting needed physicians to the specialty of rheumatology.
“A bigger concern is that rheumatology is already facing a significant projected workforce reduction,” says Dr. Edgerton. “These cuts make rheumatology a less attractive specialty for graduating residents and may further reduce the number of available rheumatologists in the future.”
Priority No. 1 & How You Can Help
The ACR has made this issue its current No. 1 advocacy priority. The ACR is leading a broad coalition of stakeholders, including other medical specialties and patient groups, to advocate against the proposed changes, says Dr. Edgerton.
In addition, the ACR is meeting with lawmakers and staff on Capitol Hill and the CMS, as well as talking to media outlets. The New York Times and National Public Radio recently covered the ACR’s opposition to the proposal.
“The ACR will be sending public comments and working with partners, like the American Academy of Neurology, to organize a letter to Capitol Hill for members of Congress to express concerns with CMS, as well as a coalition letter to the CMS asking it not to proceed with this proposal that could reduce access to rheumatology care,” says Dr. Worthing.
He adds that help from members is especially needed. “Democracy requires informed input from as many people as possible, and I encourage ACR/ARHP members to send an email to their members of Congress through the ACR Legislative Action Center and to send comments directly to CMS.” Contributions to RheumPAC from U.S.-based ACR and ARHP members are another way members can get involved in the efforts.