A new presidential administration took office in January 2017. Although no one truly knows what directions our government and economy will take, one projection is that healthcare regulatory and insurance coverage policies will change, possibly dramatically. In a time of uncertainty, rheumatologists and rheumatology health professionals can turn to the ACR/ARHP for support, guidance and resources to continue their valuable work.
ACR/ARHP volunteers and staff are closely watching developments in Washington, D.C., and are ready to respond to any healthcare policy changes by providing appropriate advocacy, resources and support for you—so you can continue to focus on clinical practice, research, training and other work.
I have worked in a busy rheumatology private practice in Dallas since 1987. Over the years, I have seen many dramatic changes: more work required for each patient encounter, more frustrating prior authorizations, pressure to invest time and money in expensive technology at a time of decreasing reimbursement, etc. The list is long. The ACR’s mission is to Advance Rheumatology!, and we can do that only if we ensure that every member can do their work effectively.
The ACR has many volunteer committees and subcommittees, supported by a large professional staff, that focus on particular areas of rheumatology practice. These individuals and committees work to identify members’ needs and refine our programs so the ACR can provide our members with truly useful, easy-to-access resources. Reach out to the ACR staff or the volunteers on committees and subcommittees if you have any question or problem and need help. We shall Advance Rheumatology! only by engaging with each other, learning from each other and solving challenges together. We want to hear from you so we know your needs and concerns.
Practice Management Support
Thanks to ACR volunteers and staff, practicing rheumatologists and their staff adapted to ICD-10 in the past year without major issues—although one may have had an occasional challenge when dealing with a more complex coding system. The ACR has certified coders available to answer your questions on correct coding guidelines on all rheumatology diagnoses and procedures.
You may not know that the ACR also has certified auditors available to offer members free chart reviews so you can identify potential problems and fix them. The ACR also offers coding/auditing education nationwide for a fee with as few as 10 individuals participating. If you can attend the ACR/ARHP Annual Meeting, you can take advantage of hands-on coding and practice compliance workshops. Be sure to check out Coding Corner in every issue of The Rheumatologist (one of several member benefits) to quiz yourself on coding challenges, catch up on practice management trends and changing regulations, and look at actual chart assessments.
Insurance is a hot topic in the news these days, including possible repeal or significant revision of the Affordable Care Act. Rheumatologists and their staff members must deal with insurance issues every day, from time-consuming prior authorizations to wondering if our patients can stay on their treatments due to formulary or insurance changes. The ACR and ARHP are here to help you.
Our Insurance Subcommittee (ISC) fields and responds to questions from individual members; if you have any, please reach out to us via email or phone. Below are some pressing issues this group is working on now:
- Ensuring that payers who are implementing site-of-service policies designed to move infusions away from higher cost hospital settings will not harm patients’ care; and
- Addressing downcoding by some Medicare carriers, a tactic that could reduce patient access to biologic drugs by decreasing Medicare reimbursement for administration of these important treatments.
We will also write or call insurance carriers to address pressing issues on your behalf. We review draft policies by all carriers to provide our feedback—so rheumatologists have a voice when it comes to how our patients’ treatments are covered and how your practice is reimbursed.
The ACR’s mission is to Advance Rheumatology!, & we can do that only if we ensure that every member can do their work effectively.
RISE Is on the Rise
The ACR’s qualified clinical data registry, Rheumatology Informatics System for Effectiveness (RISE), now includes data from about 900,000 rheumatology patients and is growing each week. RISE can help practicing rheumatologists track the quality of care they deliver to their patients and identify areas where their practice can improve. They can also compare the quality of care in their practice to that provided by peers, regionally or nationally.
RISE is a qualified registry and using it can help members score points under MACRA if their practice reports quality measures on the MIPS track, which most will do in the early years of the new reimbursement program. Did you know that using RISE automatically gets you points to improve your overall quality score and avoid a negative payment adjustment in this first year of MACRA? Once RISE is hooked up to your practice’s electronic health record, it can passively extract quality data and report it to the CMS so your staff does not have to do any dual data entry work to report quality measures.
Signing up for RISE is free for all ACR and ARHP members. The ACR will provide technology support to connect you to RISE and tailor it to the way your practice collects and analyzes data. This way, you will not have to change your workflow or style to collect and report quality data.
We know that not every rheumatology practice can successfully set up RISE at this time due to connectivity challenges with EHR systems with cloud-based data storage or networks with tough security firewalls. We are committed to solving these problems so more rheumatologists can use RISE—both for reporting quality measures under MACRA and to improve the quality of care they deliver to their patients.
Why leave the office to test your skills and get up to date on the latest rheumatology knowledge? Try the ACR’s excellent self-assessment CARE (Continuing Assessment, Review and Evaluation) programs, including the new 2016 module, right from your office or home. CARE is an online self-assessment tool designed to assess your rheumatology medical knowledge base. The questions have gone through an extensive review and validation process so you can be sure they are relevant to your clinical practice.
Although I have highlighted some of the valuable resources the ACR provides to its members, I want to stress that there is much more that goes on behind the scenes to impact the future of rheumatology and patients’ access to quality care. Beyond the various member communications meant to keep you informed of important developments in such areas as rheumatology education, treatment, research and legislation, the ACR and its volunteers work continually on the advocacy front both at the federal and state levels. We also have a very active voice in regulations surrounding the use of biosimilars. The ACR exists to actively support your profession, and I am excited to see continued progress in the coming year.
We want and need practicing rheumatologists and their staff to get actively involved in the ACR and ARHP. You can give us valuable feedback on our resources and advocacy efforts; or better still, if you are passionate about our mission, join us as a volunteer. The ACR’s volunteer nominations process opens on March 1, 2017.
The ACR is committed to Advancing Rheumatology!, and that begins with supporting you and your staff in the important work of caring for patients. So call, write or email us today, and let us know how we can help you and your practice thrive.
Sharad Lakhanpal, MBBS, MD, is in private practice at Rheumatology Associates and a clinical professor of internal medicine at the University of Texas Southwestern Medical School, both in Dallas, where he has lived and worked since 1986. He is also the 80th president of the ACR (2016–17).