The ACR’s delegation to the American Medical Association (AMA) House of Delegates (HOD) will have a busy agenda at the AMA’s annual HOD meeting, June 7–12 in Chicago.
At the meeting, the ACR delegation will lead a resolution that supports efforts to shore up the pediatric specialist workforce, including pediatric rheumatologists, and improve access to timely care. They will also co-lead four resolutions addressing issues impacting rheumatology practices and patient access, along with representing the rheumatology community in many other impactful debates slated for the meeting.
The AMA holds annual and interim meetings in June and November of each year, respectively, at which delegates from medical specialty societies and state medical associations set policy and direction for the nation’s largest physician organization.
A Critical Shortage of Pediatric Specialists
Much like adult rheumatology, pediatric rheumatology faces critical workforce shortages. There are far too few pediatric rheumatologists to meet the needs of children who need care for rheumatic conditions, and this coverage gap continues to grow.
Pediatric rheumatology, like other cognitive pediatric specialties, faces several challenging issues: a lower income than general pediatrics, despite three required years of fellowship training; high burnout rates due to higher workloads with lower numbers of colleagues; high student debt; and maldistribution of available care across regions. Lower income is a primary factor in the low recruiting rates for pediatric specialists and is mostly due to Medicaid reimbursement rates. Medicaid reimbursement rates for pediatric subspecialists are often significantly lower than private insurance and Medicare reimbursement rates, leading to financial challenges for healthcare providers and limited access to care for Medicaid-enrolled children.
The ACR’s related resolution, Pediatric Specialty Medicaid Reimbursement, seeks to address these issues. It has been filed for the HOD meeting and already has the support of the American Academy of Allergy, Asthma and Immunology; American Academy of Neurology; American Academy of Ophthalmology; American Urological Association; and Association for Clinical Oncology. If passed by the HOD, it would have the AMA:
- Make increasing Medicaid reimbursement for pediatric specialists a significant part of its plan for continued progress toward health equity;
- Work with pediatric specialty societies to develop a value-based payment model that makes pediatric specialist practices sustainable and promotes access to care and health equity among the pediatric patients; and
- Work with state stakeholders to support the implementation of the value-based payment model for pediatric specialists in state Medicaid programs.
The resolution would also take into account budget neutrality requirements and call for associated improvements to modernize Medicaid payments to be exempt from budget neutrality, in particular with regard to Medicaid demonstration projects. There will also be a push to have the AMA advocate for payment parity with Medicare for the same or similar services provided to pediatric patients under Medicaid.
