In the ever-changing healthcare delivery landscape, the ACR continues to go to work on behalf of its members to ensure public policies encourage delivery of high-quality rheumatology care and treatment.
With stepped-up efforts to meet with federal administrative and Congressional representatives, and broadened coalitions of partners to strengthen advocacy for key issues important to the rheumatology community, the ACR achieved many key successes in 2017.
“Our ACR team, and all our member advocates and coalition partners once again were the ‘mouse that roared’,” says Angus Worthing, MD, FACP, FACR, a practicing rheumatologist and chair of the ACR’s Government Affairs Committee. “Despite the fact that rheumatologists represent only a small fraction of U.S. physicians, our advocates raised their voices and made our priorities part of the national conversation about healthcare.”
Key Successes
Dr. Worthing highlighted a number of key achievements made by the ACR and its coalition partners over the past year, including:
- A 50% reduction in Medicare penalties for 2018;
- A delay in implementation of an insurance carrier policy to drop reimbursement for consultations;
- The cancellation of the Medicare Part B Demonstration plan to cut reimbursement for medication administration in the office;
- The development of a draft alternative payment model (APM) for rheumatoid arthritis;
- The reversal of the Medicare policy to reimburse for in-office biosimilars based on average of drugs in groups, which would have increased financial risks to practices. The new policy will reimburse drugs individually; and
- Premium processing for physicians applying for H-1B visas to work in underserved areas and to boost the rheumatology workforce was reinstated by the U.S. following coalition activities.
Key MACRA Achievements
Other key achievements were related to the Quality Payment Program set up by the Medicare Access and CHIP Reauthorization Act (MACRA), with advocacy efforts resulting in extended flexibilities to the program for physicians and small practices. Specific successes include:
- Securing an increase of the low-volume threshold to <$90,000 in Medicare Part B allowed charges or <200 Medicare Part B patients;
- Adding a significant hardship exception to the advancing care information performance category for the Merit-Based Incentive Payment System (MIPS)–eligible clinicians in small practices;
- Providing bonus points that are added to the final scores of MIPS-eligible clinicians in small practices; and
- Obtaining technical assistance support to help MIPS-eligible clinicians in practices of 15 or fewer so they may receive guidance and assistance on the MIPS performance categories or to make the transition to APM participation; priority is given to practices located in rural or medically underserved areas and practices with low MIPS final scores.
Challenges Ahead
The ACR has already carried its strong advocacy efforts into 2018 to meet the many challenges that continue to face rheumatologists, including a successful effort to have Congress implement an ACR-advanced fix to the MACRA law so that payments for Part B drugs are not impacted by performance in the Merit-Based Incentive Payment System (MIPS) of MACRA. Dr. Edgerton underscored that patient access to treatment remains a constant challenge, citing ongoing concerns such as step-edit schemes from commercial insurers and proposals from the White House and HHS that would reduce reimbursement for Part B drug costs and threaten patient access to medically-necessary treatments.
