The House of Delegates (HOD) is the policy-making body of the American Medical Association (AMA), and twice a year, representatives of all seated specialties, service societies and state medical associations review hundreds of resolutions to determine which will become AMA policies. Once those policies and priorities are determined or updated, we benefit from the AMA having one of the strongest lobbies for organized medicine. It is important and impactful for our rheumatology delegation to have a voice in HOD deliberations on behalf of ACR/ARP members—and this is possible only when enough ACR members are also members of the AMA.
The ACR can represent rheumatology and bring members’ concerns and issues to the AMA only because ACR members join or renew memberships in the AMA. You can make a difference and help these efforts by renewing your AMA membership or joining the AMA, and encouraging fellows to join, so rheumatology can continue to have a strong voice in the AMA’s HOD. It is important that every ACR member join and continue to renew their membership in the AMA, because the AMA continuously assesses the number of ACR members who are also AMA members, to determine the number of seats in the HOD that will be allotted to rheumatology.
Moving Issues Forward
At the most recent HOD meeting, which took place last month in Chicago, June 8–12, the ACR’s delegation advanced two resolutions on behalf of ACR/ARP members, one concerning prior authorization and another concerning step therapy.
The ACR and our partner societies sought support for exclusions from prior authorization requirements that delay patient care and increase administrative burden on physicians. We also sought expansion of patient protections with regard to step therapy, arguing the CMS has not yet done enough to protect patient access to life-saving drugs. Current regulatory guidance and proposed rules allow Medicare Advantage plans to use step therapy for Part B drugs and leave many patients unprotected in 2019 due to timing.
With the support of our co-sponsors—the American Society of Clinical Oncology, American Association of Clinical Endocrinologists and American Academy of Ophthalmology, as well as other specialty societies that testified—the ACR was able to successfully persuade the AMA to add to its policy our detailed patient protections with regard to step therapy in Medicare Advantage plans. This resolution will also result in AMA advocacy, with the CMS implementing patient protections for 2019 and beyond, if the policy allowing Medicare Advantage plans to use step therapy protocols is not rescinded.
Additionally, the ACR received strong supportive testimony for its prior authorization resolution that would explicitly lay out in AMA policy support for exceptions to prior authorization—including, for example, if evidence-based guidelines from a national specialty society are being followed, or when the order or prescription is routinely approved. The resolution resulted in reaffirmation of AMA policy on prior authorization, which currently directs readers to 21 Prior Authorization and Utilization Management Reform Principles. The ACR was an original member of the coalition that developed the principles and contributed to ideas in the document. Reaffirmation of prior authorization policy means that the policies will remain viable, and robust AMA work on prior authorization reform will continue.
The ACR’s delegation also supported several resolutions including measures addressing pharmacy benefit manager transparency issues, ways to reduce physician hassle and burdens in quality reporting programs, and repeal or modification of the Sunshine Act, as it is currently implemented, to decrease burden and support efforts at administrative simplification for physicians. Additionally, the ACR delegation worked with partnering specialties to address an AMA-authored board of trustees report on “Handling of De-identified Patient Information.” The draft report suggested reexamining and possibly limiting the use of de-identified, aggregated patient data, which could threaten viability of clinical data registries, such as the ACR’s RISE registry, for purposes of quality and practice improvement initiatives. Working with partnering societies, our coalition was able to have the report withdrawn and sent back to the AMA Board of Trustees for reconsideration.
A Note of Thanks
I would like to thank our other members of the ACR’s delegation to the AMA HOD: Eileen Moynihan, MD, Colin Edgerton, MD, and Cristina Arriens, MD. Action on behalf of ACR/ARP membership is based on policies and guidance developed by ACR committee volunteers and approved by the Board of Directors.
Additionally, the ACR thanks its Relative Value Update Committee (RUC) and Current Procedural Terminology (CPT) representatives and advisors for their dedicated service. The ACR representatives to the AMA RUC committee include Timothy Laing, MD, Eileen Moynihan, MD, Deborah Desir, MD and Fredrica Smith, MD. For the AMA CPT Editorial Committee, the ACR representatives include Dr. Laing and Joseph Huffstutter, MD. The RUC makes recommendations to the CMS regarding reimbursement for CPT codes, and having a rheumatologist as a CPT advisor gives the ACR a voice as CPT codes are being developed and modified. We are able to have a voice in these important deliberations because enough ACR members are members of the AMA.
Your AMA membership helps provide the ACR a voice at the HOD and at the AMA’s important RUC and CPT committees. Thank you for the important role you play in rheumatology advocacy through your AMA membership.
Despite being one of the smaller specialties (with around 6,000 rheumatologists out of more than 1 million doctors in America), and thanks to its active membership and experienced delegation of representatives to the AMA, based on direction from ACR committees and board leadership, we have significant influence on the direction the AMA takes on key issues.
Calling Young Rheumatologist Leaders
The ACR’s delegation will be interviewing prospective young physician representatives (YPS) during this year’s ACR/ARP Annual Meeting in Atlanta, taking place Nov. 8–13, 2019. Cristina Arriens, MD, currently serves as YPS representative and AMA Alternate Delegate for the ACR, and she will be joined by a second YPS representative for the ACR.
The selected rheumatologist will join the ACR’s delegation at House of Delegates meetings and attend the Young Physician Section. During these meetings, the ACR’s delegates advance issues and positions important to rheumatology, deliberate issues affecting healthcare, and vote on the positions and direction the AMA will take. The candidate must:
- Be under the age of 40 or within the first 8 years of practice after residency and fellowship training programs by the time the position commences;
- Be a member in good standing with the ACR and AMA; and
- Be willing to work with the ACR delegates and communicate back to the ACR Board of Directors.
To apply, write to [email protected], providing your statement of interest and CV, by Sept. 30, 2019. Select applicants will be invited to conduct a brief interview during the Annual Meeting.
Gary Bryant, MD, FACR, is chair of the ACR’s delegation to the AMA House of Delegates.