The Medicare Payment Advisory Commission (MedPAC) makes recommendations to Congress on Medicare policy including physician payments and patient access issues. These recommendations can directly impact rheumatology care coverage and rheumatologist reimbursement. Representatives of the ACR and partners recently met with new MedPAC Executive Director James E. Mathews, PhD, to discuss appropriate recognition of rheumatology care and other cognitive specialty concerns, workforce development and other key issues.
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Even if Congress doesn’t move forward with MedPAC recommendations, this commission publishes annual reports that others, such as the CMS and the Center for Medicare & Medicaid Innovation (CMMI), may take ideas from.
That’s why ACR government affairs advocates, led by Timothy Laing, MD, and ACR Regulatory Affairs Director Kayla Amodeo, PhD, made a trip to Washington, D.C., to meet with Dr. Mathews.
“Maintaining a good relationship and communication with MedPAC [allows us to provide them] the perspective of rheumatologists and rheumatology health professionals. With a new executive director [at MedPAC’s helm], we thought it was a great time to go in and discuss our thoughts on several key issues,” Dr. Amodeo says.
Bringing Important Issues to the Table
The issues critical to rheumatology that were discussed during the meeting include:
- Cognitive care issues;
- Payment reflecting the value and expertise of rheumatologists;
- Workforce development issues;
- Loan repayment; and
- Graduate medical education (GME) funding.
“Because MedPAC exerts a lot of influence on policymakers in Congress, it’s critical for the ACR to communicate our ideas to MedPAC about solutions for our projected workforce shortage, such as loan repayment programs, boosting GME slots and funding, and improving how cognitive care is valued in billing codes,” explains Angus Worthing, MD, chair of the ACR’s Government Affairs Committee (GAC).
“Because rheumatology is a small specialty, working with influencers like MedPAC helps us leverage our voice,” he adds. “Our hope is that meetings like this will help create victories on Capitol Hill on behalf of ACR members, our profession and our patients.”
Dr. Worthing suggests that one important victory with MedPAC would be a focus on making changes to address the projected workforce shortage for rheumatologists, including reforming reimbursement of cognitive specialists who experience the same recruiting problems as primary care providers. “Rheumatologists and cognitive specialists bill with the same evaluation and management [E/M] codes, so efforts to improve coding and reimbursement solely for primary care are unfair and will lead to further shortages in cognitive specialties.”
Timothy Laing, MD, a rheumatologist in Ann Arbor, Mich., and the ACR’s adviser at the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) and Current Procedural Terminology (CPT) advisor, agrees.