Although advocacy is a shared responsibility within the ACR, it is led by the Committee on Government Affairs (GAC) and supported by RheumPAC, the ACR’s political action committee.
This year, ACR advocates have enjoyed success at both the federal and state levels. Through the work of the ACR and its lobbyists as well as other professional societies, the Sustainable Growth Rate payment formula was finally repealed by the federal government and replaced in April 2015 by the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA puts in place a five-year period of small, stable updates followed by value-based payment adjustments and, beginning in 2019, combines Meaningful Use, Value-Based Modifier and PQRS into a single payment program. We need to realize that MACRA gives the Centers for Medicare and Medicaid Services (CMS) significant leeway in implementing many aspects of the value-based adjustments over the next one to two years. The ACR is ramping up its efforts to influence these regulations by engaging a lobbying firm specializing in regulatory advocacy to complement its ongoing legislative lobbying activities.
In addition, two pieces of ACR-drafted legislation were introduced into Congress: H.R. 1600, Patients’ Access to Treatments Act, and H.R. 2247, the ICD-TEN Act, which was designed to provide a safe harbor period after ICD-10 implementation. The introduction of this latter piece of legislation prompted CMS to enact a 12-month safe harbor period after the Oct. 1 implementation of ICD-10, meaning that Medicare claims will not be denied or audited for reasons of ICD-10 diagnosis code specificity. This CMS ruling was a win for rheumatologists and other physicians and should help eliminate disruptions in payment.
The ACR’s advocacy efforts are expanding, too, at the state level through partnerships with 34 active Affiliate Societies, which have represented the interests of rheumatology in the passage of more than 10 new state laws related to the prescribing of biosimilars.
… In Practice Management
Because most of the new government policies and legislation have a direct impact on clinical practice, much of the work of the GAC has been in collaboration with the Committee on Rheumatologic Care (CORC). In the ACR, CORC serves as the clearinghouse for practice-related matters. Among its many activities, CORC is actively monitoring and evaluating changes to the physician fee schedule, relative value units and CPT coding. A key strategy last year was the submission of a code change proposal to modify the language for the biologic infusion codes.
