ACR fellows, committee members and others learned ways to promote positive changes on issues that affect their practices and their patients during the ACR’s Advocacy 101 program, held in association with the annual Capitol Hill virtual Advocates for Arthritis “fly-in” in late September.
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The virtual program included a mix of general sessions and breakouts covering topics from federal- and state-level legislative advocacy to concerns about insurance, high drug costs and patient accessibility to services. “Everyone was really excited to talk about these issues,” says Advocacy 101 organizer Amanda Schnell, MD, assistant professor in the Division of Clinical Immunology and Rheumatology and program director of the Rheumatology Fellowship Program at the University of Alabama at Birmingham. She is also a member of the ACR’s Government Affairs Committee.
Putting Information into Practice
These kinds of discussions are particularly crucial for new rheumatologists, Dr. Schnell says. With insurance, for example, the attending physician typically handles the back-office processes required to obtain insurance approvals for the often-expensive drugs rheumatologists prescribe. “Providing education about this aspect when rheumatologists are in training—whether that be in medical school, residency or even fellowship—is important so they understand how it works, how it is going to affect their practice after they graduate fellowship and how they can effect changes that will improve access to care for all of our patients,” she asserts.
During the program, participants also got hands-on experience advocating for two pieces of legislation. One was H.R.3173, the Improving Seniors’ Timely Access to Care Act of 2021, which is designed to speed patient access to care by allowing the Centers for Medicare & Medicaid Services (CMS) to regulate the usage of prior authorization in Medicare Advantage plans. The bill would also establish a process for real-time decision making and finally switch from paper to electronic prior authorization forms, Dr. Schnell says.
The second bill, the Pharmacy Benefit Manager Accountability Study Act (S.298/H.R.1829), is currently in both the Senate and the House and would require the Government Accountability Office to report on the role of pharmacy benefit managers in the pharmaceutical supply chain. That role is not as transparent as it should be, Dr. Schnell notes. “Drug pricing is very complex and includes the drug manufacturer, insurance companies, pharmacy benefit managers and the pharmaceutical industry. The requirements of this bill should give us more information about where high drug costs are coming from,” she says.
Building on Connections
Insurance hurdles have been a big concern for Advocacy 101 participant and pediatric rheumatologist Deepika Singh, MD, a full-time practicing clinician at Valley Children’s Hospital in Madera, Calif. “It was just frustration with the whole prior authorization issue that we face every day that led me to see what I could do about it, rather than just commiserating with my colleagues. So I clicked on the online application to attend,” she recalls. Dr. Singh found the program well-designed, concise and informative. “It was broken down into very practical overviews. For example, I thought it was very helpful to learn how to frame your message when talking to different people with different ideologies,” she remarks.
While at the program, Dr. Singh accepted an offer to serve as a volunteer member of ACR’s Insurance Subcommittee of the Committee on Rheumatologic Care, a group she learned more about during one of the breakout sessions. “Prior to this,” she notes, “I only had a vague idea about its function, so I would say this was good timing. Understanding how the subcommittee engages in insurance advocacy definitely helped with my decision.”
Samuel Gagne, MD, fellow in pediatric rheumatology at Nationwide Children’s Hospital in Columbus, Ohio, was also a first-time attendee at the Advocacy 101 program. “The noteworthy part for me and the thing that I found most interesting was just the variety of people and backgrounds that were involved,” he says. “It was nice to see and hear from different physicians, but also from non-physicians who are part of the advocacy process and to see the teamwork, not just within the medical discipline, but with many other disciplines and how that teamwork plays out.”
Dr. Schnell encourages rheumatology fellows and trainees to get engaged in future events. “This is a good way to learn more about how these processes work and how we can effect change. Really, that’s why we’re here: to improve patient care, including patient access to care,” she says. “As physicians, we help our patients through their disease process every day, but advocacy lets us help our patients in a more global sense. There are not many rheumatologists in the country, and the more of us who participate in advocacy, the better care our patients can receive.”
Leslie Mertz, PhD, is a freelance science journalist based in northern Michigan.