It is important for all ACR members—especially those who serve in leadership roles for the ACR—to make their voices heard to their elected officials. In this spirit, the ACR board of directors, standing committee chairs, and senior ACR staff headed to Capitol Hill on May 10. This unprecedented event, scheduled to coincide with the ACR’s May board meeting, was a first for the leadership as a group, though many of us have individually met with members of Congress.
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Congressman Frank Pallone, Jr. (D-NJ), spoke to the leadership before its visit to the Hill. Pallone serves as a senior member of the House Energy and Commerce Committee and chair of its powerful Subcommittee on Health. The subcommittee has sole jurisdiction over Medicaid, the Food and Drug Administration, the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC), and shares jurisdiction of Medicare with the Ways and Means Committee. It oversees public health, biomedical programs, food and drug safety, mental health and related research, hospital construction, and all healthcare homeland security-related concerns.
All told, some 40 volunteers and staff spent part of Thursday visiting more than 16 members of Congress from more than 22 states to advocate on behalf of rheumatology. We talked about four of the most important issues affecting rheumatology today, which I will summarize below.
It is the duty of every citizen according to his best capacities to give validity to his convictions in political affairs.
Not all ACR members could join us in Washington, D.C., but you each can make sure the voice of rheumatology is heard. I encourage you to use this summary as a basis for a letter or phone call to your senators and representatives, or visit the ACR Legislative Action Center online at www.rheumatology.org for more details on each of these issues and assistance in contacting your member of Congress.
Fair Physician Reimbursement
The ACR strongly urges Congress to support legislation revising Medicare payment methodology to ensure appropriate reimbursement for specialists treating arthritis and rheumatic and musculoskeletal diseases.
In 2006, Congress again prevented what would have been a damaging 5% cut in the Medicare fee schedule for 2007 by including a 0% update in the Tax Relief and Healthcare Act of 2006. Unless Congress takes remedial action, rheumatologists and other physicians are expected to face Medicare reimbursement cuts of 10% or more in 2008 and in each year through at least 2012.
The Sustainable Growth Rate (SGR) is part of the formula used to calculate physician reimbursement for Medicare. Unfortunately, the basic premise of the formula is flawed. The SGR formula is linked to the performance of the overall economy, yet the medical needs of individual patients do not shrink whenever the economy slows. When overall spending on services in the SGR exceeds the per capita gross domestic product, cuts to physician reimbursement are triggered. The SGR also includes the costs of drugs covered under Medicare Part B, a cost over which physicians have no control. Notably, spending on these Part B drugs is increasing at a higher rate than spending on actual physician services. This skews the calculation of the SGR and triggers overly harsh reductions in physician reimbursement.
Congress should repeal the SGR formula and base payments on the growth of the Medical Economic Index, replacing the flawed payment methodology to avoid continually bandaging a broken system.
The ACR asks Congress to support a long-term fix to the Medicare physician reimbursement issue. Repairing the SGR formula is imperative to ensure that physicians will be fairly compensated and that patients will have access to appropriate care.
Enact Arthritis Act
The ACR exhorts Congress to enact the Arthritis Prevention, Control, and Cure Act of 2007 (S. 626/H.R.1283). This legislation would expand efforts to discover and implement new ways to prevent, treat, and care for patients with arthritis and related rheumatic diseases. See “Arthritis Act Provisions,” above, to learn how the act would enhance rheumatic disease research and public awareness.
Revoke Imaging Cuts
Because of a provision in the Deficit Reduction Act of 2005, imaging studies such as flat films and duel-energy X-ray absorptiometry (DXA) have been reduced to the Hospital Outpatient Perspective Payment System rate. This reimbursement reduction negatively affects not only rheumatologists who perform vital and timely imaging studies in their offices but also patient care—especially women’s access to treatment—and will increase cost for Medicare beneficiaries.
Additionally, the Centers for Medicare and Medicaid Services has made changes to the practice expense calculation for DXA, decreasing reimbursement for this vital service a staggering 75%. The ACR is concerned that if reimbursement continues to drop, patients will be unable to receive these important studies.
The ACR encourages members of Congress to revoke the imaging cuts in the “Deficit Reduction Act of 2005” so physicians can continue to perform these necessary studies.
Increase Research and Public Health Funding
The ACR supports increased funding to federal programs engaged in vital research to combat arthritis and related diseases. (See “Key Rheumatology Research Agencies,” below.) These programs are essential for finding innovative treatments that can help millions of Americans live longer, healthier, and more productive lives, and they are critical to developing more effective treatments, decreasing costs, and improving the quality of life for patients suffering from rheumatic diseases.
While this leadership visit to the Hill is a first for us, we hope it won’t be the last. I’ll let you know how it went in my report of the ACR board meeting, which I’ll send to all members later this month.
Dr. Birnbaum is president of ACR. Contact him via e-mail at [email protected].
Key Rheumatology Research Agencies
- National Institutes of Health: The NIH is a key agency for advancing the prevention, detection, diagnosis, and treatment of disease and disability, including arthritis and rheumatic diseases.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: The NIAMS leads the federal medical research effort in arthritis and rheumatic diseases and conducts research related to the causes, treatments, and prevention of diseases of the bone, joints, muscle, skin, and other connective tissues.
- National Institute of Allergy and Infectious Diseases: The NIAID conducts research that strives to understand, treat, and prevent a myriad of infectious, immunologic, and allergic diseases.
- Centers for Disease Control and Prevention The CDC conducts surveillance, epidemiology, and prevention research to reduce the occurrence of arthritis.
- National Arthritis Action Plan: The NAAP—a public health program developed by CDC and the Arthritis Foundation—works with state health departments to develop or enhance programs to address arthritis.
- Agency for Healthcare Research and Quality: The AHRQ provides evidence-based information on healthcare outcomes, quality, cost, use, and access.
- Veterans Administration Medical and Prosthetic Research Program: This program supports studies on many conditions, including arthritis.