The ACR’s advocacy team has been busy lobbying for rheumatology with Congress, federal regulatory agencies, state legislatures and private payers on many fronts—from fighting for adequate reimbursement to building more transparency around prior authorization and pharmacy benefit managers. In these efforts, member involvement is “the key to move the initiatives across the finish line,” says ACR Health Policy and Practice Specialist Ashley Vassallo.
That call for more involvement was a shared sentiment during a virtual roundtable discussion among members of ACR’s professional advocacy team recently. They took time as the legislative season is winding down to discuss what’s next in lobbying efforts, especially as they look to elections that could reshape the legislative and regulatory landscape.
Here’s an inside look at what the ACR’s professional advocacy team members are working on and how they work together and with ACR/ARP volunteer leaders to continue making important strides for rheumatology. (This conversation has been edited for length and clarity.)
The ACR’s professional advocacy team is:
- Adam Cooper, MS, vice president, practice, advocacy & quality, based outside Atlanta;
- Joseph Cantrell, JD, director, state affairs and community relations, based in Newnan, Ga.;
- Lennie Shewmaker McDaniel, JD, director, congressional affairs and head of the ACR’s Washington, D.C., office;
- Colby Tiner, manager, regulatory affairs, based in Washington, D.C.;
- Paige Colston, manager of grassroots engagement and RheumPAC, based in Washington, D.C.; and
- Ashley Vassallo, specialist, health policy and practice, based in Washington, D.C.
The Rheumatologist (TR): What goals do you hope to achieve as a member of ACR’s advocacy team this year?
Adam: One overall goal is increasing members’ awareness of the many issues impacting their professional lives, as well as patient access to care and treatment. In particular, we need their awareness of the robust advocacy work the ACR is doing on their behalf to address those issues at the state and federal levels.
Joseph: I echo what Adam said, raising awareness is key. We also need that awareness to be followed by more active engagement from a broader section of our membership by posting on social media, completing legislative action alerts or even joining us for a day on Capitol Hill. Members have a number of options to engage on the issues in ways that fit their life and schedule, but I can’t stress enough how important it is for members to be engaged in advocacy in some way.
Lennie: I want to make sure that issues impacting rheumatologists and their patients have the attention of federal legislators. One way I can do this is to capitalize on the momentum behind certain reforms going into the end of this Congress—especially Medicare reimbursement, which is the number one policy concern of our members. A number of physician leaders will retire from the Republican caucus at the end of the year and have asked their party to get on board with necessary reforms as their legacy legislation. So we hope to do everything we can to help these legislators get policy updates across the finish line and change the trajectory for physicians struggling to serve American seniors.
Paige: With momentum for positive policy change on Capitol Hill, my goal is to leverage RheumPAC and member advocacy to capitalize on that momentum as much as possible. It is imperative that we use our grassroots programs to show Congress what policies our members care about.
Colby: As our members know well, rheumatologists are among the lowest paid specialties, and their patient footprint is disproportionately of Medicare age. I hope to increase the role our members have in regulatory advocacy.
TR: How do the various members of the advocacy team work together?
Joseph: Advocacy really doesn’t work well when it is siloed. For example, because of the way insurance is regulated, advocacy has to take place at the federal and state level. We collaborate across the team to ensure our policy priorities are uniformly aligned and reflected in state and federal policy.
Lennie: We all meet every week at least once to stay in the loop on any issues that may bleed into each other’s policy spheres. For example, Congress makes laws that draw the boundaries around Medicare, and that’s my area. But the [Centers for Medicare & Medicaid Services] (CMS) puts out the rules each year with the specifics of Medicare, which the regulatory and practice teams analyze. Then the private payers take cues from those terms.
Colby: In a federalist system that emphasizes division of powers and checks and balances, advocacy teams in any sector must be cohesive, well-oiled machines. The ACR is top-notch in this area. For example, we recently had a meeting with the CMS on underwater biosimilars, G2211 restrictions and physician reimbursement. Because these are regulatory issues that deal with the ACR’s work on drug and coding policy, I had to pull in the ACR’s Meredith Strozier (payer advocacy and policy) and Antanya Chung (coding and billing) as well as Chris Phillips, MD, and Rebecca Shepherd, MD, from the ACR’s Committee on Rheumatologic Care. It was a highly intersectional and productive meeting that is going to lead to further work in the immediate future with the CMS.
TR: Your work may seem “behind the scenes” to many members. What do you wish members knew about your work and how it affects them?
Joseph: Advocacy doesn’t take place in a vacuum, and there are a lot of different players in rheumatology advocacy who are also doing a lot of really great work. We work with those organizations on an almost daily basis, and it takes the rheumatology community working together toward a common goal to move the needle. When we get to celebrate a win, we also recognize that it takes many different organizations working behind the scenes—and working together—to achieve those wins.
Paige: Small steps forward are actually big steps forward! Congress has become increasingly polarized and less effective over time. Getting bills introduced, logging a large number of cosponsors or seeing a bill go through committee mark-up are big achievements.
Lennie: Yes, Congress has changed, and it’s not as easy to identify what progress on policy looks like anymore. Very few organizations have policy positions on aspects of a multi-thousand-page bill, so declaring victory looks different. A great example is the ACR’s celebration of the aspects of the Inflation Reduction Act that we had lobbied for on behalf of our members. We could not celebrate the entire package as “ACR-supported legislation,” but policies therein were hard-fought victories.
Ashley: Whether it’s regulation, legislation or insurance policies, the ACR is up to bat for our members on the issues that impact the practice of rheumatology, no matter how long it takes. Consider one relatively recent win, the passage of dedicated Congressionally Directed Medical Research Funding within the Department of Defense. Although it took close to a decade to pass, it exemplifies that reform is possible through sustained and consistent advocacy.
Colby: We know our members have limited time and opportunities to consume substantive news, so we step in to find what our members need to know. For example, the Medicare Physician Fee Schedule is meaningful information, but no doctor has the time to read a 2,000-page document. We find the details on how physicians can treat Medicare patients and how much they get paid for doing so—that’s important.
TR: What do you enjoy the most about what you do?
Adam: My favorite part of my job, by far, is interacting with the members who volunteer for ACR committees, subcommittees and the Board of Directors, many of whom move through various volunteer leadership roles over the years. I know the volunteer experience is very fulfilling to ACR and ARP members as well. I would definitely encourage all members to consider their interests and where they may want to get involved with the ACR.
Paige: I relish the opportunity to chat with ACR members about their practices, interactions with the healthcare system or just their daily lives. It always strikes me as incredible that our members take on the responsibility of advocating for their patients and practices outside of the time they spend in a practice environment.
Ashley: As an early career professional, I appreciate the ability to contribute to moving the needle on significant health policy issues and the opportunity to develop my skill set in a meaningful way while doing so. It is especially rewarding to learn from our members’ perspectives of policy impacts experienced in daily practice and to empower our members through involvement in advocacy.
TR: What are some of the things you’re paying particular attention to this year, especially given that it’s an election year?
Adam: From this point on, a lot of what will be further accomplished this year in Congress will be taking place in the lame-duck session after the election. How many rheumatology priorities will we manage to get included in any large, year-end legislative package in Congress? There are major opportunities here, but the list of potential issues to address keeps growing, too.
Colby: I’m curious about what Congress is going to do with Medicare reimbursement. Also, many of the telehealth flexibilities that were put in place during the pandemic will expire at the end of the year unless legislative or regulatory actions are taken to extend the waivers or make them permanent.
Joseph: Because most state legislatures are out of session already, I am thinking about the potential impacts of the upcoming elections. Although most of the attention will be paid to the two candidates at the top of the presidential ticket, I think the most interesting thing to watch will be the impacts of the presidential nominees on the down-ballot candidates. If enthusiasm is low for either candidate, we could have some surprises on Election Day that could shake up leadership at the state level. That could open up some opportunities or create difficulties for our priorities at the state level next year. I also like to watch voter trends. One trend we have seen over the past few presidential cycles is an increase in split-ticket voting. I think this year that trend may reverse, and we may see dissatisfied voters just stay home.
Ashley: I’ll be paying particular attention to congressional races during election season. The makeup of the House and Senate chambers impacts the landscape in which legislation, and our priorities, move through Congress. I also have my eyes on the lame-duck season after the election because it presents a unique environment to move policy through Congress in potential end-of-year packages.
TR: What’s something you’re looking forward to this summer outside work?
Paige: I’m looking forward to enjoying summer produce and time on my front porch.
Adam: Definitely looking forward to travel and exploring new hiking trails.
Joseph: I’m a big DIYer. I am currently working on an extensive backyard renovation project, and I’m really looking forward to getting that completed. After that is done, I’m looking forward to doing some traveling with my wife and three daughters later in the summer.
Lennie: August recess. I am using some of that time to go to London to see the Eras Tour again now that Taylor Swift has reworked her set list, and I always look forward to traveling with my husband to the Major League Baseball All-Star Game every July.
Colby: I am an outdoor enthusiast and amateur photographer. I am always looking forward to opportunities to combine both passions.
Ashley: This will be my first summer living in the D.C. area. I’m looking forward to exploring all the city has to offer while checking various museums, restaurants and events off my bucket list.
Connect with Your Advocacy Team
To share concerns, ask questions or get advice on a problem you are encountering in your practice, contact [email protected] or the ACR practice team at [email protected].
Follow legislative developments that impact your practice through ACR/ARP’s Advocacy News.
Carina Stanton is a freelance science journalist based in Denver.
