The ACR and its delegation to the American Medical Association (AMA) House of Delegates (HOD) capped a busy and highly successful interim HOD meeting Nov. 8–12 in Orlando. Hundreds of delegates from medical specialty societies and state medical associations gather at two AMA HOD meetings each year—in June and November—to set the policy and direction for the nation’s largest and most powerful physician organization. The November interim meeting is the smaller of the two and usually includes fewer resolutions.
The ACR’s resolution at this meeting—Medicare payment parity for telemedicine—was supported by several delegations and the Specialty and Service Society (SSS) of the AMA, and it was recommended for reaffirmation. The ACR delegation also worked to shape policy discussions in a number of other areas affecting members. Topics addressed included updates to Medicare Physician Fee Schedule payments, budget cuts and budget neutrality issues, approaches to sustaining community practices, artificial intelligence in healthcare, prior authorization and many more.
ACR members are encouraged to suggest topics of focus for future ACR resolutions by writing to [email protected]. Many ACR-developed policies and directives have been previously passed by the AMA, addressing issues including copay accumulator policy, third-party pharmacy benefit administrators, stakeholder engagement with Medicare Administrative Contractors, payer financial incentives to switch treatments, selective application of prior authorization, step therapy in Medicare Advantage, biosimilar interchangeability pathways, ensuring an effective H-1B visa program to enhance the rheumatology workforce, drug pricing, drug cost attribution in quality payment programs, pharmacy benefit manager (PBM) reform, opposing the previous Medicare Part B drug payment demonstration and more.
Medicare Payment Parity for Telemedicine
Resolution 227, which addressed Medicare payment parity for telemedicine, was developed by the ACR. Due to the AMA having existing policy that supports the expansion of telemedicine in Medicare, as well as having standing policy that prohibits the AMA from advocating for the valuation of CPT codes, the resolution was recommended for reaffirmation.
The ACR will continue its initiative to develop policy based on the priorities of rheumatologists and coalesce around the support of other concerned stakeholder specialty societies. This advocacy and coalition-building is made possible because ACR members join and maintain memberships in the AMA, allowing the delegation representation at the meeting. Join now to not only access benefits for yourself, but also to support this work to elevate rheumatology issues at the national level.
Therapy Cap Exception Process
The HOD passed Resolution 812, authored by the Michigan Delegation and cosponsored by the ACR, to require all health plans with therapy caps or thresholds to include an exception process that, at a minimum, follows the Medicare standard for therapy cap exceptions.
MIPS Reform
The HOD recommended for reaffirmation Resolution 220, the repeal of the Merit-Based Incentive Payment System (MIPS) and replacement with a practicing physician-designed program that has far less administrative burdens and only adopts measures that have been shown to measurably improve patient outcomes. Although the ACR agrees with the need for MIPS reform, it is working with the AMA and other specialties on long-term reform components for MIPS and the Quality Payment Program, which is a multi-year effort with Congress. The ACR has submitted to the CMS rheumatology-specific measures that have been approved for MIPS adoption.
Other Actions
The HOD adopted policies from the following ACR-supported resolutions:
- Resolution 218, which called for the U.S. Department of Labor to establish uniform, time-sensitive provider credentialing standards for third-party administrators serving ERISA plans;
- Resolution 808, which called for all payers to communicate covered alternatives to patients and providers when a medication is denied;
- Resolution 818, which called for the banning of retrospective payment denials or recoupments for precertified procedures; and
- Council on Medical Service Report 4, which called for the elimination of acquisition cost and reimbursement disparities for in-office biosimilar treatment across diverse treatment locations.
The HOD recommended the following ACR-supported resolutions and reports for either reaffirmation or referral for later decision or report back to the HOD:
- Board of Trustees Report 03, which supports initiatives to expand Stark law waivers to allow independent physicians, in addition to employed or affiliated physicians, to work with hospitals or health entities on quality improvement initiatives to address issues including care coordination and efficiency;
- Resolution 215, which called for federal and state incentives for recruitment and retention of physicians to practice in rural areas;
- Resolution 219, which called for permanent telehealth reimbursement from Medicare and all health insurance providers;
- Resolution 223, which called for mandated economic escalators in insurance contracts;
- Resolution 605, which called for the AMA to provide $1000 stipends directly to HOD attendees;
- Resolution 801, which called for reimbursement for managing patient portal messages;
- Resolution 802, which called for addressing physician burnout with inbox management resources and increased payment; and
- Resolution 809, which called for all payers to maintain minimum formulary requirements.
Resolutions are introduced and considered by the ACR based on its positions and policies and the work of ACR committees and the Board of Directors. The ACR’s delegation to the AMA House of Delegates consists of Gary Bryant, MD (delegate and delegation chair), Eileen Moynihan, MD (delegate), Cristina Arriens, MD (alternate delegate), Colin Edgerton, MD (alternate delegate), Luke Barre, MD (Young Physician Section representative) and Christina Downey, MD (Young Physician Section representative).
The ACR asks rheumatologists to continue to join or renew membership in the AMA so this work may continue. Rheumatology’s voice at the House of Delegates meeting is determined based on the number of ACR members who are also members of the AMA, so every single person who is a member of both the ACR and the AMA adds to the strength of this effort. Visit the AMA’s membership site to join or renew your AMA membership and receive valuable membership benefits along with helping to advance rheumatology.
Input on the AMA delegation’s work on behalf of the rheumatology community can be directed to [email protected]. If you are experiencing specific issues with payers or have other practice concerns, the ACR offers individualized assistance to members of ACR and ARP. Write to [email protected] with your insurance, coding, billing and other practice issues.
