The ACR Helps Members Meet Insurance Challenges

Audrey B. Uknis, MD

Advocacy efforts are key in meeting the needs of our members. My original advocacy efforts for the ACR began on the Regional Advisory Council (RAC). The RAC was established in the early 2000s, and divided the United States into regions. Along with my co-council member, Herbert Baraf, MD, I addressed insurance issues in the Northeast region. We tackled insurance dilemmas for members and teamed up with providers and insurance companies to resolve barriers to good patient care. Over time, the RAC evolved into two cooperative committees, the Affiliate Society Council (ASC) to address the practical needs of community rheumatologists by offering a range of services to state/local affiliates and the Insurance Subcommittee (ISC). These two committees continue to grow the ACR’s vision of supporting rheumatologists at a local level while serving as a national voice for our members. We have been able to represent rheumatologists and their issues through our single professional society—we are seen as the voice of rheumatology, and as a result, can maximally advocate for the field, for our members, and ultimately, for our patients.

Today, the ASC booms with a membership of over 20 societies across the United States. Under the current leadership of Angus Worthing, MD, the ASC continues to grow both by the number of societies and the actions of the affiliates. ASC was formed to serve as a communication tool for members at all levels, bringing important issues to the attention of the Committee on Rheumatologic Care (CORC), and, where necessary, to the ACR board of directors. The reverse has also occurred, where actions of the Board and CORC flow down to the ASC members for dissemination to members at their local society level. I am also hopeful that the ASC can become a way to get more rheumatologists actively involved with ACR and provide the opportunity for many of these members to serve on other committees and eventually the board of directors.

In addition to the support to its societies, the ASC focuses on sharing best practices to improve fundraising, organizing meetings, and supporting local political action. The ASC is also sharing successful strategies for working with insurance companies and payers. I am grateful to my Pennsylvania colleagues who participate in these important ASC meetings, and to the other participants from around the country who share their trials and tribulations, challenges, and successes. Local society success stories include:

• Jeffrey Lawson, MD, reported that the South Carolina Rheumatism Society created an insurance committee that works throughout the state. Several members work on insurance issues that happen within the state and meet with insurance companies.
• Jeff Peterson, MD, informed ASC that the Washington State Rheumatology Association succeeded in preventing a pharmacy benefits manager (PBM) from becoming a sole-source supplier for all infusion services. The association, through a show of solidarity, postponed implementation (which may be an indefinite postponement) by notifying members throughout the state and meeting with the PBM.
• Meera Oza, MD, from the Florida Society of Rheumatology (FSR), mentioned that the FSR holds annual meetings and brings in great speakers, engaging all rheumatologists in the state. The FSR meeting even includes an exhibit hall. At another meeting, Yvonne Sherrer, MD, member of the ACR board of directors, mentioned that the FSR has hired a state lobbyist to work on legislative issues at the state level.
• Max Hamburger, MD, invited Kathleen Arnt­sen to a meeting to share her success with Tier IV legislation in New York. Other states are trying to replicate this success. The ACR worked with Rep. McKinley (WV) to introduce similar legislation at the federal level.
• Gary Feldman, MD, discussed the success of the California Rheumatology Alliance with prior authorization legislation. This reform requires the state to use a standard prior authorization form, limited to less than two pages. The ACR continues to encourage insurance companies to use a standard prior authorization form and works with government committees on this topic.

These are just a few brief examples of the knowledge and experience that is shared through the ASC meetings. Member societies have been very active and are able to share meaningful successes.

In addition to the sharing of best practices, the ACR provides special products and programs to facilitate the work of the societies. ASC members are able to request a limited number of blast e-mails for the members in their state each year. State list serves are also available on an opt-in basis, providing the opportunity for ASC members to quickly and easily communicate with their members. Presentations are available to ASC members at no charge, including an overview of the College from a board member and presentations on government affairs, coding, auditing, and insurance issues. Meeting space at the annual meeting is made available at no cost for state societies to bring attendees together. I attended our own Pennsylvania society meeting in Washington, D.C., a few weeks ago, where I heard the results of a statewide survey on prescribing habits in the treatment of rheumatoid arthritis. I would encourage state societies to use these benefits in developing robust and meaningful programming for their members

The ISC Tackles Insurance Issues

From the origins of the efforts of RAC, the ACR also formed the Insurance Subcommittee (ISC). The first two chairs—Dr. Feldman and Rudy Molina, MD—came directly from the ASC. Dr. Molina has recently become a member of the Board and has passed the reigns to Elizabeth Perkins, MD. She is a current member of CORC, and is a solo private practitioner in Alabama with experience on CORC since her fellowship. The goal of the ISC is to identify the common issues burdening practitioners nationally and to provide member societies with resources to resolve them. The ISC’s essential strategies include strong partnerships with the insurance companies and societies; effective communication between providers, the ACR, and insurance representatives; and proactive assertion of our ACR policies. The ISC will continue to develop standardized letters, build better relationships with insurance companies, and support the efforts of ASC and ACR members. I am excited to see their work go live with additional website resources, as well.

The ISC is currently working on difficult prior authorization and precertification procedures; access to biologics and differential availability between insurance companies; reimbursement for procedures, infusions, imaging, and office visits; subversive tactics that deny equal access to effective treatments; the effect of quality measures on practitioners; and defending fair, equal, transparent fee schedules. Like the ASC, the ISC comprises strong advocate members from all over the country with a breadth of leadership experience. It’s a real pleasure to work with volunteers committed to making our profession more successful.

The volunteers on the ISC and the ASC perform vital work for the ACR and for the profession. A vast amount of work remains ahead for these groups, and I am confident that these great teams will have more success stories to share in the near and distant future. We welcome fresh ideas, new members, and new societies to join these efforts. If you are interested in starting a new group or joining your state society, serving as an ASC representative, or participating on the ISC, I encourage you to reach out to your state or local society or contact ACR staff in the practice management department. Contacts include Antanya Chung, director of practice management staff for the insurance subcommittee at [email protected], and Cindy Gutierrez, senior specialist of practice management staff at [email protected] for the Affiliate Society Council.

Advocacy is the key to the healthy future of our profession and, ultimately, to the excellence in care that we can provide to our patients. I am proud to know that the ACR committees are working together to promote and support excellence in healthcare and to facilitate our work as rheumatologists and rheumatology health professionals.

Dr. Uknis is professor of medicine and senior associate dean for admissions and strategy at Temple University in Philadelphia. Contact her at [email protected].