The COVID-19 Crisis: Uncharted Waters & the ACR’s Response

Dr. Ellen Gravallese

The ACR is aware the physical distancing measures implemented to reduce transmission of the SARS-CoV-2 virus place many rheumatology practices under financial strain. On the ACR website, we have compiled resources to help you sustain your practice financially. We also provide information about the Coronavirus Aid, Relief and Economic Security (CARES) Act and the federal paycheck protection program, including detailed information about how rheumatologists can apply.

To further assist our members in continuing to serve their patients, the ACR has provided several resources regarding telehealth, which presents a new avenue to meet patient needs. We recognize that telehealth has posed a challenge to many of our members, some of whom had not previously integrated this into their practices and many of whom have patients who cannot participate in telehealth in an ideal way.

The resources available through the ACR website also include coding and practical guidance to help ensure proper reimbursement for both video and phone-based telehealth services, as well as information about telehealth vendors, commercial health payers, Medicare reimbursement and potential malpractice concerns. The ACR has also provided a template that members can use to send letters to their state medical boards to advocate for clearer guidance about practicing telehealth across state lines. At the federal level, we are advocating for proper reimbursement for telehealth services, even for medical appointments that need to occur over the phone.

On a related note, the ACR is also reaching out to insurance companies to encourage them to expand access to telehealth services. We have also advocated for relief from potentially avoidable administrative challenges, such as those mandating prior authorization of treatments before prescribing. With members of other specialty societies, the ACR wrote a letter urging the Centers for Medicare & Medicaid Services to waive prior authorization requirements for Medicare Advantage plans during this time. The ACR has also provided a comprehensive position statement regarding the detrimental problems prior authorization causes for both rheumatologists and their patients.

Finally, the ACR has developed documents centered on practice guidance, including information about how to best handle treatment infusions and principles for helping  decide which patients may need in-person services vs. telehealth monitoring. We have also created guidance on advising patients as to how they might best seek care during this time, including their telehealth options.

The Practice and Advocacy Task Force continues to meet virtually to gather new resources that will provide further guidance.