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As president of the Georgia Society of Rheumatology (GSR), Wambui Machua, MD, a rheumatologist with Piedmont Physicians Rheumatology, Atlanta, oversees a membership of 90 rheumatologists, six orthopedists, two nurses, 85 physician assistants and 27 fellows and residents.
According to Dr. Machua, the GSR, founded in 1967, continues to pursue its original mission of providing educational and advocacy opportunities, as well as keeping members connected.
“We’re a very tight-knit group, and we believe in supporting each other,” Dr. Machua says. “If a member has a challenging patient scenario or health policy concern, they know they can receive guidance and input from their GSR colleagues.”
Recently, the GSR has been involved in a number of legislative efforts, including support for House Bill 63, introduced in 2019 by Rep. Sharon Cooper (R-Marietta). The bill, signed into law in April 2019, reforms the insurance practice known as step therapy or fail first. Step therapy forces patients to try therapies preferred by the insurance company before the therapy their doctor prescribed will be approved—even when doctors are certain the initial therapies won’t be effective. The practice puts the financial benefit of insurers and pharmacy benefit managers above the judgment of healthcare providers, and poses unnecessary risk to patients’ health by delaying effective treatment.
“This bill, at the state level, gives patients faster access to effective treatments prescribed by their rheumatologist rather than [delaying] appropriate therapy,” Dr. Machua says.
According to the Georgia Department of Public Health’s most recent Arthritis Burden Report, arthritis is a major public health problem in the state. Roughly one in four adult Georgians (1.7 million people) has doctor-diagnosed arthritis, and nearly half of those are disabled.1
Increasing Patient Access
As in other states with a mix of urban and rural areas, access to rheumatologists is also an issue in Georgia, a state of 10.52 million people, says Dr. Machua. The ACR noted last year that Georgia averages 74,713 people per rheumatologist.2
“Most of our rheumatologists are concentrated in urban areas, such as metropolitan Atlanta,” Dr. Machua says. “This results in many rural patients having to travel long distances or waiting for several months to secure a rheumatology appointment.”
Telemedicine is one option being explored as a way to provide rheumatology care to patients in rural areas. Dr. Machua cites a recent lupus telemedicine pilot launched by the Georgia Council on Lupus Education and Awareness, which looked at ways to improve access and outcomes for lupus patients who live in rural Georgia.
‘If a [GSR] member has a challenging patient scenario or health policy concern, they know they can receive guidance & input from their GSR colleagues.’ —Dr. Machua
Sung Sam Lim, MD, MPH, clinical director of rheumatology for Grady Health System, has also conducted research on racial disparities in lupus. Last year, Dr. Lim and his colleagues released research showing lupus health data from two counties in Georgia. Their work found that African American women with lupus are disproportionately impacted by the disease and experience more rapid progression and worse outcomes than other races.3
Telemedicine could potentially expand to other parts of Georgia, because the state’s telemedicine law went into effect this past January. SB 118 was passed as a direct effort to increase the prevalence of telemedicine and requires insurance companies to cover telemedicine services.
Addressing the Looming Physician Shortage
With many rheumatologists in Georgia approaching retirement age, Dr. Machua says a physician shortage, especially in rural areas, is a concern. Last year, the ACR reported 31% of Georgia’s rheumatologists are approaching retirement age.2
Dr. Machua says the rheumatology fellowship program at Augusta University and other programs that have increased fellowship positions are one way the state is hoping to increase the number of future rheumatologists. In addition, the Augusta University Medical College of Georgia announced in 2019 its “three plus three plus six” program, which—beginning in 2021—will offer medical students free tuition or loan forgiveness if they commit to medical school for three years, residency in the state of Georgia for three years and then practice in rural Georgia for six years. More rheumatologists are also needed to care for Georgia’s aging patient population. By 2030, the U.S. Census Bureau estimates more than 20% of Georgia’s residents will be 60 or older.4
The GSR’s annual meeting, originally slated for June 5–7 at the Ritz-Carlton, was moved to an online format given the COVID-19 pandemic. Speakers included Alan Baer, MD, founder and director of the Jerome L. Greene Sjögren’s Syndrome Center in the rheumatology division at Johns Hopkins Medicine, Baltimore; Adam Brown, MD, a rheumatologist with the Cleveland Clinic; Jeffrey Curtis, MD, a professor of medicine in the division of clinical immunology and rheumatology at the University of Alabama, Birmingham; and Catherine Najem, MD, a staff rheumatologist and assistant professor of medicine at Temple University’s Lewis Katz School of Medicine and director of Temple’s Vasculitis Clinic, Philadelphia.
Supporting Independent Rheumatology Practices
John A. Goldman, MD, a retired rheumatologist in Atlanta, has been a member of the GSR since its inception. One of his concerns is the difficulty private rheumatology practices are having staying afloat.
Dr. Goldman notes the Centers for Medicare & Medicaid Services (CMS) has cut reimbursement rates for dual-energy X-ray absorptiometry (DXA) in the private practice setting. “The Medicare reimbursement rate for many rheumatologists is $37,” Dr. Goldman says.
The GSR is one of many organizations that has supported S. 283: Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2019, legislation that would preserve access to DXA testing and establish national minimum payments for such services. The bill was introduced last year in the U.S. Senate by Rep. Susan Collins (R-Maine).
Linda Childers is a health writer located in the San Francisco Bay Area.
References
- Martyn A, Bayakly AR, Bagchi S. Arthritis Burden Report. Georgia Department of Health, Health, Epidemiology Program, Chronic Disease, Healthy Behaviors and Injury Section. 2012 Aug.
- ACR addresses workforce challenges at the state level. The Rheumatologist. 2029 Mar 21.
- Chae DH, Martz CD, Fuller-Rowell TE, et al. Racial discrimination, disease activity and organ damage: The Black Women’s Experiences Living with Lupus (BeWELL) study. Am J Epidemiol. 2019 Aug 1;188(8):1434–1443.
- Georgia police academy state profile: Georgia population. Substance Abuse and Mental Health Services Administration in partnership with the U.S. Administration on Aging. 2012 Dec.