With a new federal administration and Republican-controlled Congress taking the helm in 2017, the ACR Government Affairs Committee has identified top legislative and regulatory priorities for the year.
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“The main priority is going to be helping represent the rheumatology community as Medicare is reformed, because the era of MACRA started Jan. 1,” says Angus Worthing, MD, FACR, FACP, chair of the ACR’s Government Affairs Committee (GAC).
Priority No. 1
First and foremost, Dr. Worthing says, is ensuring Medicare does not unfairly penalize rheumatologists for providing biologic drugs.
“If the new system penalizes physicians so severely for appropriate use of medications that [improve] patient quality of life and can be lifesaving, it could be so draconian as to run practices to the ground,” he says.
Working like a “vacuum cleaner,” RISE helps collect data from rheumatologists’ electronic medical records and “find out which quality measures will be most effective for rheumatologists to be reimbursed for our work,” Dr. Worthing says. Participation in the RISE Registry can also position rheumatologists favorably with Medicare payments under MACRA.
Other Key Priorities
Other priorities for the ACR will include:
- Supporting reintroduction of the Patients’ Access to Treatment Act, which would eliminate specialty tiers and high co-insurance fees for patients;
- Use of more transparent biosimilar drug labels, including clinical data, a statement of whether a drug is interchangeable with the original biologic and use of distinct biosimilar names;
- Protection against substitution of interchangeable biosimilars without proper notification of physicians; and
- Supporting increased FDA funding and bureaucratic and hiring reforms to ensure adequate resources are available for regulation and advancement of new biosimilars, so that more marketplace competition can drive down excessive costs.
The ACR will also seek to permanently repeal the Medicare physical therapy services cap. Congress has regularly provided exemptions, Dr. Worthing says, but the ACR hopes to help revive bipartisan support for permanent repeal.
With the recent passage of the 21st Century Cures Act, which boosted NIH research funding, Dr. Worthing says the ACR will continue to advocate for $20 million in line-item Defense Department funding for arthritis-related research.
Now off the table will be efforts to fight the Medicare Part B Demonstration Project; it was scrapped by the CMS on Dec. 15, 2016.
“It had been a very large priority,” says Dr. Worthing. “We consider it a victory for the rheumatology community and our patients.”
Forming a Plan
The ACR’s yearly priorities result from “extensive discussion among Government Affairs Committee members and other leaders,” in conjunction with ACR staff and consultants, Dr. Worthing says. “We look at the landscape in Washington and across states, at initiatives being supported by our coalition partners and at what’s important to our specialty, and come up with a yearly plan.”
The process spans two-and-a-half months; then in February, the GAC will present comprehensive policy statements to the ACR Board of Directors.
Additionally, this year, Dr. Worthing says, the ACR, “like all physician groups,” will be monitoring potential changes to the Affordable Care Act, including its possible repeal.
“The most important piece [with regard to] the Affordable Care Act is making sure our patients and as many Americans as possible stay insured and stay protected by health insurance,” he says. “It’s especially true in rheumatology, where our patients often utilize extremely expensive medications, which are unaffordable without the benefit of insurance.”
Kelly April Tyrrell writes about health, science and health policy. She lives in Madison, Wis.