As was pointed out on the ACR/Association of Rheumatology Health Professionals (ARHP) Advocacy Listserv, some plans are state specific. So if a patient lives on the border of one state and wants to see his rheumatologist across the state line 10 minutes away, the visit won’t be covered. This is a glaring example of one of the glitches being identified and that must be corrected to provide continuity of care and personal choice of providers. Because state governments affect much of rheumatologic care by creating exchanges, defining Medicaid eligibility and regulating pharmacies (and also by considering legislation to regulate biosimilar products), the ACR has stepped up its presence in state capitals and has recently hired staff to monitor and affect state government activity. Starla Tanner ([email protected]) is a new member of our advocacy crew.
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Explore This IssueJune 2014
Open enrollment through the Marketplace ended March 31, but there are special circumstances under which people can still apply for insurance. For example, when someone experiences life events, such as marriage, divorce, birth of a child, loss of a spouse or loss of other health coverage, then they would meet the special circumstances criteria. The special enrollment period lasts 60 days following an event. Someone applying for Medicaid or the Children’s Health Insurance Program (CHIP) may apply at any time.
As mentioned earlier, increases in the number of Americans with access to coverage come without the necessary enhancements in infrastructure. The ACR, through its Government Affairs Committee (GAC) and Committee on Rheumatology Training and Workforce Issues (COTW), is working to address infrastructure issues as they relate to rheumatology.
For years, GAC has advocated for more pediatric rheumatologists, using training loan forgiveness as a mechanism to improve access. The COTW monitors and develops curricula for trainees in rheumatology, along with other initiatives designed to encourage selection of rheumatology training among internal medicine residents and medical students. In a recent publication of the Rheumatology Research Foundation’s Pathways, the rheumatology workforce study anticipates the demand for services to increase 46% between 2005 and 2025. Unfortunately, the number of practicing rheumatologists is only expected to increase 1.2% in that same period. In contrast, since 2004, ARHP membership has increased by 30%. Such programming as the Fundamentals of Rheumatology and Advanced Rheumatology Online Courses for health professionals helps train health professionals and aid in meeting this unprecedented growth in demand for rheumatology services. We believe that this is an excellent way to help meet the need as patient demand grows.
Three core goals of the ACA are to provide access to affordable coverage, improve healthcare quality & reduce the growth in healthcare spending.
The second major focus of the ACA is to address healthcare quality. Reporting of quality data is becoming standard across the entire healthcare delivery system. Just as data collection and system quality improvement changed the automotive and airline industry years ago the hope is this will be the case with healthcare. Realizing that healthcare delivery is complicated, quality measurement in healthcare is not a new concept. The National Quality Forum (NQF) is celebrating its 15th year. Such groups as the Hospital Quality Alliance, Ambulatory Care Quality Alliance, Pharmacy Quality Alliance and the ACR are engaged in the development, testing and dissemination of quality measures related to the respective areas. We have submitted new rheumatoid arthritis quality measures that are currently being vetted through the NQF process.