The world in which we currently practice is not the same one we knew five to 10 years ago. Insurers second-guess our decisions and create numerous hurdles for us to overcome before our patients can be treated. Government agencies are seeking ways to reduce healthcare expenditures and improve what they perceive as a lack of quality and consistency in healthcare delivery. These groups, as well as Congress and employers (who purchase benefits for their employees), have begun a concerted effort to grade rheumatologists on the basis of what they perceive to be quality and efficiency and then pay us according to those criteria.
Recognizing these trends, the ACR has changed its priorities in the last several years, putting advocacy and practice support at the top of its goals.
In November 2004, the Regional Advisory Council (RAC) was formed as a subcommittee of the ACR Committee on Rheumatologic Care. Ten RAC advisors assist physicians across the country. The ACR also hired two professional coders to help members resolve coding and insurance questions. The RAC’s mission is to advocate on behalf of ACR members on local and regional issues, serve as a two-way communication link between the ACR and its members, and facilitate the advocacy efforts of state societies and individual practitioners.
Since 2005 RAC has developed several lines of communication with members. RAC advisors, members of the ACR board of directors, and others have given presentations on ACR activities to state societies throughout the United States. Our coders have given numerous CME talks on coding and reimbursement at state society meetings, and will do so again in 2007. RAC initiated regional list serves for physicians and one list serve for office managers so that problems can be shared and solutions provided by ACR staff and others.
RAC has been in continuous dialogue with the Physicians Regulatory Issues Team of Centers for Medicare & Medicaid Services (CMS) along several issues—most significantly the confusion about drugs that can be covered by either Part D or B of Medicare. The ACR has challenged the continued preauthorization requests by insurers for drugs such as methotrexate, azothioprine, and prednisone. CMS has agreed to allow these drugs to be covered by Medicare if the diagnosis and “Part D” are written on the script. Although not an ideal solution to the problem, it will eliminate countless hours of frustration and staff time spent handling these issues. Some insurers and pharmacists have been slow to adopt this system, but RAC representatives continue to speak with CMS about ongoing problems and the agency has resolved to fix any that we bring to their attention.