Editor’s note: Welcome to the first installment of Experiences in Advocacy, a special series authored by ACR members detailing personal experiences in advocacy.
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Explore This IssueOctober 2015
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We need rheumatologists to join the American Medical Association (AMA). Here’s why, and how to do it.
Having participated in your delegation for over a decade, I have seen major improvements in focus, prioritization of issues, transparency, collaboration and diversity in the AMA, and we need your help now to keep rheumatology’s seat at the table. You can help by renewing your membership in or joining the AMA. Call the AMA at 800-262-3211, and specify that you want to join or renew for 2015. If you haven’t been an AMA member for more than a year, you can even get a half-dues discount.
Our participation in the House of Delegates (HOD) gives us a seat at the table for the Relative Value Scale Update Committee (RUC) and other vital decision-making and informational aspects of organized medicine. Despite being a relatively small subspecialty, the ACR is able to make things happen at the AMA HOD, the AMA’s policymaking meeting, through our partnerships and nimble approach to advancing issues important to rheumatologists, their practices and patients.
The most recent AMA HOD meeting was held this summer in Chicago. Your AMA membership translates into results for you—because rheumatologists have a seat at the table. Some of the major topics discussed and actions taken are:
Great work was done by my colleagues Colin Edgerton, MD (alternate delegate), Cristina Arriens, MD (Young Physician Delegate), and Erin Mary Bauer, MD, who for the first time brought an ACR voice to the Resident and Fellows Section of the AMA.
ICD-10: The HOD adopted policy that the AMA would ask CMS and other payers for a safe harbor “grace period” for the ICD‑10 transition, based on existing policy the ACR and partners put in at previous meetings. Additionally, the AMA would aggressively promote this implementation compromise to Congress and CMS (this was new, inserted after testimony and the amendment offered by the ACR and others).
As you know, mitigating the burdens and risks of ICD-10 implementation has been a major focus of the ACR’s advocacy efforts, specifically with regard to legislation introduced by Rep. Diane Black (R-TN-06), H.R. 2247. The House moved this bill up the agenda in order to start the updated advocacy campaign with letters to Congress and continued efforts with CMS. This led to the joint announcement by the AMA and CMS in early July of additional flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD‑10 code set, which was based in large part on the legislation the ACR supported.
The ACR succeeded in having the HOD adopt policy regarding the value-based modifier (VBM) and flawed drug cost attribution. The ACR-drafted Resolution 236 asked that the AMA work with CMS to modify VBM cost attribution with regard to drug costs to ensure the cost calculation does not unfairly disadvantage certain providers. The VBM will remain part of the future Merit-Based Incentive Payment System (MIPS) called for by the MACRA (H.R. 2) legislation that repealed the SGR. Our Resolution 236 was co-sponsored by the American Academy of Allergy, Asthma & Immunology (AAAAI), American Academy of Dermatology, American College of Gastroenterology and American Society of Clinical Oncology.
The reference committee heard largely supportive testimony regarding Resolution 236. Testimony noted that disparate treatment of the costs of Part B vs. Part D medications can have an unfair impact on certain physicians under VBM and result in the greater likelihood of penalties. Testimony also noted that physicians should not be forced to make drug choices that may not improve patient care because of the flawed VBM approach to drug costs. Others noted that when MIPS replaces VBM in 2019, the costs of Part D, as well as Part B, drugs will be included in the costs attributed to physicians, providing a more fair assessment. A minor amendment was offered to ensure that all drug costs would be considered. The reference committee agreed with this testimony and recommended that Resolution 236 be adopted as amended to support a more balanced playing field, and our resolution was passed by the House.
Maintenance of Certification: There were two Committee on Medical Education Reports—one on MOC and one on Maintenance of Licensure and controversy of linking this with MOC. In addition, there were six resolutions dealing with MOC that were extensively debated. We also participated in the internal medicine caucus, in which the president and executive vice president of the American College of Physicians summarized their extensive ongoing dialogue with the American Board of Internal Medicine (ABIM), and an open forum sponsored by the Pennsylvania Medical Society that also had a significant focus on concerns with ABIM. The CME report asks the American Board of Medical Specialties (ABMS) to develop “fiduciary standards” for its member boards. The policy asks the ABMS to urge full transparency related to the costs of preparing, administering, scoring and reporting MOC exams. It also seeks to ensure MOC “doesn’t lead to unintentional economic hardships.” The ACR has since issued its own physician-driven position statement on ABIM’s MOC requirements.
Other new policies direct the AMA to work with the ABMS toward the following:
- Any assessment should be used to guide physicians’ self-directed continuing medical education study.
- Specific content-based feedback after any assessment should be provided to physicians in a timely manner.
- Multiple options should be available for how an assessment could be structured to accommodate different learning styles.
- Physicians need to know what their specific MOC requirements are and the timing around when they must complete those requirements. The policy directs the AMA to ask the ABMS and its member boards to develop a system to alert physicians to the due dates of the multi-stage requirements of MOC.
- Part III of the MOC exam, known as the high-stakes exam, should be streamlined and improved, and alternative formats explored.
We also co-sponsored Resolution 235 with the American Association of Clinical Endocrinologists, AAAAI and Endocrine Society regarding the newly launched Interstate Medical Licensure Compact commission to clarify that the intent of the compact’s model legislation requiring that a physician “hold” specialty certification refers only to initial certification and not MOC. This was passed by the HOD.
We co-sponsored Resolution 505 along with the dermatology caucus members regarding the difficulties we often face obtaining coverage for our patients for off-label use of medications. The HOD amended current policies and resolved to advocate that the FDA work to establish a process whereby official drug labeling can be updated in a more expeditious fashion when new evidence becomes available affecting the clinical use of prescription medications and that evidence-based standards or peer-reviewed medical literature can add to legacy information contained in official drug labeling statements to guide drug administration and usage.
In another effort with the dermatology caucus, we sponsored Resolution 702 regarding access to in-office administered drugs. This strengthens AMA policy that we had previously brought forward regarding this issue. Rheumatologists leverage our advocacy efforts and dollars by using the significant resources the AMA brings to bear.
We have learned that AMA membership among ACR members has declined since 2012, and because our membership is now measured yearly, we lost our second delegate.
We can Advance Rheumatology! more forcefully and serve you and our patients better by having a larger voice at the AMA. We’re asking that rheumatologists who are not current members of the AMA join now for 2015 so rheumatology can keep our seat and remain involved in steering the direction of the AMA. Call the AMA at 800-262-3211. You can also contact ACR staff at [email protected] for assistance in becoming an AMA member or renewing your membership. If you are already an AMA member, make sure you have designated the ACR as your representative society.
Thank you for your support, and if you have any questions, e-mail [email protected].
Gary Bryant, MD, chairs the ACR’s delegation to the AMA’s House of Delegates. He is vice chair for clinical affairs in the Department of Medicine and associate professor of medicine in the Division of Rheumatic and Autoimmune Diseases at the University of Minnesota Medical School in Minneapolis.