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In 2018, did you interact with the Medicare payment system, receive payment for a consultation code or worry about the Centers for Medicaid & Medicare Services (CMS) reducing reimbursement through its proposal to combine evaluation and management codes in the Physician Fee Schedule?
If your answer to any of those questions is yes, then you directly benefited from the ACR/ARP’s advocacy efforts. Elected officials and government entities make decisions every day that affect the work of rheumatologists and the lives of our patients. These decisions are based on education and awareness presented by advocates, constituents and other lawmakers. The truth is that many members of Congress have little idea what rheumatologists are, much less the important work they do. To mitigate this, ACR/ARP leaders and staff, armed with RheumPAC resources, advocate for rheumatology to lawmakers and their staff.
What difference does it make? In 2018, ACR/ARP fought combining evaluation and management codes, which would result in a 7% cut to reimbursement by Medicare for rheumatologists. After years of grassroots opposition from ACR/ARP members and their patients, Congress repealed the Independent Payment Advisory Board, whose recommendations were not subject to executive or judicial branch review and whose proposals would have automatically become law and could not be modified without three-fifths of the Senate voting to do so.
In Congress: The Senate passed legislation prohibiting the inclusion of gag clauses in contracts between prescription drug plans and pharmacy benefit managers (PBMs) and the pharmacists who provide those drugs to patients. Such clauses had prevented pharmacists from being able to tell patients when paying out of pocket without insurance would be cheaper than their co-payment with coverage. This bill was signed into law.
In January, an arbitrary cap was placed on Medicare outpatient therapies and other rehabilitation services 20 years after being approved in the Balanced Budget Act. Congress had temporarily prevented implementation of the caps 16 times before it began limiting access to services on Jan. 1, 2018. A permanent repeal of these caps passed in March after years of advocacy by ACR/ARP, ending a long battle to allow Medicare patients access to the care they need based on individual circumstances.
The ACR/ARP worked with the Coalition for Accessible Treatments to advance federal step therapy legislation in the House of Representatives. With ACR/ARP’s support, research funding for the National Institutes of Health was boosted by $1.25 billion in 2018, despite the administration’s threats to cut it in 2017. The ACR/ARP raised awareness of the impact of arthritis on service members and veterans, including that it is the second leading cause of medical discharge from the Army behind battlefield injury and the leading cause of disability among veterans, resulting in continued support for arthritis research through the Department of Defense (DoD). Notably, an amendment to add a $20 million line item to the DoD’s Congressionally Directed Medical Research Program got through the House Rules Committee this appropriations season, marking the impact of this educational effort.
At the state level in 2018, ACR/ARP helped pass bills in 10 states to reform concerning practices by pharmacy benefit managers.