In 2017, did you interact with the Medicare payment system, receive payment for a consultation code or worry about the Centers for Medicare & Medicaid Services (CMS) reducing reimbursement through its proposed Part B Demonstration Project?
If your answer to any of those questions is yes, then you directly benefited from the ACR/ARHP’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 a rheumatologist is, much less the important work they do. To mitigate this, ACR/ARHP leaders and staff, armed with RheumPAC resources, advocate for rheumatology to lawmakers and their staff.
What difference does this make? In 2017, the ACR/ARHP fought for regulatory relief to ease the reporting burden and increase benefits by making the Medicare payment system work better for rheumatology, with a 50% reduction in penalties for 2018 (the final year of the value-based modifier), and by extending MACRA flexibilities for physicians and small practices. After months of grassroots opposition from ACR/ARHP members and their patients, the CMS cancelled its Part B Demonstration Project, which would have reduced reimbursement for certain drugs, and Congress reauthorized the FDA User Fee programs, allowing the FDA’s valuable work to continue.
In addition to regulatory agencies, the ACR/ARHP worked directly with payers to delay a policy that would have ceased payments for consultation codes and halted expansion of the onerous lab benefit management program. The ACR kicked off an initiative within the American Medical Association (AMA), calling on the U.S. to restart premium processing for physicians applying for the H1-B Visa, which succeeded in time for newly graduated fellows to arrive in underserved American communities in July 2017.
In the U.S. Congress, the Senate Committee on Health, Education, Labor and Pensions held hearings on drug costs, raising points ACR/ARHP leaders and patients took to Capitol Hill during the September 2017 Advocates for Arthritis fly-in, including the negative impact of rebates and the need for transparency in the work of pharmacy benefit managers (PBMs). The ACR/ARHP worked with the Coalition for Accessible Treatments to advance federal step therapy legislation in the House of Representatives and with the Local Coverage Determination (LCD) Coalition to enhance transparency and accountability in the LCD process used by Medicare regional contractors.