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An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

From the College

SCHIP Legislation a Priority

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There are approximately 9 million uninsured children in the United States, and the number is increasing. Of those 9 million, 6 million are eligible for – but not enrolled in – the State Children’s Health Insurance Program (SCHIP) or Medicaid.

Stop the Steep Imaging Cuts of 2005

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DXA reimbursement will be cut 75% by 2010 if Congress does not act now. Reimbursement for imaging studies such as DXA has been reduced to the Hospital Outpatient Perspective Payment System (HOPPS) rate, based on a Deficit Reduction Act (DRA) provision. This reduction not only negatively affects rheumatologists who perform imaging studies in their offices, but will also affect access to care and increase costs for Medicare beneficiaries.

Profiling Providers: Is Your Practice Ready?

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Medicare may start profiling physicians as soon as mid 2008. The Government Accountability Office (GAO) recommended that the Centers for Medicare & Medicaid Services (CMS) develop a profiling system to identify physicians with inefficient practice patterns. At a House Ways and Means Subcommittee on Health hearing, Herbert Kuhn, acting deputy administrator of the CMS, said that identifying inefficient physicians, or “profiling,” would involve comparing the number of tests ordered by a physician for certain types of patients with the number ordered by colleagues in cases with the same outcome.

The Quality Movement Explained

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“To Err is Human,” published by the Institute of Medicine in 1999, set off a firestorm of quality initiatives when it announced that at least 44,000 to 98,000 people die in hospitals every year because of medical errors. The first quality initiatives, which were aimed at hospitals, have now trickled down to physician practices. For two years there have been reports of payors moving to a pay-for-performance system or value-based purchasing.

Support for a Future without RA

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Shirley Enis of Jacksboro, Texas, has decided to get involved with “Within Our Reach” because the campaign has the capacity to improve RA patients’ quality of life, alleviate long-term effects of RA, and ultimately ensure that future generations can enjoy life without RA.

Antiphospholipid Antibody Syndrome

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A recently identified autoimmune disorder, antiphospholipid antibody syndrome (APS) mainly affects young women between age 30 and 40. Those affected by APS may otherwise be healthy or have an underlying disease such as systemic lupus erythematosus (SLE).

Advocacy: An essential component of professional practice

Karen L. Kerr, MSN, NP, CPNP, APRN-BC  |  

In our challenging and cost-conscious healthcare environment, advocacy is an essential skill for all health professionals. As rheumatology health professionals, we advocate for our patients with insurers, institutional administrators, employers, and teachers. To bring about needed healthcare reforms, we must also learn to be effective political advocates.

Be Aware of New Waived Tests

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Keeping current on changes to laboratory certifications for common lab tests can save your practice time—and money. Since the passage of the Clinical Laboratory Improvement Amendments (CLIA) in 1988, all health-assessment laboratory tests are ranked for complexity, and their complexity dictates which labs can process Centers for Medicare and Medicaid Services (CMS)–reimbursed tests. In accordance with CLIA, each laboratory facility must register with CMS to receive a CLIA certification. There are five certifications, each with differing degrees of complexity, listed from least to most complex: Certificate of Waiver, Certificate of Provider-Performed Microscopy Procedures, Certificate of Registration, Certificate of Compliance, and the Certificate of Accreditation.