ACR Past President Douglas White, MD, PhD, discusses his transition to private practice & the tensions between private practice & academic rheumatologists.
Rheumatology in China: An American Fellow’s Experience
An American rheumatology fellow explores the differences& similarities between the U.S. & Chinese health systems through a visit toa hospital inHangzhou, China.
CMS to Implement AI-Based Model to Streamline Prior Authorization
Last week, the Centers for Medicare & Medicaid Services (CMS) announced that it is implementing a new prior authorization model called the Wasteful and Inappropriate Services Reduction (WISeR) Model. This six-year model, starting on Jan. 1, 2026, aims to reduce fraud, waste and abuse in traditional Medicare by using technology-enabled processes for prior authorization and…
Aetna Implements Specialty Pharmacy Requirements
On July 1, Aetna launched its new Combined Benefit Management Drug List, effectively moving romosozumab-aqqg (Evenity) and infliximab (Remicade) to pharmacy-only coverage for most fully insured commercial plans. The ACR has contacted Aetna leaders to raise concerns about patient access to these therapies.
ACR Meets with Trump Administration to Discuss 2026 Physician Fee Schedule Proposed Rule
Issues discussed at a meeting with the Office of Management & Budget included increasing Medicare reimbursement for physicians, telemedicine permanence, removing G2211 restrictions, adequate reimbursement for therapies and more flexibility for chemotherapy administration codes. The proposed rule is currently under review by the OMB, which is usually the last step prior to releasing publicly for stakeholder review and comment.
The ACR Calls on CMS, OMB to Reduce Burdensome Healthcare Regulations
In response to agency requests for feedback on how to streamline regulations and reduce administrative burden on Medicare program stakeholders and small business owners, the ACR called for the removal of certain regulations related to prior authorization, pharmacy benefit managers and Medicare Part B and Part D access.
Inaugural Practice Innovation Summit Focuses on Building a Blueprint for Private Practice Success
Registration is now open for the first-ever Practice Innovation Summit, which will dive into operational and financial strategies to grow and sustain private and community-based practices.
ACR Responds to Aetna Specialty Pharmacy Requirements
Aetna recently notified practices about the launch of its Combined Benefit Management Drug List, which will result in romosozumab-aqqg (Evenity) and infliximab (Remicade) moving to pharmacy-only coverage on July 1. The ACR is working to oppose this change.
Aetna Expands Evaluation & Management Downcoding Program
Aetna recently expanded its Claim and Code Review Program, which results in the downcoding of certain level 4 and 5 evaluation and management claims. Practices are advised to monitor remittance documents for appropriate reimbursement.
Underwater Biosimilars Coalition Shares Results of Practice Survey with Congressional Leaders
This week, the Coalition sent Congressional leadership a letter detailing the results of a recent survey about how underwater biosimilars are impacting physicians’ ability to provide high-quality care. Almost all of the nearly 200 practices queried reported being underwater on several biosimilars, with rituximab and infliximab biosimilars being the most common.
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