In June, state lawmakers in New York passed legislation on step therapy designed to help ensure patient access to the best and most appropriate care. Step therapy mandates that a patient with a specific condition receive prescribed drugs approved for that condition in the order that an insurance company determines it will cover as the…
Proposed CMS Physician Fee Schedule May Offer Slight Increases
All eyes are on the new physician fee schedule proposed by the Centers for Medicare & Medicaid Services (CMS), which will be finalized this year and go into effect Jan. 1. The ACR is reviewing the proposal and will be providing comments and recommendations to CMS. And many rheumatologists have payment and coding questions: Will…
Milestones of Rheumatology Education
In 2013, a collaboration began to advance the training and assessment of fellows. The result: A uniform set of educational reporting milestones for all internal medicine subspecialties was developed. Key stakeholders were then asked to develop a list of entrustable professional activities (EPAs), a set of responsibilities any specialist should be able to perform, for their subspecialties. The ACR’s Next Accreditation System working group developed 14 EPAs for rheumatology…
From the Expert: Musculoskeletal Ultrasound Training Benefits Rheumatology Practices & Patients
Eugene Kissin, MD, says the use of musculoskeletal ultrasound can help rheumatologists diagnose and treat disease. Getting the proper training is critical. USSONAR is a training resource that can help…
UnitedHealth Sees Further Losses for Obamacare Insurance
(Reuters)—UnitedHealth Group Inc. on Tuesday said it anticipated another $200 million more in losses this year on the individual insurance business created under U.S. President Barack Obama’s national healthcare reform law, citing the program’s high medical costs. The largest U.S. health insurer says the problem was confined to this one business line, which it plans…
ACR Advocacy at the State Level in 2016
A majority of state legislatures have concluded their work for 2016. The ACR’s state advocacy efforts continued to focus on policy benefiting rheumatologists and patients alike. The two dominant issues this year were biosimilar substitution and step therapy. Biosimilar Substitution Biosimilar substitution remains the most prevalent issue throughout the states. The ACR continues to monitor…
Rheumatologists on the Move, July 2016
HSS Holds First Rheumatology Gala The Hospital for Special Surgery (HSS) in New York City hosted a Rheumatology Gala in May. The event, held at The Park Avenue Armory in Manhattan, was held to increase awareness of HSS’s leading research and treatment of rheumatic diseases—particularly with “high-net worth people,” according to former ACR President Mary…
The ACR’s Collaborative Initiatives Promote Awareness of Lupus, Rheumatic Diseases
When I began my tenure as ACR president this past November, I posited that it “takes a village” to grow and succeed in rheumatology’s rapidly changing environment. The ACR village includes volunteers who represent a diverse leadership pipeline reflecting the demographics of our younger members. It also includes the international rheumatology community that accounts for…
U.S. Justice Department Has Concerns about Aetna-Humana Deal
(Reuters)—The U.S. Department of Justice has significant concerns about Aetna Inc.’s proposed acquisition of health insurer Humana Inc., a source familiar with the situation said on Thursday, and shares of Humana fell more than 11%. Aetna’s purchase of Humana would combine two of the largest providers of Medicare Advantage plans for elderly people, and investors…
Medicare Advantage Grows, but Provider Choice Is Limited
CHICAGO (Reuters)—Medicare enrollees are moving in greater numbers than ever to the program’s managed care option as a way to save money. But the tradeoff is much less ability to use their preferred doctors and hospitals. Seniors can choose between traditional fee-for-service Medicare—which is accepted by most healthcare providers—or a Medicare Advantage plan. The latter…
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