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Editor's Pick

The Burden Imposed by Prior Authorization Requirements

Deborah Levenson  |  February 9, 2025

‘Prior authorizations are the bane of our existence as rheumatologists,’ says Physician Editor Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS. ‘How bad is it, how can we manage them, and how is the ACR helping?  Read on in this month’s Editor’s Pick.’ Healthcare providers consider prior authorization (PA) a significant burden, but to different degrees…

Filed under:Patient PerspectivePractice SupportTechnology Tagged with:artificial intelligenceprior authorization

Rheumatology 2025 State Legislative Preview

Joseph Cantrell, JD  |  January 20, 2025

As state legislatures begin to convene their sessions in 2025, several key issues related to rheumatology are expected to take center stage, including drug costs, utilization management, telehealth and copay accumulators.

Filed under:From the CollegeLegislation & Advocacy Tagged with:state legislation

Adobe Stock | Creativa Images

RA: How High Is the Toll?

Samantha C. Shapiro, MD  |  January 9, 2025

Patients with RA not only suffer from functional limitations, but also face increased healthcare costs, primarily due to prescription drug use, says Dr. Yinan Huang.

Filed under:ConditionsResearch RheumRheumatoid Arthritis Tagged with:economic burdenMSPhDphysical burdenRA Resource CenterYinan Huang

What Providers & Patients Should Know About Medicare Benefit Changes in 2025

From the College  |  December 9, 2024

Changes to Medicare benefits in 2025 include an annual $2,000 cap on out-of-pocket costs for covered Part D drugs and a new, voluntary Medicare Prescription Payment Plan intended to help beneficiaries manage drug costs.

Filed under:Insurance Tagged with:Medicare Part Dprescription drug costs

The Ethical Tug-of-War Over Biosimilar Adoption

Karen Ferguson, MS, & Richard L. Allman, MD, MS, FACP, FACR  |  December 9, 2024

The advent of biosimilar medications has offered the promise of significant cost savings for healthcare systems and patients. Biosimilars are highly similar versions of existing biologic drugs, providing a more affordable alternative once the original biologic patent expires. However, the adoption of biosimilars in the U.S. has been hampered by myriad roadblocks, many of which…

Filed under:Biologics/DMARDsDrug UpdatesEthicsGuidance Tagged with:BiosimilarsEthics ForumMedical necessitypharmacy benefit managers (PBMs)

MCTD: Is It Just Letters?

Ruth Jessen Hickman, MD  |  December 4, 2024

At a Great Debate session, speakers discussed whether mixed connective tissue disease is a distinct disease entity in rheumatology.

Filed under:ACR ConvergenceConditionsGuidanceMeeting ReportsOther Rheumatic Conditions Tagged with:ACR Convergence 2024connective tissue diseasemixed connective tissue disease (MCTD)

Can Cultural Humility Conquer Systemic Inequity in Pediatric Rheumatology?

Glen Rodman  |  November 26, 2024

Doctors and patient advocates urged the rheumatology community to address the drastic inadequacies in care faced by marginalized people in a session held at ACR Convergence 2024.

Filed under:ACR ConvergenceLegislation & AdvocacyMeeting ReportsMeeting ReportsPatient PerspectivePediatric ConditionsSystemic Lupus Erythematosus Tagged with:ACR Convergence 2024Equitypatient advocacyPediatric

It’s Not Just Joint Pain

Mary Beth Nierengarten  |  November 19, 2024

Experts offered perspectives on how symptoms of rheumatic disease, such as fatigue, affect the physical, cognitive and emotional health of patients and offered solutions.

Filed under:ACR ConvergenceConditionsMeeting ReportsOther Rheumatic Conditions Tagged with:ACR Convergence 2024Exercisefatiguehealthy eatingpatient carequality of life

Unless Congress Acts, Medicare Reimbursement Will Remain Flat or Drop in 2025

From the College  |  November 12, 2024

The 2025 Medicare Physician Fee Schedule final rule, released Nov. 1, includes a conversion factor of $32.3465, a 2.83% drop from 2024. In response to advocacy efforts from the ACR and other medical societies, Congress recently introduced the Medicare Patient Access and Practice Stabilization Act of 2024, which would eliminate the 2.83% payment cut and provide an inflationary update for 2025 equal to 50% of the Medicare Economic Index.

Filed under:Billing/CodingLegislation & Advocacy Tagged with:ACR advocacyMedicare Physician Fee Schedule (MPFS)Medicare Reimbursement

Updates in Ultrasound for Rheumatology 2024

Samantha C. Shapiro, MD  |  November 10, 2024

It’s an exciting time for ultrasound in rheumatology, & it’s never too late to learn. Whether you’re just starting fellowship or have been practicing for decades, there’s a place for ultrasound in your practice.

Filed under:Clinical Criteria/GuidelinesEducation & TrainingGuidanceGuidelinesPractice Support Tagged with:diagnostic imagingimagingMusculoskeletal UltrasoundUltrasoundUltrasound School of North American Rheumatologists (USSONAR)

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