ACR advocacy efforts advance despite pandemic

The ACR advocacy team has been busy since ACR Convergence 2020. Rheumatology reimbursement is up, documentation burden is down, and patients with compromised immune systems are high on the priority list to receive COVID-19 vaccinations and boosters. Those are just a few of the challenges that have kept the ACR advocacy team busy during the pandemic.

“The big issues right now are drug pricing, drug shortages, and easing the prior authorization burden,” said Ryan Jessee, MD, Clinical Associate Professor of Rheumatology at Duke University School of Medicine. “One of our other goals is increasing the transparency of pharmacy benefit managers, who can act as a middleman for drug pricing with virtually no oversight. We are working to build support for House and Senate bills currently being considered to increase both transparency and accountability for PBMs.”

Dr. Jessee will moderate Make Your Voice Count: Annual Advocacy Update from 11 a.m. – 12 p.m. ET Sunday, Nov. 7. Look for updates on legislative and regulatory victories and losses and continuing efforts, as well as a look at how patients benefit from every ACR advocacy victory. And get ready for insider takes from ACR advocacy professionals on ways to inform and move opinion on Capitol Hill and in statehouses.

Registered ACR Convergence participants will have on-demand online access to watch a replay of the session through March 11, 2022.

“From a medical perspective, advocacy is not the sexiest or most exciting topic, but it affects everything we do on a daily basis,” Dr. Jessee said. “Advocacy touches very real issues like how we are going to be able to get our patients the medications they need, how they are going to be able to pay for them, even how many minutes we can spend with them and how we will be reimbursed. Every patient we see is affected by the things we advocate for. That’s why it’s so important for members to get involved on an individual basis to support our efforts as an organization.”

What has ACR advocacy done for you recently?

“Key wins this year include supporting E/M advances in the Physician Fee Schedule, rescinding the Most Favored Nation CMS model, and collaborating with the CDC and FDA on vaccine guidance for immunocompromised patients,” said Blair Solow, MD, Chair of the ACR Government Affairs Committee. “We have had great success at the state level in copay accumulator and step therapy policies.”

Other legislative priorities include avoiding cuts to reimbursement, funding for research initiatives through the Department of Defense and the CDC, programs supporting loan repayment for pediatric rheumatologists, streamlining management tools like step therapy and prior authorization, and legislation impacting telehealth and workforce expansion.

“2022 will be the second and final year of the 117th Congress,” Dr. Solow continued, “which I suspect will be busy leading up to midterm elections. We will work toward moving bills forward that will impact rheumatology providers and our patients.”

But legislative advocacy is only half the picture and half the battle. Elected representatives legislate, but regulators turn legislation into policy and action. And sometimes not successfully.

“E/M codes were revalued this year, which gave a bump to our members, theoretically,” said Amanda Grimm Wiegrefe, MScHSRA, ACR Director of Regulatory Affairs. “But we are hearing that some members are not seeing those bumps that we had all anticipated. We are trying to figure out why and where those discrepancies are happening. I hope attendees can give us some feedback on what they have been experiencing so we can help providers within the jurisdiction and resources that we have as an organization.”

Telehealth is another key regulatory issue. Telehealth use exploded during the COVID-19 pandemic thanks to waivers from CMS and commercial carriers.

“What does telehealth look like post-pandemic?” Wiegrefe asked. “We’re starting to have some of those conversations with regulators. CMS is thinking about what this looks like when we’re not in a public health emergency.”

Drug pricing and availability are also key issues. The Biden administration, like others before it, is pushing for changes to drug pricing. Specifically, the President is pushing the Department of Health and Human Services to develop a strategy to deal with skyrocketing drug prices, Wiegrefe noted.

“We are in the forefront of those conversations with regulators and other stakeholders on what pricing looks like that allows for financial sustainability but does not get in the way and does not harm that all-important patient-provider relationship,” she said. “Patient access is our number one concern and consideration. These issues directly impact providers, their practices, and how they are able to care for their patients. Rheumatology providers can be their patients’ best advocates.”

Advocating for patients and for the profession doesn’t have to be time intensive. One of the most effective ways to make your voice heard is also among the quickest: email, write, or call your representative about a specific bill or issue. Dr. Solow noted that the ACR’s Legislative Action Center has contact information for Congressional and state representatives nationwide.

“Advocacy is in the background for most providers in practice,” Dr. Jessee said. “This hour will move it to the foreground and help you use advocacy to improve your practice and your patients’ lives.”