Category: ACR

The following is a press release from ACR dated June 24, 2024:

The American College of Rheumatology (ACR) has submitted to the United States House Committee on Ways and Means Health Subcommittee a response to the recent subcommittee hearing, The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine, highlighting issues facing private practices, including inadequate reimbursement for Medicare physicians, burdensome prior authorization policies, and the growing shortage of physicians in the workforce.

In its letter, ACR notes that rising inflation, cuts to reimbursements to below the cost of treating Medicare patients and growing operating costs threaten the viability of private practices. To address these concerns, ACR advocates for legislation to address two persistent challenges impacting Medicare payment to physicians: inflation and a mandatory budget-neutrality requirement. The Strengthening Medicare for Patients and Providers Act (H.R. 2474) would add a permanent annual inflationary update for Medicare physician payments, while the Provider Reimbursement Stability Act (H.R 6371) would help to curtail the negative impact of budget neutrality requirements by raising the current budget neutrality threshold from $20 million to $53 million and requiring its regular re-evaluation.

Given the administrative burden created by costly prior authorization policies, ACR noted its support for efforts to streamline the process so that healthcare team members can spend less time negotiating with insurance companies and more time taking care of patients.

Finally, the shrinking physician workforce creates significant challenges across the healthcare continuum. Unless policymakers intervene, the problem will continue to worsen as fewer physicians are asked to meet the treatment needs of a growing and aging patient population. To address this issue, ACR recommends policies to increase training opportunities, address burnout and early retirement in the healthcare workforce, mitigate the impact of medical education debt, and expand workforce access for visa-holding physicians.

“Private practices are essential to our communities and should be supported by policy,” the letter concludes. “The ACR looks forward to partnering with the Ways & Means Health subcommittee as legislative solutions are considered.”

ACR’s full response letter is available here.

The following is a press release issued by ACR dated June 3, 2024:

The American College of Rheumatology (ACR) has submitted its response to the Centers for Medicare & Medicaid Services (CMS) request for information (RFI) and feedback from stakeholders on how best to enhance Medicare Advantage (MA) data capabilities and increase public transparency.

“Given more than half of Medicare beneficiaries are now choosing Medicare Advantage plans, we applaud CMS for more closely examining this program and, in particular, its impact on those living with complex chronic and acute conditions—including many rheumatic diseases that require specialized expertise and care,” said Dr. Christina Downey, chair of ACR’s Government Affairs Committee. “More reporting and greater transparency around prior authorization processes, care quality, health equity, MA market competition, and prescription drug plans can inform CMS’ decision to implement policies that improve the system for physicians and the healthcare experience for patients.”

ACR notes in its response letter that, “for too long, prior authorization policies by MA-managed care plans have been burdensome and time-consuming and have delayed care for beneficiaries.” To begin addressing this issue, the ACR requests that CMS make publicly available certain metrics on prior authorization, including requests, denials, response rates, reasons for denials, and frequency of denials categorized by type of service. ACR also joined a similar request letter from the Regulatory Relief Coalition asking CMS to implement policies that remove prior authorization barriers to timely care.

ACR also asks CMS to collect and report metrics that would help to better evaluate care quality and outcomes, including value-based care arrangements and efforts to meet health equity goals. This reporting should evaluate potential care disparities faced by MA beneficiaries of color by looking at the prevalence of certain diseases, enrollment in low-rated plans, access to 5-star plans, care outcomes, and average annual premiums. Additional reporting on the percentage of MA beneficiaries under 65 would help paint a clearer picture of how plan design and features impact various populations.

Additionally, given the growth of MA plans, ACR requests that policies support a truly competitive healthcare market. Concerns about consolidation and its impact on quality-of-care prompted ACR to request CMS evaluate bidding figures from each MA plan on an annual basis juxtaposed to the Herfindahl-Hirschman Index score of the markets in which each MA plan operates. Both pre- and post-merger analyses should look at the changes in average annual premiums by the state of residence, plan type, calendar year, and the number of rheumatologists each MA beneficiary has in-network. Consolidation has driven many independent rheumatologists out of practice and limited beneficiaries’ access to care, particularly in underserved communities challenged with accessing a local rheumatologist.

Finally, ACR asks that CMS look specifically at MA prescription drug plans to evaluate their quarterly listings of medications MA beneficiaries have access to and the percentage of MA beneficiaries who reach their out-of-pocket limits every year. Policies that limit choice or increase the cost burden for patients often lead patients to ration their doses or even abandon treatment altogether; in fact, according to recent research, 70% of new patients opt out of filling their prescriptions due to cost. Instead, ACR strongly supports patients having access to the right treatment and any necessary reference products at the right time.

“As the agency begins to explore changes and improvements to MA, ACR stands by as a resource to help ensure that enrollees with rheumatic diseases have better access to the quality care they deserve,” concluded Dr. Downey.

The following is a press release issued by ACR on March 25, 2024:

The American College of Rheumatology (ACR) today expressed strong support for several key measures included in the Fiscal Year (FY) 2024 budget. The budget allocates crucial funding to the Department of Defense’s Congressionally Directed Medical Research Program (CDMRP) for research on arthritis risks, outcomes, and treatments among service members; secures a significant funding increase for the National Institutes of Health (NIH), the cornerstone of medical research in the United States; and extends the Conrad 30 program. This program allows foreign-trained physicians to seamlessly enter the United States healthcare workforce after residency completion.

“The ACR applauds Congress for including provisions in the budget that prioritize the future of rheumatology. This budget recognizes the critical need for both a stronger physician workforce and continued research funding for arthritis and rheumatic diseases, ultimately benefiting millions of patients,” said Deborah Dyett Desir, MD, president of the ACR.

The Further Consolidated Appropriations Act of 2024 delivers a win for veterans and active-duty service members. The act allocates $10 million in the CDMRP for needed arthritis-related research among those who serve our nation. This targeted funding is crucial considering the alarming statistic that one in three veterans is battling arthritis, making it the second leading cause of medical discharge from the Army. By supporting research in this area, the CDMRP benefits veterans and service members and contributes to a broader understanding of rheumatic diseases.

This package also secures a notable funding boost for the NIH, reversing earlier proposals for deep cuts. Importantly, it protects funding for the National Institute of Allergy and Infectious Diseases (NIAID), which plays an important role in ongoing public health battles. This robust NIH funding ensures continued progress in critical medical research, including advancements in treatments and prevention strategies for rheumatic diseases.

The final spending bill also includes an extension of the Conrad 30 program, which allows U.S.-educated and trained physicians with a J-1 visa to enter the American medical workforce upon the completion of their residency. This delivers a much-needed boost to the American medical workforce given the current physician shortage. Typically, J-1 visa-holders training in the U.S. must return to their home country for two years after their program ends before they can apply for a work visa or green card to work in America. Each Conrad 30 waiver translates directly to a physician serving patients in underserved communities, for at least three years, who might otherwise face limited access to care.

“This budget represents a major victory for the 53.2 million Americans living with physician-diagnosed rheumatic conditions,” said Desir. “Including these vital programs promises to unlock significant patient care and research advancements in the coming years. We eagerly await the positive impact this will have on millions of lives.”

The following is a press release issued on January 17, 2024:

The American College of Rheumatology (ACR), on behalf of over 7,900 rheumatologists and rheumatology professional team members, applauds the Centers for Medicare and Medicaid Services (CMS) for finalizing its Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations rule recently.

“Prior authorization policies create significant undue burdens on patients and healthcare professionals and often result in significant delays to needed care, treatment abandonment, and irreversible harm to patients’ health,” said Deborah Dyett Desir, MD, president of ACR. “The ACR commends CMS for recognizing the negative impact of prior authorization on patients and the need to streamline the process to promote greater transparency between doctors’ offices and payers.”

Specifically, the rule would reduce the decision time to 24 hours for urgent requests and seven days for non-urgent requests. The rule also requires payers to provide the reason for prior authorization denials, creating greater transparency and establishing a more streamlined practice for resubmissions and appeals.

However, the ACR is concerned with the inclusion of e-prior authorization measures for merit-based incentive payment system (MIPS)-eligible providers under the performance improvement (PI) category as it will create additional burden for physicians.

While this final rule addresses many concerns about the use of utilization management tools, the ACR continues to urge Congress to pass the Improving Seniors’ Timely Access to Care Act (S. 3018/H.R. 3173) to statutorily address prior authorization issues in Medicare, Medicare Advantage and Medicaid plans.

“The ACR welcomes the opportunity to be a part of this discussion as policymakers work to ensure these programs are implemented in a way that streamlines patient care and minimizes administrative burden on physicians,” Desir concluded.

The following is a press release issued by the ACR on December 14, 2023:

Full title: ACR Applauds Lawmakers for First-Time Dedicated Arthritis Research Funds in the National Defense Authorization Act

Today, the American College of Rheumatology (ACR) celebrates the first new medical research line item in the Congressionally Directed Medical Research Program (CDMRP) in eight years for arthritis research under the Department of Defense’s (DoD) C recently passed National Defense Authorization Act (NDAA) for fiscal year 2024.

“Investment in arthritis research will not only benefit those serving in our armed forces, but also the thousands of Americans, including many veterans, living with arthritis,” said Deborah Dyett Desir, MD, president of the American College of Rheumatology. “Efforts from this program will not only help curb the costs associated with managing and treating this disease but will also spur innovations and a better understanding of arthritis in the servicemember population.”

Arthritis research has been funded through the DoD’s Peer Reviewed Medical Research Program (PRMRP) at varying levels since 2009, but given the many priorities of the PRMRP, funding is not guaranteed. The ACR and Arthritis Foundation have advocated for this CDMRP line item to designate specific funding annually to arthritis research and advance research on arthritis risks, outcomes, and treatments among service members. The ACR thanks House appropriations leaders for recognizing the necessity and value of arthritis research in the DoD with this $10M annual line item for arthritis research.

“We know that one in three veterans are diagnosed with arthritis, and it is the second-leading cause of medical dismissals from the military.  This funding is critical to advancing arthritis research and I’m optimistic that we will see the impact and benefits of this investment for years to come,” Dr. Desir concluded.