Legislative and Regulatory Updates


San Diego, CA—At the 2017 American College of Rheumatology (ACR) Annual Meeting, Angus Worthing, MD, Arthritis and Rheumatism Associates, Washington, DC, and Chair, ACR Government Affairs Committee, provided a legislative and regulatory update. Discussion topics included ACR contributions on policy development and change, as well as regulatory initiatives currently before Congress and how they may impact rheumatology practices in the future.

Dr Worthing noted that “there is a workforce shortage of rheumatologists in the United States, and there is a maldistribution of rheumatologists into major cities,” with the demand for adult arthritis care expected to exceed the supply of rheumatologists by 138% in 2030. To bridge this gap at the federal level, 3 active bills are being supported by the ACR—the Conrad State 30 and Physician Access Reauthorization Act (H.R.214/5, S. 898), which allows streamlining visas for foreign physicians to practice in underserved areas; the Resident Physician Shortage Reduction Act of 2017 (H.R. 2267), which will create additional residency positions; and the Ensuring Children’s Access to Specialty Care Act of 2017 (H.R. 3767/S. 989), which makes pediatric rheumatologists eligible for the National Health Service Corps loan repayment program when they serve in underserved areas.

Regarding efforts to repeal the Affordable Care Act, Dr Worthing noted that “all 4 bills in the Senate and the House, when analyzed by the ACR advocacy team, did not go far enough in providing access to care and treatment,” which was communicated to Congress. In early 2017, the ACR Board of Directors established a list of principles that constituted appropriate healthcare reform in the United States, which would have to be met to receive the support of the ACR. Some of these principles have bipartisan support, such as allowing children to stay on their parent’s insurance until age 26. There is also a great deal of support for prohibition of exclusions based on preexisting conditions.

“Most of the problems we saw in fine print of the Repeal and Replace Bill is that it took away, or put at risk, some of the essential health benefits,” Dr Worthing stated.

Another ACR success story came through coalition efforts by the Alliance for Transparent and Affordable Prescriptions and other groups to improve transparency related to pharmacy benefits manager processes, drug pricing, and access to treatment. As a result of these efforts, the US Senate Health Committee has conducted hearings highlighting the role of pharmacy benefits managers in drug pricing. In this context, Dr Worthing discussed the emerging role of biosimilars in the marketplace, noting that there is a high level of frustration with rising drug prices, especially related to these agents.

“There is a promise with biosimilars that the drug price can come down and access can go up, and more patients can get these important drugs,” he stated.

Dr Worthing indicated that the ACR supports strong interchangeability pathways, which would allow pharmacists to substitute the bio-originator drug with an interchangeable biosimilar. In addition, the ACR supports increased funding for the US Food and Drug Administration’s biosimilar review and assigning unique billing for each product rather than grouping biosimilars for reimbursement.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has several reimbursement ramifications that will affect practicing rheumatologists in the coming years. The 2 payment pathways in MACRA are the Merit-Based Incentive Payment System (MIPS) and the alternative payment model (APM). The Centers for Medicare & Medicaid Services deemed 2017 a transition year, allowing practices to participate in the “Pick your Pace” program and select from 1 of 3 options to submit measures within the MIPS track to avoid negative payment adjustments in 2019. Dr Worthing noted that one concern with MACRA is the fact that Part B drug payments will be adjusted in the MIPS system.

“The MIPS system allows the government to reduce payments 4% the first year, 5% the next, 7%, and then 9%. You could end up buying a drug for 4% and then have 9% taken away; it is a large sum of money. This will be the next advocacy push,” he said.

Other ACR goals relating to MACRA include the Rheumatology Informatics System for Effectiveness Registry participation to allow full credit in the Advancing Care Information system of MIPS, designing a rheumatology-specific APM, lowering thresholds to qualify for APM track with less cost attribution, and developing rheumatology quality measures.

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