ACR Cheers Funding for Rheumatology Research, Workforce Relief Inclusion

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.”

ACR Commends Congress for Mitigating Medicare Cuts, Calls for Ongoing Healthcare Reforms

The following is a press release issued by the ACR on March 11, 2024:

The American College of Rheumatology (ACR) applauds Congress for passing legislation to mitigate the 3.4 percent reduction in physician payments outlined in the Medicare Physician Fee Schedule (MPFS) Final Rule for CY2024 but also calls on policymakers to seek long-term systemic policy changes that will provide more stability and predictability for providers.

“While we commend Congress for this partial fix, rheumatologists remain concerned that without long-term reform to the Medicare payment system, maintaining access to quality care for individuals managing rheumatic diseases and other chronic conditions will be in jeopardy,” remarked Deborah Dyett Desir, MD, President of the American College of Rheumatology. “The annual recurrence of MPFS cuts underscores the urgent need for comprehensive healthcare reforms. The American College of Rheumatology urges Congress to prioritize sustainable solutions, ensuring patient access to essential services and fair reimbursement for healthcare providers.”

The payment cut reduction, from 3.4 percent to 1.68 percent, was included in recently passed broader funding legislation. This reduction comes on top of cumulative cuts that, when adjusted for inflation, amount to an overall decline in Medicare physician payment of 30 percent since 2001, according to the American Medical Association.

As the nation’s leading medical specialty society representing rheumatologists, the ACR remains committed to advocating for policies that prioritize patient well-being and support the needs of rheumatology practices across the country.

The LGBTQ+ Community & Rheumatology

One of the things I’ve shared a decent amount in talks or research work I’ve done is the need for the medical community to learn about the LGBTQ+ community. I know great providers who openly support the community or are a part of it themselves. I also know providers who know nothing about the community.

Why is this a problem? Because they’re missing opportunities to understand & work with our lives and to make connections that we know will positively impact patient engagement.

I won’t lie — it’s been frustrating to see rheumatologists and the field in general not wade into speaking against anti-trans and anti-queer laws. It’s likely due to not knowing enough or not being tuned into what’s going on… but that fuels my question about how providers are then supporting their patients through this — or, at the very least, understanding that the increased stress level can and will lead to flares, etc.

That’s why I was so excited to see a new editorial piece published in The Journal of Rheumatology today by Jeffrey B. Driban, Bill M. Jesdale and Timothy E. McAlindon. Embracing Diversity: The Imperative to Represent the LGBTQIA+ Community in Rheumatology Research delves into this issue. From discussing outdated clinical forms to needing to recognize and embrace the community, the authors highlight some incredibly important points.

Please go check out the full article at the link below.

Citation: Driban JB, Jesdale BM, McAlindon TE. Embracing Diversity: The Imperative to Represent the LGBTQIA+ Community in Rheumatology Research. The Journal of Rheumatology. Published online November 1, 2023:jrheum.2023-0830. https://doi.org/10.3899/jrheum.2023-0830

ACGME and Docs with Disabilities Initiative Partner for Disability Hub

The following are excerpts from a press release issued by the Accreditation Council for Graduate Medical Education on January 23, 2024:

The ACGME, in partnership with the Docs with Disabilities Initiative (DWDI), is a recipient of the Josiah Macy Jr. Foundation Catalyst Award for Transformation in Graduate Medical Education for their project, Multimedia Resource Hub for Disability Inclusion in Graduate Medical Education. The aim of the project is to support education and enhance disability inclusion, learner safety, and accessibility in the clinical learning environment for residents and fellows.

The Multimedia Resource Hub for Disability Inclusion in Graduate Medical Education will be added to the content portfolio available on the ACGME’s distance learning portal, Learn at ACGME. The ACGME Equity Matters® program supports the development of innovative resources that increase workforce diversity, encourage adoption of equity practices, and foster inclusive learning environments.

Calls for community involvement and inclusion in the hub will be forthcoming.

Read the full press release here.

ACR Applauds Prior Authorization Rule

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.

ACR JIA Resources Walkthrough on Facebook Live Feb 8 @ 8 pm

As many of you know, I recently had the honor of working with the American College of Rheumatology and pediatric rheumatologists. Our team developed a series of parent and family-focused handouts covering a range of topics, from practical tips for managing daily activities to emotional support strategies and more. You can view those handouts here.

On Thursday, February 8, at 8 pm Eastern Time, I’ll be hosting a Facebook Live walkthrough of these resources. If you’d like to join, please RSVP on the Facebook Event page or visit the Not Standing Still’s Disease Facebook Page as the event starts.

Still’s Disease Onset After mRNA COVID-19 Vaccine

An 82-year-old woman was diagnosed with still’s disease following an mRNA COVID-19 vaccination. Onset after age 80 is really uncommon, making this an interesting study.

Now, it’s important to remember that these kinds of reactions are incredibly rare. Less than 30 patients have had this happen. Please still get your COVID-19 vaccines if you’re medically able to do so.

Check out the full case study:

Nishioka H, Shirota S (January 02, 2024) Adult-Onset Still’s Disease After an mRNA COVID-19 Vaccine in an Older Woman. Cureus 16(1): e51540. doi:10.7759/cureus.51540

JAK Inhibitors & ILD in Pediatric Rheumatology Patients

Interstitial Lung Disease (ILD) is a known complication of many rheumatic diseases. It can be hard to treat and get into remission.

One study published on December 21, 2023, digs deep into one possible treatment. Janus kinase inhibitors (JAKis) include drugs such as Tofacitinib, Baricitinib, Peficitinib, Upadacitinib, and Filgotinib.

After exploring JAKis, the study calls for more research.

Read the full article below.

Sapountzi E, Fotis L, Kotanidou E, et al. (December 21, 2023) Janus Kinase Inhibitors and Interstitial Lung Disease Associated With Pediatric Rheumatic Diseases: An Unexplored Field. Cureus 15(12): e50928. doi:10.7759/cureus.50928

New MAS Warning Sign Discovered

A journal article published on December 20, 2023, shows the discovery of a new MAS warning sign.

Intermediate monocytes produce TNF and IL-1B. Medications, such as TNF-inhibitors and IL-1B inhibitors, help suppress the ongoing inflammatory responses these IMs bring.

IMs are also known to increase inflammation within the cardiovascular system. This may be a part of why many rheumatic patients also have cardiovascular disease.

For people with adult-onset Still’s (AOSD) specifically, there was an uptick in the measured IMs leading up to and during MAS events. This could help explain why the IL-1B inhibitor Anakinra is a go-to treatment for MAS.

The study even went on to point out that this could become a biomarker, allowing us to catch MAS events earlier. This would hopefully lead to better outcomes, too.

Read the full article below.

Jia, J., Wang, M., Ma, Y. et al. Neutrophil extracellular trap-induced intermediate monocytes trigger macrophage activation syndrome in adult-onset Still’s disease. BMC Med 21, 507 (2023). https://doi.org/10.1186/s12916-023-03231-9