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 

ACR Applauds Dedicated Arthritis Research Funds in the NDAA

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.