The following is a press release from the ACR dated August 30, 2023.

The American College of Rheumatology (ACR) has developed a new whitepaper and position statement that outlines the Clinical and Economic Value of Rheumatology in various hospital and practice settings. The documents emphasize the benefit to the quality of patient care when a rheumatologist is a part of the care team and the positive financial impact rheumatologists have on healthcare systems and the economy.

“Many rheumatologists can attest to the value they bring to the care team at a healthcare system,” said Christina Downey, MD, corresponding author of the white paper and chair of the ACR’s government affairs committee. “Our goal with the paper and position statement is to emphasize what that value looks like from a preventive and financial perspective. A rheumatologist on the care team benefits patients, practices, and the economy.”

The paper, an analysis based on adjusted insurance claims data, focuses on two aspects of economic value: preventive value and direct value. The study compared markets with high and low rheumatologist supply and found that markets with an increased supply of rheumatologists had lower costs per patient. Ultimately, having an appropriate supply of rheumatologists is crucial for optimizing patient outcomes and increasing the economic benefits within healthcare systems.

Highlights from the white paper, and emphasized in the position statement, include:

• Markets with a high supply of rheumatologists had lower average costs per patient for emergency room visits and hospitalizations than those with a low supply.
• Rheumatologists generate $3.5M annually in revenue for healthcare systems by calculating direct and downstream billings associated with a full-time equivalent (FTE) rheumatologist. The calculation includes office visits, lab testing, radiology services, therapy referrals, consultations, etc.
• The preventive value of rheumatology care was estimated to be $2,762 per patient per year, representing the cost savings associated with a high supply of rheumatologists.
• The need for expensive and invasive joint replacement surgery due to rheumatoid arthritis has fallen substantially in recent years because of medications that only rheumatologists have the experience and expertise to administer.
• Appropriate medical therapy with disease-modifying anti-rheumatic drugs (DMARDs) or biologics provided by rheumatologists can significantly decrease disease activity, modify comorbidities, and improve the quality of life for patients with rheumatoid arthritis (RA).
• Systemic lupus erythematosus (SLE) is among the leading causes of death of young women in the United States. They have higher disease activity, morbidity, and mortality, which often leads to one of the highest 30-day hospital readmission rates among chronic diseases in the nation. Access to a rheumatology clinic post-discharge reduces rates of readmission in this group.
• Rheumatologists have developed electronic registries, such as the Rheumatology Informatics System for Effectiveness (RISE), to nationally track and improve the quality of care administered by rheumatologists. This registry provides timely feedback on the performance of 24 quality metrics like functional status and receipt of DMARD prescriptions for RA patients.

“Emphasizing the impact rheumatologists have on the entire medical community is more important than ever, especially as we contend with an impending rheumatology workforce shortage coupled with an expected increase in patient demand for rheumatologic care” Downey said. “This paper supports our recruitment and sustainability efforts for the specialty by spotlighting the significant contributions we make every day and every year to patient outcomes, hospitals, and other healthcare practices.”

An ACR task force, commissioned by the ACR board of directors, worked with ECG Management Consultants to analyze the value of care given by rheumatologists. ECG has worked with other specialties, such as primary care, to help quantify their economic value.

View the full Clinical and Economic Value of Rheumatology: An Analysis of Market Supply and Utilization in the United States whitepaper and position statement at https://rheumatology.org/policy-position-statements.

The following is a press release issued by the ACR on August 22, 2023:

The American College of Rheumatology (ACR) released summaries of two new guidelines for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Disease and for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases (SARDs). The guideline summaries provide recommendations for screening, monitoring, and treating patients with rheumatic conditions like rheumatoid arthritis, systemic sclerosis (SSc), and idiopathic inflammatory myopathies (IIM) who may be at risk of interstitial lung disease (ILD) development or progression.

“Interstitial lung disease is a major cause of morbidity and mortality across several systemic autoimmune rheumatic diseases,” said Sindhu R. Johnson, MD, Ph.D., lead author on the guidelines and director of the University of Toronto’s clinical epidemiology & healthcare research program. “Guidance was needed for which tests to use for screening and monitoring this particular disease.”

A few recommendations from the guidelines include:

• A conditional recommendation to screen patients at high risk of ILD with HRCT chest, PFTs, or both
• A conditional recommendation to monitor ILD progression with PFTs and/or HRCT chest, albeit with different frequency.
• A conditional recommendation to monitor with ambulatory desaturation testing.
• A conditional recommendation against screening and monitoring with a 6-minute walk test distance (6MWD), chest radiography, and bronchoscopy.
• For people with SARD-ILD other than SSc-ILD, we conditionally recommend glucocorticoids as a short-term, first-line ILD treatment.
• A strong recommendation against glucocorticoids as a first-line ILD treatment for people with systemic sclerosis-associated ILD.
• A conditional recommendation for use of mycophenolate, rituximab, cyclophosphamide, and azathioprine as first-line ILD treatment options.
• A conditional recommendation against using leflunomide, methotrexate, TNF inhibitors, and abatacept as first-line ILD treatment options.
• For people with SARD-ILD progression despite first ILD treatment, it is conditionally recommended to use mycophenolate, rituximab, cyclophosphamide, and nintedanib as treatment options.
• For people with Sjogren’s-ILD and IIM-ILD progression despite first ILD treatment, a conditional recommendation against using tocilizumab as a treatment option.

“In those with systemic sclerosis-ILD, we strongly recommend against using glucocorticoids as a first-line ILD therapy or after ILD progression because glucocorticoids confer an increased risk of scleroderma renal crisis,” said Johnson. “Given the moderate certainty of the evidence for harm and low certainty of the evidence for benefit, we voted strongly against using this treatment for patients with systemic sclerosis-ILD.”

These new recommendations will provide guidance for clinicians on the screening, monitoring, and use of a wide range of treatments for patients with rheumatic diseases. The ACR developed these with the best available evidence and consensus across a range of expert opinions and incorporated patient values and preferences. These guidelines may reduce regional variation in patient care and may be used for patient advocacy.

“We know that early detection and hastened referral to care, in collaboration with pulmonology, is critical for the best patient outcomes,” said Sonye K. Danoff, MD, Ph.D., guideline author, pulmonologist and director of the Interstitial Lung Disease/ Pulmonary Fibrosis program at Johns Hopkins University School of Medicine. “Because symptoms of ILD (cough, shortness of breath, fatigue) can be subtle or result from other common diseases, the diagnosis of ILD can be delayed. Increasing awareness of the groups at highest risk for developing ILD and implementing appropriate screening and treatment practices should have long-term benefits.”

Full manuscripts have been submitted for journal peer review. Both are anticipated to be published in rheumatology journals by early 2024. View the complete summaries of the guideline recommendations at https://rheumatology.org/interstitial-lung-disease-guideline.

The following is a press release from ACR dated June 15, 2023:

The American College of Rheumatology (ACR) today expressed disappointment that the Medicare Payment Advisory Commission (MedPAC) has recommended yet another cut to physician reimbursement for infusing life-altering treatments as part of its June 2023 Report to the Congress: Medicare and the Health Care Delivery System.

In a letter to MedPAC, ACR took issue with the organization’s recommendation to Congress to keep a six percent add-on payment for the lowest-cost drugs, reduce the add-on payment for mid-to-high-level drugs, and add a payment cap for the costliest drugs.

“While we support efforts to rein in the cost of prescription drugs, we firmly believe that this policy would jeopardize provider practices and patients’ health by reducing access to life-changing provider-administered therapies,” said Douglas White, MD, PhD, president of the ACR. “We urge Congress to address the high cost of drugs at the root cause, like the opaque pharmacy benefit manager business practices, and not at the expense of providers.”

In its recommendation, MedPAC asserted that providers prescribe and administer the highest-price medications in order to receive higher reimbursement. ACR firmly rejects this premise. Administering Medicare Part B drugs in provider offices requires rheumatologists to buy the drug in bulk, maintain full-time staff to administer the treatment, and only bill Medicare after it has been given to the patient.

The six percent of the average sales price (ASP) add-on does not incentivize high-cost treatments, but rather offsets the costs of acquiring, storing, and administering treatments. As written, MedPAC’s recommendation would force providers to cut back on offering cutting-edge therapies or offer these medications at a loss, severely limiting patients’ access to medication and threatening practice viability.

“As providers, it is our job to prescribe the most appropriate treatment for our patients. The add-on payments are not considered in our clinical decision-making. We are concerned that policymakers are concentrating on these add-on payments rather than focusing on policies that address the true cause of drug prices,” said Christina Downey, MD, chair of ACR’s Government Affairs Committee. “The ACR will always express concern when provider payments to administer drugs are eschewed by widely supported policies. Hopefully, the bipartisan movement to reform the PBMs industry will yield meaningful change, and patients will see the benefits.”