ACR Announces 2021 Health Policy Priorities
January 25, 2021 | Advocacy
Rheumatology community urges Congress and the Biden Administration to prioritize policies that expand access to care for individuals living with rheumatic disease
ATLANTA – The American College of Rheumatology today announced its 2021 health policy priorities, a set of detailed policy recommendations that the new Congress and incoming Administration should prioritize to improve access to care for the 54 million Americans living with a rheumatic disease.
"These updated policy priorities will guide the ACR’s legislative and regulatory advocacy efforts in 2021 and ensure that we are best prepared to represent our members and the patients under their care,” said Blair Solow, MD, Chair of the ACR’s Government Affairs Committee. “We look forward to working collaboratively with the new Congress and Administration to advance policies that preserve and expand access high-quality care for the millions of Americans living with a rheumatic disease.”
The ACR’s health policy priorities for 2021 include:
- Strengthening the rheumatology workforce. Despite growing demand for rheumatic disease care, the number of practicing rheumatologists in the U.S. continues to shrink due to the rate of retirement within the specialty and an unchanging number of new specialists entering the field. According to the most recent estimates, the U.S. will need nearly 5,000 more rheumatologists by 2030 to meet growing demand. The shortage of pediatric rheumatologists is particularly acute. By 2030, demand for pediatric rheumatologists is projected to be twice the current supply.
- In 2021, the ACR urges policymakers to increase funding for Graduate Medical Education (GME), increase the number of GME residency slots, expand fellowship training positions for adult and pediatric rheumatologists, and establish new state-based student loan forgiveness programs that would encourage more rheumatologists to practice in underserved areas. Further, policymakers should build on progress made last year by fully funding the Pediatric Subspecialty Loan Repayment Programs (PSLRP) which was authorized by the CARES Act, and by re-introducing the Resident Physician Shortage Reduction Act (H.R. 1763, 116th Congress) during the 117th Congress.
- Expanding patient access to telemedicine. As a consequence of the COVID-19 pandemic, healthcare providers around the country have rapidly adopted telemedicine into routine practice. The ACR believes that increased use of telemedicine can improve patient access to care both during and after the public health emergency, however it must not be used as a substitute for essential face-to-face assessments conducted at medically appropriate intervals. Last year, the Centers for Medicare and Medicaid Services (CMS) along with commercial insurers expanded the number of services that could be covered by telehealth and increased reimbursement for telehealth services to match in-person visits for audio-visual and, later, audio-only visits. In 2021, the ACR urges policymakers to extend many of these flexibilities, including reimbursement parity for in-office, audio-visual visits after the public health emergency has ended with appropriate guidelines meant to ensure quality, protect patient privacy, and encourage provider choice.
- Reducing the burden of prior authorization on patients and providers. Rheumatologists have long advocated for easing prior authorization requirements that cause harm to patients in the form of care delays and treatment abandonment. Last March, the ACR released a detailed policy statement outlining a framework for policymakers to modernize and simplify the prior authorization process. In 2021, the ACR will continue to support legislation such as the Improving Seniors' Timely Access to Care Act (H.R. 3107, 116th Congress) meant to reduce the burden of prior authorization on patients and providers. The ACR will also advocate for a uniform electronic prior authorization process that is compatible with electronic health records.
- Ensuring appropriate reimbursement for rheumatology evaluation and management (E/M) services. In December 2020, CMS finalized long-awaited updates to Medicare reimbursement for evaluation and management (E/M) services provided by cognitive specialists, including rheumatologists. These changes were the product of several years-long effort that included the American Medical Association (AMA) and over 170 specialty societies and state medical associations. The year-end Omnibus spending legislation enacted by Congress preserved these increases and also increased Medicare Fee Schedule payments for all specialties by 3.75%. In 2021, the ACR will advocate for the continuation of these E/M reimbursement changes and will continue to engage with the AMA’s CPT Editorial Panel to create new codes that accurately reflect the time and expertise of cognitive specialists who primarily provide E/M services.
- Increasing federal funding for rheumatic disease research. Rheumatic diseases, including multiple forms of arthritis, are among the leading causes of disability in the United States and are estimated to cost more than $304 billion annually. Arthritis is also the leading cause of disability among military veterans and is the second leading cause of medical discharge from the U.S. Army. In 2021, the ACR will urge Congress to increase funding for federal institutions engaged in vital research to combat arthritis and related rheumatic diseases. In addition, the ACR urges Congress to dedicate $20 million in existing funds to create a standalone arthritis research program at the Department of Defense to study the prevalence and impact of arthritis in the military and among veteran communities.
- Lowering prescription drug costs. The ACR believes that safe and effective treatments should be accessible to all patients at the lowest possible cost and that policies intended to reduce prescription drug costs should support optimal patient outcomes and continued shared decision-making between patients and providers. Some recent efforts to lower drug prices – such as the Most Favored Nation Model (MFN) Interim Final Rule – would severely threaten the viability of many rheumatology practices to offer treatment to their patients and would jeopardize patients’ access to treatments while doing little address the root causes of rising drug prices. Further, insurer attempts to control costs through utilization management practices such as step therapy, prior authorization and specialty tiering make treatments inaccessible and unaffordable for many patients. In 2021, the ACR will continue to advocate for policies that reduce patients’ prescription drug costs while preserving access to care. This includes supporting regulatory and legislative efforts to:
- Allow Medicare to negotiate with pharmaceutical companies to achieve more affordable drug prices.
- Limit or cap out-of-pocket prescription drug costs for Medicare and commercially insured patients.
- Reduce utilization management tools used in the drug distribution system, including in Medicare Part D, which delay and prevent patients from accessing medicines.
- Oppose restrictive insurance policies that prevent copayment programs from supporting patient copayments and deductibles (so-called copay accumulator programs).
- Streamline the development and approval of safe, effective biosimilars and generic drugs.
View a full listing of the ACR's highest 2021 health policy priorities.
About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves nearly 8,500 physicians, health professionals, and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.