American College of Rheumatology Organizes a Unique Patient-Physician Call-In Day
Newswise — On November 10, people with arthritis and other rheumatic diseases will share one important message with Congress: “I need my rheumatologist!”
The American College of Rheumatology is partnering with nine national patient organizations to fight devastating cuts to Medicare—which will cause access-to-care problems for rheumatology patients and financial turmoil for rheumatology practices—by organizing an “I Need My Rheumatologist” Call-in Day.
“By failing to repeal the sustainable growth rate, Congress is demonstrating that health care for people on Medicare—primarily senior citizens, people on disability, and military families—is not a priority, and this is simply unacceptable to the rheumatology community,” says ACR President Stanley B. Cohen, MD, who is a practicing rheumatologist in Dallas. “Additionally, this issue doesn’t just apply to the rheumatology community; each-and-every Medicare patient will be affected, and all physician practices will be forced to look at their Medicare participation.”
There are nearly 50 million adults—and 300,000 children—in the United States suffering from arthritis and other rheumatic diseases. Many of these people must see a rheumatologist because they are the only specialists devoted to effectively diagnosing, managing and treating complex, chronic rheumatic diseases, such as rheumatoid arthritis and lupus. If inadequately treated, these diseases can cause unnecessary illness, disability and even death – making it vitally important for people with rheumatic diseases to have access to their rheumatologists.
“To our knowledge this is the first time patients and their specialists have partnered in an organized effort to address the SGR with Congress. Until now, this has largely been seen as a physician issue, but people with rheumatic diseases are rallying around it because of their need for access to specialty care,” says Sharad Lakhanpal, MD; chair of the ACR government affairs committee and practicing rheumatologist in Dallas.
“It is extremely important for me to have access to a rheumatologist, because of the insidious damage my auto-immune disease, ankylosing spondylitis, causes throughout my body,” explains Kyle Brownfield, who is a rheumatology patient in California and an ACR patient advocate. “As a specialist in musculoskeletal diseases, he knows better than anyone where specific bone and tissue damage is occurring. And, because of the chronic nature and length of my disease, my rheumatologist doesn't have a specific area to check like most doctors, but has to review all my bones, muscles, nerves and connective tissue.”
If Congress does not appropriately address the sustainable growth rate in its upcoming lame-duck session, the reimbursement rate for treating Medicare patients will decrease by nearly 30 percent on January 1.
The SGR is a fatally-flawed formula, and if Congress doesn’t buckle down and take care of this situation, the United States health care system will take a devastating hit – leaving Medicare patients medically-displaced.
“By calling our lawmakers on November 10, we will be telling them enough is enough. Rheumatologists want to provide quality care for their patients, and patients deserve access to their physicians. It is that simple. If you are on Medicare, have a loved one on Medicare, or plan to reach the age of 65—when you’ll automatically be placed on Medicare—this is an issue that affects you, and this is a call you should make,” says Dr. Lakhanpal.
A Flawed Formula That Prevents Access to Care
More than 43 million Americans are enrolled in the Medicare program, and Medicare uses the SGR formula to calculate physician reimbursement rates for more than 7,500 services provided to these patients.
The SGR is intended to control medical expenditures, but the basic premise of the formula is flawed. When you combine that flawed formula with rising health care costs, it creates a damaging health care environment where physicians must face the possibility of decreased reimbursement and are forced to consider whether they can afford to see Medicare patients.
“There are more than 100 rheumatic diseases, which require specialized ongoing care that may become unavailable to Medicare patients if the SGR is not fixed,” says ACR member and practicing rheumatologist in Fairfax, Va., Paul Rochmis, MD. “The flawed formula detracts from the quality of care, and many rheumatologists may have to see more patients in less time – something that I am not willing to do.”
“I am worried that more and more rheumatologist’s offices will close because they cannot afford to continue to accept Medicare patients and therefore cannot afford to stay in business,” says Tami Brown, a rheumatology patient in Indiana, who is also an ACR patient advocate. “This concerns me a great deal because there is already a shortage of rheumatologists in my area, and if more are forced out of business, or if they close their doors to Medicare/Medicaid patients, I will be forced either to travel great distances to find another rheumatologist (which is difficult enough for someone with RA who isn’t even able to drive anymore and therefore no longer owns a car) or to simply have my internist provide my rheumatological care, which would be rudimentary, at best. I find having to make this choice completely unacceptable – no one should be faced with this kind of choice. We all deserve to receive the best and most appropriate care for our conditions.”
A Flawed Formula That Hurts Small Businesses
Rheumatology practices, for the most part, are small businesses, and this upcoming cut would not only be devastating to Medicare patients, but also to these small businesses and the communities and people who depend on them.
“The main issue is keeping our doors open to the people on Medicare who need our services, but I also have concerns for my employees. If Medicare cuts continue, we’ll have to take a good look at downsizing – perhaps letting go of 20 to 25 percent of our staff. Small businesses go bankrupt and close their doors every day in this country. It costs money to keep our doors open, and we want to keep our doors open; we want to continue helping our patients,” says Max Hamburger, MD, an ACR member and practicing rheumatologist in Dix Hills, N.Y.
This year, Congress prevented the Medicare reimbursement cut three times – each time, withholding payments from physician practices. In June, payments were held for more than three weeks, and many medical practices across the nation were forced to take drastic measures (such as taking out loans) just to be able to afford to treat their Medicare patients.
"When payments are withheld, our rheumatology practices enter a period of uncertainty. We're doing what we can to keep seeing Medicare patients, but I am not sure we can continue if Medicare reimbursement is cut,” says Malin Prupas, MD, an ACR member and clinical rheumatologist in Reno, Nev. “When I decided to go into medicine, and especially rheumatology, I never imagined I would struggle with Congress to keep my doors open to see the patients that need me most. I will do what it takes to resolve this issue once and for all – because my patients and office employees depend on me. Rheumatologists must maintain reimbursement from Medicare just to sustain out practice and keep doing what we do best, treating patients with arthritis."
A Call To Fix a Flawed Formula
Medicare is an issue that does, or eventually will, impact every American. Taking action today will not only ensure access to care for current Medicare beneficiaries, but will ensure access to care for future beneficiaries.
The American College of Rheumatology asks all rheumatologists, rheumatology health care professionals, rheumatology patients and their loved ones to join the “I Need My Rheumatologist!” Call-in Day efforts on November 10 and encourage lawmakers to ensure access to care for patients and fair reimbursements for the physicians who treat them.
“Congress has proven to be receptive to their constituents,” says ACR Government Affairs Director, Aiken Hackett. “The call-in day is a grassroots initiative, and we are asking all rheumatologists, rheumatology health professionals, and their patients to demand a permanent fix of the SGR by calling their U.S. representative and senators.”
To quickly and easily reach out to lawmakers, dial the AMA Grassroots Hotline at (800) 833-6354. Be sure to begin the conversation with, “I need my rheumatologist (or, “my loved one needs his/her rheumatologist”).” Please fix the SGR before November 30 to ensure access to my doctor.” For more information about the SGR and its impact on rheumatology, visit www.rheumatology.org or call (404) 633-3777.
The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. For more information, visit www.rheumatology.org.
Editor’s Note: Participating organizations include The American College of Rheumatology, Arthritis Foundation, Lupus Foundation of America, National Psoriasis Foundation, Polyarteritis Nodosa Support Network, Scleroderma Foundation, Sjögren’s Syndrome Foundation, S.L.E. Lupus Foundation, Spondylitis Association of America and the Vasculitis Foundation.
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