The U.S. Department of Health and Human Services recently proposed a Medicare policy update for the 2018 calendar year, which it says is part of a broader strategy to ease regulatory burdens, improve patient-doctor relationships, and increase transparency.

“Doctors want to spend less time on burdensome regulations from Washington, D.C., and more time with their patients,” says Seema Verma, administrator of the department’s Centers for Medicare and Medicaid Services (CMS), in a news release. CMS is anxious to hear feedback ahead of issuing the final rule later in 2017, the release adds.

In a statement, Sharad Lakhanpal, president of the American College of Rheumatology, applauded several aspects of the proposed rule and said there are other areas where ACR hopes to see more changes.

Some of the concerns could impact patient access and care, the college’s government affairs team tells CreakyJoints. “We will be commenting after our thorough review of the proposed rule is completed,” says Jocelyn Givens, the college’s public relations director.

[See a fact sheet on the CMS website about the proposed changes.]

One particular area that college will highlight is the way the proposed rule addresses biosimilars. “The ACR welcomes the introduction of biosimilars to the U.S. healthcare system and is hopeful that the decrease in cost resulting from the availability of safe and effective biosimilars will help more patients to access and afford life-changing therapies,” Givens says.

The Physician Fee Schedule Proposed Rule has been drawing mixed reviews from other groups. The American Medical Association is “encouraged by many of the proposed changes and applauds the administration for working with the AMA to address physician concerns,” said association president David Barbe. The American Academy of Family Physicians said in a statement that the proposed rule “failed yet again to achieve the required, minimum net expenditure reduction through identifying misvalued codes.”

The American College of Rheumatology also had some concerns:

  1. Quality feedback reports. The process of receiving performance feedback in real-time requires simplification and streamlining, the ACR says, noting that many physicians find the current process slow and too complicated. “Specifically, the rheumatology community proposes that quality and resource use reports (QRURs) be issued on a quarterly basis in a user-friendly format,” the ACR says. “We also recommend lengthening the appeal period to 90 days.”
  2. Decreases in injection reimbursements. The ACR is “troubled” by these cuts, per the announcement. “Additional reimbursement cuts could reduce Medicare patients’ access to vital injection services, especially in already underserved areas,” it states.
  3. New billing codes. The college has long recommended new evaluation and management billing codes “that accurately reflect the scope and complexity of services provided by cognitive specialists, including rheumatologists.” Existing codes don’t reflect “the breadth of services required by many Medicare beneficiaries, especially those with multiple chronic conditions who require extensive evaluations and treatment regimens.”

“We look forward to a constructive dialogue with CMS to ensure better care and lower costs for the millions of Medicare beneficiaries living with rheumatic diseases,” the ACR said.

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