Rheumatology providers and patient advocates urge lawmakers to address healthcare challenges

Reviewed by Emily Henderson, B.Sc.Sep 14 2020

The American College of Rheumatology (ACR) will hold its first virtual Advocates for Arthritis event on Tuesday, Sept. 15, where more than 120 rheumatologists, rheumatology health professionals, and patient advocates will meet with lawmakers via video to discuss the healthcare challenges they are facing in the midst of COVID-19. During the event, advocates will urge lawmakers to adopt legislation that ensures continued delivery of accessible, safe and affordable care throughout this public health emergency and beyond.

The pandemic has altered almost every aspect of our rheumatology practices. It has impacted our patients' lives significantly and required us to create new ways of delivering care through improved telehealth and other adaptations."

Ellen Gravallese, MD, ACR President

Rheumatology providers face significant resource challenges as a result of the current climate. As providers work to balance patient safety and continued access to care, many have been forced to retool their operations, move a significant portion of visits to telehealth, source their own personal protective equipment (PPE), and help patients navigate drug supply challenges - while in many cases operating with less staff due to social distancing protocols, furloughs and layoffs.

Meanwhile, patients are concerned about their ability to access rheumatic care while avoiding exposure to the SARS-CoV-2 virus. A recent national patient survey conducted by the ACR found a 52 percent decline since 2019 among patients who say they are currently being treated by a rheumatology provider. Further, 66 percent of respondents reported using telehealth for rheumatology visits, with COVID-19 cited as the most common reason. While telehealth has been a welcome option for providers and patients alike, some visits - such as those involving biologic therapy infusions - must be conducted in-person via an office visit. Additionally, the rheumatology workforce shortage has made it increasingly difficult for patients in rural areas to find a practicing rheumatologist.

According to the latest federal estimates, 54 million Americans have a doctor-diagnosed rheumatic disease. A recent academic study suggests that number that could be as high as 91 million when taking into account symptoms reported by undiagnosed individuals. Even though as many as one-quarter to one-third of U.S. adults may be living with a rheumatic disease, there is an average of only one practicing rheumatologist for every 40,000 people, while it is estimated that the U.S. will need thousands more adult rheumatologists by 2030 to meet the challenges caused by a rapidly aging population and a fast-retiring workforce.

To address these challenges and ensure the continued delivery of high-quality care, rheumatology providers and patients are encouraging Congressional leaders to adopt the following legislative solutions:

• Health Care at Home Act (H.R. 6644/S. 3741) - This legislation would require all employer-sponsored ERISA-regulated health insurance plans to provide reimbursement for telehealth visits (including audio-only visits) at the same rate as in-office visits for the duration of the COVID-19 Public Health Emergency.
• The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (H.R. 4932/S. 2741) - This legislation would expand telehealth services through Medicare and make it easier for patients to connect with their providers.
• The Resident Physician Shortage Reduction Act (H.R. 1763/S. 348) would better prepare the nation for its next health care crisis by increasing the number of residency positions eligible for Medicare support by 15,000 slots over five years. Further, the legislation requires that at least 50% of the additional 3,000 slots added each fiscal year be directed to a "shortage specialty" residency program as identified by the Health Resources and Services Administration (HRSA), like rheumatology.
• Funding for the Pediatric Subspecialty Loan Repayment Program (PSLRP). This program supports loan repayment and pediatric provider training experiences for primary care and dentistry providers who serve rural and underserved areas or community-based settings. Reauthorization of this program was included in the CARES Act but has not been funded.
• The Healthcare Workforce Resilience Act (H.R. 6788/S. 3599) reallocates to healthcare workers visas that were previously authorized by Congress and have not been used. Of these, 15,000 visas would be reallocated for international medical graduates and 25,000 visas for international nurses to ensure durable immigration status for our vital workforce.

Noting the precarious financial state of cognitive care specialists who treat complex conditions, rheumatology leaders are also urging lawmakers to support the Centers for Medicare & Medicaid Services' important updates to the Physician Fee Schedule slated to take effect in January 2021. Established in concert with the American Medical Association, these updated reimbursements for complex office visits - also known as "Evaluation and Management" (E/M) visits - are critical to ensuring specialties on the front lines of treating chronic illness can continue serving patients in need.

"While the rheumatology community has adapted to meet these challenges head-on, there is serious concern about the long-term sustainability of this new practice landscape without additional, targeted federal interventions and funding support from lawmakers," said Gravallese.