Healthcare Reform for Rheumatologists, Take-a-Way Lessons

Healthcare reform will affect private practice rheumatologists in unique ways in 2016. In this interview, Herbert S. B. Baraf, MD, FACP, MACR, provides his take-a-ways from ACR/ARHP 2015 about new policies private practice rheumatologists need to be aware of.

Dr. Baraf is the senior member and managing partner of Arthritis and Rheumatism Associates, the country’s largest private practice rheumatology group. He is a Clinical Professor of Medicine at The George Washington University School of Medicine and a Clinical Associate Professor of Medicine at the University of Maryland School of Medicine. He is also a member of the Rheumatology Network editorial board.

Video transcript:

“There is a lot going on this year with changes in Medicare laws. There are a whole new set of realities that we will be facing over the next year that will influence how and where we practice and whether or not we can stay viable as practitioners in an environment that increasingly seems to be less aware of rheumatology and more aware of the primary care and hospitals that control our system.

“One of the major takeaways this year is that this is the first year in which if you don’t do PQRS, you’ll be injured in three different categories of reimbursement by Medicare, the Meaningful Use program, PQRS itself and the value-based payment modifier (VBPM), the last of which is highly dependent on PQRS. The failure to file PQRS in 2015 will result in cuts in reimbursement by 2017 in all three programs.

“The other piece of news is that as we get our arms around MACRA, the SGR repeal law, we’re beginning to understand that it is a mechanism that will be pushing physicians by 2019 toward alternative payment models like patient centered medical homes (PCMH), bundled payment models and ACOs, none of which work particularly well for rheumatologists. And so, the ACR and its government affairs and RheumPAC committees are very concerned about how this is going to look for us and we are just starting to grapple with these issues. There were a number of talks that dealt with advocacy with the need to get involved with the political process and to shape the law as the regulations take form over the next 24 months. To me, those are the interesting points for rheumatology and its survival as a viable specialty, particularly in a private practice service oriented setting.”