Challenges to rheumatology practices won’t end with the COVID-19 pandemic

The ACR and the National Organization of Rheumatology Managers (NORM) collaborated to present the practice management session, Business of Rheum: Preparing the Practice of Rheumatology for the New Normal, on Monday, Nov. 8, during ACR Convergence 2021. The session can be viewed by registered meeting participants through March 11, 2022.

NORM President Nancy Ellis, BA, MBA, MHA, shared results from an October member survey on issues related to COVID-19. More than 90% of the practices represented in the 100-plus responses are encouraging staff to get vaccinated for COVID-19, with 37% indicating they would require employees to be vaccinated by the end of the year, said Ellis, a practice administrator at Piedmont Arthritis Clinic in Greenville, South Carolina.

Following a big uptick in the use of telehealth at the beginning of the pandemic, 70% of survey respondents continue to use telehealth to deliver care, while more than half (60%) of providers say they plan to continue to use telehealth once the pandemic is over.

The biggest practice-related pain point during the pandemic has been patients questioning a practice’s rules related to COVID-19, which was listed by 37% of survey respondents, Ellis said. Other pain points included non-vaccinated patients coming into the office and the additional stress on practices resulting from employees quarantining after exposure to the virus.

“Fortunately, 90% of the practices reported having access to the supplies they need to address the COVID pandemic,” Ellis said. “Overall, we see that practices are continuing to adapt well to this new normal with the unique challenges the pandemic has presented.”

In the coming year, changes to Medicare reimbursement may pose a different kind of challenge for rheumatology practices.

If the proposed CY 2022 Medicare Physician Fee Schedule goes into effect on January 1 as expected, it will have significant implications, said Ethel Owen, NORM Advocacy Chair and practice administrator at Arthritis & Rheumatology Associates of Palm Beach, Palm Beach Gardens, Florida. The statutory 0% update to the Medicare conversion factor required by the Medicare Access and CHIP Reauthorization Act (MACRA) will result in steep cuts to physician reimbursement, she said.

“We get a down-code adjustment of 0.14% due to budget neutrality across the relative value units,” Owen explained. “And we’ve also got the expiration of the temporary one-year payment update of 3.75% provided by Congress under the Consolidated Appropriations Act of 2021.”

Additional Congressional actions, including the end of a 2% sequestration and a 4% cut triggered by the American Rescue Plan, will reduce physician reimbursement rates further.

“This is something that is facing all practices out there,” Owen said.

Decision-making on the national stage creates particular challenges for the buy-and-build business model, said Jay Salliotte, MBA, Past President of NORM and a medical practice manager for Advanced Rheumatology in Lansing, Michigan. He expressed concern over proposed reimbursement reductions for injection codes used by rheumatologists in the Medicare Physician Fee Schedule.

“We’re looking at potentially losing 13% to 16% on those codes, which is a big hit,” he said. “That’s something that’s potentially going to be a big problem.”

Salliotte also discussed business considerations for three infusion service models — in-office infusion, in-office infusion managed by a third party, and home infusion. The risks associated with purchasing and storing infusion drugs, billing accuracy and compliance, and the potential for audits all need to be top of mind for providers offering in-office infusion services, he said.

“Overall, the biggest thing is you need to have a dedicated staff who will manage this entire process very tightly, because if they don’t, that’s when you run into problems,” Salliotte said.

Karen Ferguson, MS, NORM Payer Committee, founder of Our Stories Rx, and co-founder and CEO of Discus Analytics, shared a case study of a rheumatology practice that successfully implemented a shared-savings contract.

Transitioning from a fee-for-service to a value-based contract reduced waste and variability among providers, she said. The change also allowed physicians to reduce the administrative burden of prior authorizations and step therapy, incentivizing them to deliver the right medication for the right patient at the right time.

“The most exciting part of this whole contract was that it united the shareholders — being the payors — and our physicians together with a common aligned purpose,” said Ferguson, adding that the practice is now asking for risk-adjusted scores to “follow our patients better and move toward an alternative payment model that doesn’t seem quite as daunting.”