CSRO Leaders Represents Rheumatology at Alliance of Specialty Medicine Fly-In | | |
CSRO President Aaron Broadwell, MD, FACR, and Vice President of Advocacy and Government Affairs Madelaine Feldman, MD, FACR, represented CSRO this week at the Alliance of Specialty Medicine's Annual Fly-In, a three-day advocacy conference held in Washington, D.C. The Alliance Fly-In brings together specialty physicians from the Alliance's 15 national medical societies, representing over 100,000 specialty physicians dedicated to advancing policies that increase patients' access to specialty care. CSRO is a founding member of the Alliance of Specialty Medicine.
On the first evening, Drs. Broadwell and Feldman were invited to join the leadership of the other Alliance members for a dedicated Physician Advisory Council meeting to discuss the key policy challenges facing each of the national medical societies. On the second day of the conference, Drs. Broadwell and Feldman held meetings on Capitol Hill with members of the Louisiana delegation. During these congressional meetings, they discussed the Alliance's priority issues, including CSRO-backed prior authorization and step therapy reforms, along with modernizing the Medicare Physician Fee Schedule (MPFS). Attendees also heard from eight physician members of Congress — Reps. Mariannette Miller-Meeks, MD (R-IA), John Joyce, MD (R-PA), Kelly Morrison, MD (D-MN), Bob Onder, MD, JD (R-MO), Kim Schrier, MD (D-WA), Ami Bera, MD (D-CA), Mike Kennedy, MD (R-UT), and Herb Conaway, MD (D-NJ) — about the current political dynamics in Congress and how they impact the healthcare industry.
| | Take the Survey: Help Shape a Sustainable Biosimilar Market | | The Academy of Managed Care Pharmacy's (AMCP's) Biologics and Biosimilars Collective Intelligence Consortium (BBCIC) invites you to participate in a survey exploring the sustainability of biosimilars. The survey is designed to gather insights from a range of stakeholders on factors that support a sustainable and competitive biosimilar market. We appreciate your participation and your time involved in responding to the survey. As a token of our gratitude, AMCP’s BBCIC will make a $10 donation to the Academy of Managed Care Pharmacy (AMCP) Foundation on your behalf for completing the survey. COMPLETE THE SURVEY HERE. | | Federal Regulatory Policy | | CMS Proposes Sweeping Changes to Medicare Provider Enrollment | | As part of its CY 2027 Home Health Prospective Payment System proposed rule, CMS proposed significant changes to Medicare provider enrollment that would affect all Medicare providers and suppliers. Among the most significant proposals are making all enrollment revocation authorities retroactive; expanding existing grounds for enrollment revocation or denial, including those based on provider affiliations; establishing several new revocation and denial authorities related to high-risk geographic areas, certain misdemeanor convictions, shared office space with revoked providers, and enrollment under another party's identity; and broadening the definition of "managing employee" for enrollment purposes. In addition, CMS signals its intent to require certain Medicare enrollment applicants to disclose whether affiliated organizations are private equity firms or real estate investment trusts (REITs). More details can be found in CMS’ fact sheet. Comments on the proposed rule are due by August 31, 2026. | | CMS Issues CY 2027 Medicare Physician Fee Schedule Proposed Rule | | |
On July 14, 2026, CMS released the CY 2027 Medicare Physician Fee Schedule proposed rule, which included several provisions that will impact rheumatology practices. First, CMS is proposing to update the conversion factors for Qualifying APM Participants to $33.1693 (a 1.19% decrease from CY 2026) and for all other physicians and practitioners to $32.8409, representing a decrease of 1.19 percent and 1.68 percent, respectively, from the CY 2026 conversion factors. These rates reflect the statutory payment updates under the Medicare Access and CHIP Reauthorization Act (MACRA), the expiration of the temporary 2.5% payment increase provided for CY 2026 under the One Big Beautiful Bill Act, and a positive budget neutrality adjustment of 0.53 percent due to proposals in the rule.
Of note for rheumatology practices, CMS proposes the following:
- To reduce payment by 50% (based on total RVUs) when a separately identifiable office/outpatient E/M visit is furnished by the same physician (or physician in the same group practice) on the same day as a 0-, 10-, or 90-day global procedure (note this would to services where global surgery does not apply, including drug administration services). Under this proposal, CMS would pay the highest-valued service at 100% and reduce payment for all additional same-day services (surgical or E/M) by 50%.
- To replace HCPCS code G2211 with a new modifier (MOD1) that would be reported under the same circumstances as G2211. Rather than a flat add-on payment (as under G2211), the modifier would increase payment for the associated office/outpatient E/M visit by 16 percent.
- To establish new modifiers (BB and BC), as required by statute, for certain telehealth services furnished through virtual platforms and for telehealth services furnished incident to a physician's or practitioner's professional service. CMS will provide additional implementation guidance on its website.
- To make several changes to Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM), including:
- Requiring RTM services to be furnished only to established patients;
- Requiring a separately billable initiating visit before RPM or RTM services begin;
- Limiting billing for RPM and RTM services to clinical staff employed by the physician or practice, rather than third-party contractors; and
- Revising valuation for RPM and RTM codes, resulting in reduced payment for most services.
- To sunset the traditional Merit-based Incentive Payment System (MIPS) beginning in 2029 and transition entirely to MIPS Value Pathways (MVPs), while continuing the Advancing Rheumatology Patient Care MVP.
CMS also requests stakeholder input on several broader policy issues, including:
- Potential changes to the Medicare Shared Savings Program (MSSP) and future accountable care organization (ACO) models to better integrate specialists into accountable care.
- Strategies to reduce duplicative laboratory and imaging services and improve interoperability and diagnostic result sharing.
- Redesigning primary care payment, including reconsideration of primary care valuation, technology-enabled primary care, and a potential capitated payment within the MSSP.
- Whether CMS should continue relying exclusively on CPT as the physician service coding system or consider alternative coding systems.
More details can be found in CMS’ fact sheet. Comments on the proposed rule are due by September 14, 2026.
| | Legislation Around the Country | | FL: CSRO Vice President, Robert Levin, MD, Speaks on 340B Drug Pricing Panel | | |
On July 21, CSRO Vice President and Florida Society of Rheumatology board member Robert Levin, MD, served as a panelist on a 340B Drug Program GOPAC panel entitled "Better Outcomes for a Healthier America" in Palm Beach, Florida. Dr. Levin joined speakers from the National Taxpayers Union and the National Alliance of Healthcare Purchasers to provide a physician's perspective on the financial impacts to medical practices and patient access to care.
Dr. Levin highlighted how practicing physicians feel the downstream impact of the 340B program's abuses every day, facing financial pressure that benefits large hospitals at their expense. During his remarks, he pointed out that private physician practices cannot compete on a level playing field when hospitals profit from a markup rheumatologists don't have access to, leading to underwater reimbursements. That is exactly why private practices have become such easy acquisition targets for healthcare consolidation.
| | IL: Illinois Legislature Passes CSRO-Supported Biomarker Testing Legislation | | CSRO was pleased to see SB 3509 pass the Illinois legislature and head to Governor JB Pritzker's desk last month. The bipartisan legislation would expand patients' access to biomarker testing while including measures to improve affordability and help alleviate medical debt. CSRO is working alongside a broad coalition to encourage the Governor to sign this proposal into law. | |
Want to learn more about the legislation introduced in your state? Visit CSRO’s Map Tool to find all of the new and enacted bills within CSRO’s policy priorities.
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What's Happening in the States
Interested in learning more about CSRO’s engagement in the states? Visit our State Legislation Correspondence page to review the letters submitted to state legislatures on CSRO’s priority issues.
| Click above to access CSRO’s new State Legislative Tracker to find the status of CSRO’s priority legislation affecting the rheumatology community and its patients at the state level. | | Mark Your Calendar: Upcoming Events
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