The Good, The Bad, and The Ugly: Hoping for a Better 2021
Paul Killian, MD - PRS Advocacy Chair & Deborah Ann Shoemaker - PRS Lobbyist
As Dr. Killian and I write our first advocacy article together, I can say it is with a hint of optimism. With last year being full of stress, chaos, and uncertainty- mostly because of COVID - it is safe to say that most, if not all, of us are ready for a fresh start. In that vein, I would like to take the time to introduce myself and to highlight a few of our legislative priorities for the coming legislative session. I would like to organize them as “the good, the bad and the ugly.”
THE GOOD: A NEW-FOUND FOCUS ON ADVOCACY
Formal Focus on State Advocacy: For a long time, the Pennsylvania Rheumatology Society (PRS/Society) has been interested in advocacy at the federal and state level. Last year, PRS contracted with TEAM [Total Excellence in Association Management], a division of Pennsylvania Medical Society. It is our hope that their expertise and presence in Harrisburg will enhance our advocacy efforts. Hopefully, it will lead to better patient care and an improved practice environment for our physicians.
Deborah Ann Shoemaker is now our lobbyist. She has been with PAMED for 15 years and has nearly 30 years of experience in government relations. Her primary focus has been mental health and substance use. She has served on numerous task forces and boards under the jurisdiction of the governor. She has extensive experience in working with coalitions (including both public and private stakeholder groups). Deborah has relationships with key officials within the Wolf Administration and within the halls of our state Capitol. PRS and Deborah are looking forward to a successful working relationship.
Formal Focus on Federal Advocacy Efforts: PRS has been fortunate to have physician member leaders who have kept a close eye on federal legislation via our affiliation with the American College of Rheumatology (ACR). As president, Dr. Denio has provided me with invaluable information to assist me in getting up to speed on our important federal issues. I look forward to additional updates, discussion with ACR government relations, and researching the ACR website.
PRS raised the stakes by joining efforts with the Coalition of State Rheumatology Organizations (CSRO) via grassroots advocacy work in key legislative priorities (including Most Favored Nation, Step Therapy, Prior Authorization). Our leadership and I have met via Zoom and exchanged emails with CSRO advocacy staff and their key leadership to ensure we are on the same page as proposed legislation develops both here and in our nation’s Capital.
Expected Reintroduction of Proposed Legislation: Every new two-year legislative session requires all initiatives not enacted upon to be reconsidered. My legislative watch list holds all proposed legislation of interest to organized medicine. This list includes topics such as restrictive covenants, non-compete agreements, and COVID-related liability protections. Dr. Killian and I are carefully watching for the introduction of proposed legislation related to step therapy, prior authorization (when introduced House Bill 225 and Senate Bill 225), and the prevention of Accumulator Adjustment Programs in certain state regulated plans (now Senate Bill 196).
A Member Action Alert related to proposed Prior Authorization legislation was recently sent to our members. We will also be working with CSRO on state and federal advocacy initiatives. As opportunities for member grassroots advocacy become available, we will send them your way. In the meantime, do not hesitate to contact Dr. Killian or myself if you have any questions or need more information.
THE BAD AND UGLY TOGETHER: MOST FAVORED NATION (MFN)
In one of the first meetings I had with Dr. Denio and Dr. Killian, they asked me if I knew about Most Favored Nation (MFN-not Monday Night Football 😊). My exposure with MFN was on the retail chain pharmacy side, a former client. Although they were looking at payment from a different side of the same coin, they hated it as much as we do- feeling CMS was shortchanging them for Part B drugs. After speaking with Dr. Denio and Dr. Killian, I soon realized that rheumatologists and their patients are the biggest losers in the implementation of MFN. Private practice and/or physicians not affiliated with an academic medical center or other institutional setting(s) may decide not to take as many Medicare Part B beneficiaries if MFN goes into effect. There are many reasons we oppose MFN, but if this goes into effect, it will create quite a challenge for physicians to continue treating these patients.
The Bad: CSRO’s fight vs. the implementation of MFN
When the MFN interim final rule was unveiled with an effective date of January 1, 2021, to say rheumatologists were upset is an understatement. A temporary restraining order was issued by a Maryland judge delaying the January 1st deadline.
But that was not enough for CSRO President Madelaine Feldman, MD. CSRO joined a lawsuit filed in the United States District Court (Northern District of California) to delay the proposed rule. The injunction was granted on the basis that CMS did not follow the correct procedures as required by the Administrative Procedure Act (APA).
The Ugly: The MFN injunction is not permanent.
Although the final ruling of MFN was delayed, it was not a permanent decision. The injunction allowed a delay until only January 26th. Since the interim rule was unveiled during the Trump Administration, CSRO and other stakeholders are working feverishly to determine if the Biden Administration will uphold the final ruling in its proposed form. Rest assured, we will continue to stay on top of this issue and provide updates/opportunities to have your voice heard as they are available.
In closing, it is my distinct honor to represent your interests at the state Capitol, at coalition meetings where your colleagues are present, within the walls of PAMED, and at the federal level. I have enjoyed working closely with Dr. Killian. Thanks also to Dr. Denio and the entire PRS Board, who have made me feel welcome from day one: Please do not hesitate to reach out to me via email (email@example.com) if you have any questions, need more information, or want to get involved. Here is hoping for a safe, healthy, and better 2021!!!!