I hope you and your family are safe. As the days start to get longer and the nights shorter, as COVID-19 vaccines are rolling out, as the turmoil in Washington seems to be easing, and as the COVID-19 incidence rates are declining, optimism is growing. Our ability to help patients with rheumatic disease continues to expand. Our Society’s efforts to establish an effective state advocacy activity are well underway (see message from our new lobbyist). Plans are also in place to have a mostly “in person” Annual Scientific Meeting in September at the Hershey Lodge, conditions allowing. There will be new definitions of normalcy. We are expanding our resources to attract more “private practice” rheumatologists into the society, especially new rheumatologists as well as Advanced Practitioners. Five Advanced Practitioners took advantage of scholarships to cover the cost of enrolling in the American College of Rheumatology’s online Advanced Practitioner learning modules. We will be surveying them and their sponsors to assess the utility of the scholarships for future Advanced Practitioners.

The establishment of a mentoring program for young colleagues will be a focus of the Board this year with more to follow about this activity. The definition of “private practice” has been changing for some time as many rheumatologists have joined large healthcare systems yet practice with some degree of independence. The American College of Rheumatology has just published guidelines for the administration of COVID-19 vaccines to patients with rheumatic disease. These guidelines are expert consensus and not evidence based mostly since data regarding best practices for timing of COVID-19 vaccines around our biologic therapies is scanty at best and much of the recommendations are extrapolations of what we know from studies of other vaccines. On another note, we are looking into subsidizing Objective Structured Clinical Examinations (OSCE) for the rheumatology fellows in the state so that Fellowship Programs will continue to be able in the future to afford these important simulations of patient encounters. Finally, I want to personally thank our staff, and the Board members for their hard work. 
Al Denio, MD
PRS Advocacy Update
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.”


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. 


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 ( if you have any questions, need more information, or want to get involved. Here is hoping for a safe, healthy, and better 2021!!!!
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Deborah Ann Shoemaker
Lobbyist and Ethics Specialist

Since 2006, Ms. Shoemaker has worked within the Pennsylvania Medical Society’s Total Excellence in Association Management Department (TEAM). Prior to July 2020, Ms. Shoemaker served exclusively as the Executive Director and Lobbyist for the Pennsylvania Psychiatric Society (PaPS). In her role as lobbyist and ethics specialist, her current clients are PaPS, the Pennsylvania Academy of Otolaryngology-Head and Neck Surgery (PAO-HNS) and the Pennsylvania Rheumatology Society (PRS).

As a registered lobbyist, Ms. Shoemaker works extensively with key members and staffers within the state legislature and with the Wolf Administration, in the areas of healthcare (including Pennsylvania’s Departments of Drug and Alcohol Programs, Health, Insurance and Human Services [DHS] and the Pennsylvania Commission on Crime and Delinquency [PCCD]). Ms. Shoemaker also serves as Vice-Chair for the DHS’ Medical Assistance Advisory Committee; Chair of the DHS’ Fee-for-Service Subcommittee and Vice-Chair for PCCD’s Victim Service Advisory Committee.

Ms. Shoemaker graduated from Messiah University in 1992 with a Bachelor of Arts degree in Political Science with a concentration in Communications/Spanish. While at Messiah, she spent an enrichment semester at Temple University. She resides Elizabethtown, PA with her husband, two children and their Siberian Husky. In her free time, she attends her daughter’s basketball and lacrosse games, and is an avid Philadelphia Eagles, Sixers, and Flyers fan.
Aimee Synder
Member Service Specialist

Aimee is a graduate of Penn State University and came to Total Excellence in Association Management (TEAM) in 2020. Prior to that, she worked for 6 years in Donor Relations & Operations for a Foundation serving in a Continuing Care Retirement Community system. She also has 8 years of experience as Marketing Director for a local Physical Therapy company.In her free time, Aimee enjoys time with her family and gardening, as well as following Eagles and Penn State Football.
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