PRESIDENT'S MESSAGE
Dear Members, Colleagues, and Sponsors,

Greetings! My name is Irene Tan. I am an academic rheumatologist and a fellowship program director (PD) at Einstein Medical Center, Philadelphia, and I will be serving as the Pennsylvania Rheumatology Society (PRS) President for the next two years. I hope you and your families continue to do well 20 months into the COVID pandemic. As we contemplate on when and which COVID booster vaccine to accept, younger children are finally approved to receive their first doses. The fall foliage is a reminder to get our influenza vaccines and to swap out summer clothes for colder climate apparel. Along with material supply chain issues, whether you are in a big or small practice, academic or private practice, the human resources supply chain problems are also glaring. Due to the scarcity of applicants, we have not been able to hire an additional medical assistant in the past two years at my workplace. Many frontline workers opted to retire early or not to return to health care altogether.

Our 8th Annual Scientific Meeting of the PRS this past September was in-person at the Hershey Lodge, and enduring materials are available to meeting registrants. After nearly two years of “virtual” meetings for clinical encounters, local, regional and national meetings, the in-person meeting was a much-needed respite from video-fatigue. I cannot express the joy of seeing live speakers, interacting with the poster presenters, and my colleagues. The speaker line up was excellent, and Thieves' Market presentation was lively and engaging. Everyone was appropriately masked for the gathering as our country and the world continued to face the ebb and flow of the COVID pandemic.

We again are offering up to $1,000 one-time scholarships to reimburse rheumatology fellows in the state for participation in any ACR course/meeting. I look forward to seeing our colleagues visit my city in Philadelphia for ACR 2022.
 
The PRS board approved the pilot scholarship program to reimburse Advanced Practitioners (physician assistants, nurse practitioners) who take an ACR course designed for Advanced Practitioners (either online or in person). Spearheaded by Dr. Alfred Denio, this scholarship is aimed to provide resources to help attract, train, and retain advanced providers to the field of rheumatology in our state. For more information, click here.
 
New this year, the PRS board approved funding of the Rheumatology Observed Structured Clinical Examination (ROSCE) for fellows-in-training in Pennsylvania. As in previous years, the ROSCE took place at the Penn State Clinical Simulation Center in Hershey, PA. As training programs and fellowship PDs continued to face challenges of funding, PRS aimed to help offset the financial burden of trainee assessment for PDs and programs across the state.

An unexpected consequence of COVID pandemic was the rise of virtual ROSCE. For the past eight PRS Annual Scientific Meetings, the ROSCEs are scheduled near and located in close proximity to the meeting in order to accommodate the fellows. The pandemic uncoupled the pairing of both the location and time needed to attend both by fellows. Due to the convenience of virtual ROSCE, this platform will continue to be adopted. This uncoupling increased the degree of freedom of which PRS would have to select future meeting venues. Moving forward, meeting venues for PRS outside Hershey are being vetted. We welcome family-friendly and fellow-budget-friendly suggestions.
 
I would like to thank our staff, the Annual Scientific Meeting Planning Committee, our Advocacy Committee members, the Board, and our corporate partners without whom none of this would be possible. A special shout-out to Rebecca Doctrow, our past executive director at the Pennsylvania Rheumatology Society for her hard work, resourcefulness, and professionalism over the past few years. I would like to welcome Jennifer Redmond, who is our new but experienced executive director. Finally, I want to thank you, our members, for your continued support and engagement in our professional community. Stay warm and stay well. 
Irene Tan, MD
PRS Advocacy Update
PRS Advocacy Update: A Year of Unparalleled Advocacy Opportunities

Paul Killian, MD, PRS Advocacy Chair and Deborah Ann Shoemaker, PRS Lobbyist
This year is rapidly coming to a close - whether we like it or not. Seasons change, weather changes, and we cannot control it. However, we can control how we react to challenges and opportunities thrown at us. The Society has taken huge strides to engage our membership in grassroots advocacy at the state and federal level. PRS leadership planted the seeds of engagement, personally dedicating themselves to participating in federal webinars, calls to action, and virtual legislative visits. We have spent a significant amount of time reviewing proposed legislation and policies that affect your patients and your daily practice. The PRS board has also done a tremendous job recruiting members interested in advocacy. These members - already quite busy with the practice of medicine - have volunteered their time to send out tweets, assist with populating the advocacy section of our website, lending their expertise in reviewing/commenting on overreaching insurance policies, and the list goes on for miles. I am extremely proud of our hard work and accomplishments in just one year. Exposing our members to this new way of thinking about advocating for our patients, our profession, our medical specialty colleagues- just to name a few- has opened additional opportunities moving ahead. So, before we look ahead, highlighting this year’s accomplishments can frame our future.
 
PRS has been engaged in the following issues this year:
 
Federal Collaboration with the American College of Rheumatology (ACR) and the Coalition of State Rheumatology Organizations (CSRO):
 
SIGNING ONTO JOINT STAKEHOLDER GRASSROOTS ADVOCACY LETTERS:

  1. Urging COVID Vaccinations for Immunosuppressed Patients.
  2. Supporting HR 315: Extending Moratorium on Medicare Sequester.
  3. Supporting ACR’s Application for CDC Grant.
  4. Standing with ACR to express concern/opposition to July 2020 Office of the Inspector General’s (OIG) report/recommendation on excluding self-administered versions of Orencia and Cimzia in Medicare Part B payment calculation.
  5. At the request of the Fracture Prevention Coalition, PRS signed onto a letter thanking US Senators Cardin and Collins for introducing S.1943 (the Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2021).
  6. After a much-anticipated wait, the federal Co-Payment Accumulator bill was introduced the first week of November.
  • HR 5801 (also known as the Help Ensure Lower Patient Copays Act) seeks to eliminate barriers to treatment and allow the inclusion of copayment/related financial assistance in meeting a patient’s annual deductible.
  • A copy of the bill is enclosed here for your reference: https://www.congress.gov/117/bills/hr5801/BILLS-117hr5801ih.pdf
  • Per CRSO request, PRS signed onto a joint letter endorsing the bill.
 
PARTICIPATION IN NATIONAL GRASSROOTS ADVOCACY TRAINING/LEGISLATIVE VISITS:

Alliance of Specialty Medicine Virtual Capitol Day: June 17th
  • Our lobbyist, then - PRS President Dr. Denio and other PRS members attended the Alliance of Specialty Medicine Virtual Capitol Day on Thursday, June 17th.
  • Although various topics and numerous medical specialties were represented during these day-long meetings, Dr. Denio had the opportunity to express appreciation/ask questions from Congressman John Joyce, MD, member of the Pennsylvania Congressional delegation.

CSRO’s State Society Advocacy Conference was held VIRTUALLY on September 11th.
  • PRS President Denio and Ms. Shoemaker attended the all-day event.
  • Six presentations were made during the day:
  • Federal Issues Impacting Rheumatologists and their Patients.
  • Hide and Seek with Rebates – What's Next for Rutledge?
  • Cross – Specialty Collaboration: Oncology and Rheumatology Working Together for Patient Access to Care.
  • Advocacy at the State Level – A Panel Discussion
  • NCPA Lawsuit Overview: DIR Fees; and
  • Looking Ahead – A Forecast for Rheumatologists in America
 
 
State Grassroots Advocacy Initiatives/Legislative Priorities:
 
PRS ADVOCACY WEBSITE DEVELOPMENT:

  1. At request of leadership, a dedicated Advocacy section was created on the PRS website.
  2. Dr. Killian and I, along with PRS staff, populated information/identified top legislative priorities.
  3. After PRS Board approval, the section was created and is updated on a regular basis.
  4. For more information, check out our link: https://www.parheumatology.org/advocacy.html
 
UPMC LAB BENEFIT MANAGEMENT ISSUE:

  1. At the request of a PRS member, the Society engaged our leadership and CSRO in reviewing UPMC’s plans to implement their Lab Benefit Manager policy (which was to be effective October 1, 2021).
  2. After much persistence, especially by PRS board members, the implementation date was moved to January 1, 2022. Drs. Denio and Killian are scheduled to meet with the UPMC Health Plan Administration in early December.
  3. All policy and procedure manuals, along with UPMC guidance and training, will be posted on their website.
  4. Additional updates will be given as available.
 
CO-PAYMENT ACCUMULATOR:

We labored extensively over the past year with colleagues at the state and federal level to enact legislation to prevent Accumulator Adjustment Programs within certain state regulated plans.

Brian Henderson, CSRO Government Relations Director, and Ms. Shoemaker met regularly to discuss state strategy.

PRS and CSRO are active partners in the PA Make All Copays Count Coalition (Coalition).
Over the past year, the Coalition commenced monthly meetings. Accomplishments included:
  • Meeting with key House and Senate Insurance Committee staffers, the staff of Senator Judy Ward (sponsor of the Senate bill) to attempt to move these bills within the state legislature.
  • Draft amendments by DOI were circulated to Senator Ward’s office, Representative Gleim’s office (sponsor of House Bill 1644), and to Coalition members for their review and comments.
  • After careful deliberation by the Coalition, it was decided that the DOI amended version was not unacceptable. Areas that were non-negotiable for Coalition members included exceptions language and the addition of “Creditable Drug Coverage” provisions.
  • At the Coalition meeting in late October, we were informed that Highmark has also been circulating amendments to the bills that would, if amended, mandate that “cost share optimizer programs” cannot count toward insurance deductibles. After discussion with coalition members, it was noted that their proposed amendment is not acceptable.

Updates will be given as they become available in future newsletter articles or via our website.
 
GRASSROOTS ADVOCACY WITH OUR MEDICAL SPECIALTY COLLEAGUES:
 
Prior Authorization:
  1. House Bill 225 and Senate Bill 225 were introduced early this new legislation session related to prior authorization.
  2. PAMED, along with certain medical specialty organizations leading grassroots advocacy efforts.
  3. The Society sent out a solicitation in late June, targeting members residing and/or laboring in senatorial districts of Senate Banking and Insurance Committee members.
  4. As a result of medical specialty collective grassroots advocacy efforts, Senate Bill 225 was voted out of the committee on June 25th with significant amendments.
  5. Senate Bill 225 now resides on the Senate calendar. House Bill 225 has not seen any action yet.
 
Out of Network/Surprise Billing:
  1. PRS lobbyist participated in coalition meetings to discuss Out of Network billing.
  2. The federal bill was enacted last congressional session (No Surprises Act).
  3. National medical specialty organizations reviewed provisions/determined that future state action is not necessary.
  4. PRS signed onto joint coalition letter to state legislature in early spring.
 
ASSISTING OUR COLLEAGUES WITHIN PAMED:
 
House of Delegates:
Although we did not have a dedicated representative this year at HOD, our voice was still heard. Our colleagues at the Pennsylvania Academy of Dermatology introduced a House of Delegate Resolution on non-medical switching. After careful review by Drs. Denio and Killian, we wholeheartedly endorsed their resolution. Prior to the virtual HOD in October, we reviewed all HOD resolutions and provided a comprehensive overview to educate our leadership and to provide information.
 
Other PAMED-Led Legislative Initiatives:
 
PAMED continues to keep on top of all attempts by non-physician providers to expand their scope in areas that do not reflect their clinical knowledge, medical education, and expertise.
 
As the premier medical specialty organization representing all physicians in the commonwealth, our friends at PAMED have also taken the lead on crucial legislative and regulatory initiatives, such as medical malpractice, change of venue for liability actions, non-disclosure agreements and payer relations. With their tireless dedication to the house of medicine, our Society is in good hands moving forward in 2022.
 
So, as stated in the beginning of this article, 2021 was a year full of challenges and opportunities. However, our members stepped up and took the helm by getting involved at the state and federal level. To keep informed on our legislative priorities, check out our website. We have links to both ACR and CSRO on that section of our site for your review. Our most updated tracking list and quarterly legislative update are enclosed on our website for your convenience as well.
 
In the meantime, please do not hesitate to reach out to Dr. Killian at pjkill@hotmail.com if you have any questions, need more information, or want to get involved. 
 
Have a wonderful holiday season. Here’s to another successful year of grassroots advocacy in 2022!
Frustrated by Insurance Issues? CRSO and PRS can help

Many of us are affected by payer policies that impact our ability to provide the best care for our patients, and the Coalition of State Rheumatology Organizations (CSRO) can help. They launched a new resource for rheumatologists to request assistance from CSRO in addressing payer issues impacting their patients and practices. This new form enables them to act quickly to help resolve your concern, whether by supplying template letters for your practice, writing, or calling on your behalf, or directing you to other known resources.

You can find the form under the Resources tab on CSRO’s website or by clicking here.

Our state society is proud to be a member of CSRO, and if CSRO can support you in other ways, or you have questions about the new online form or webinar, please contact their Executive Director Ann Marie Moss with suggestions at amoss@csro.info. 

SAVE THE DATE FOR THE 9TH ANNUAL SCIENTIFIC MEETING!
PRS Mentorship Program
PRS Members can sign up to be paired with a fellow PRS member with similar interests and goals as you! The Mentorship Program is designed to match a Mentee - a Fellow or Early Career Physician (Fellowship Graduation Date 2016 to Current) - with a seasoned Rheumatology physician.
If you are interested in posting a job, please contact us at (833) 770-1549 or prs@parheumatology.org​. Postings are complimentary.
Ideas or suggestions for newsletter articles can be submitted to the PRS staff office, prs@parheumatology.org or by telephone, (833) 770-1549