New Medicare Changes

We are providing information that hopefully will help our members understand the 2021 Final WRVU billing codes and reimbursements slated for Rheumatologists.

  1. The final WRVU code values for E & M coding: Please notice that at the end of 2020, the WRVU was set at a lower number, and increased to 34.89 early 2021. Because 34.89 represents the universal conversion factor, it needs to be budget neutral, so you will see other specialties actually have decreased over all. Because the E & M codes are newly defined, rheumatologists actually are increased by approximately 13%.
  2. A cheat sheet for rheumatologists to understand both the E & M coding requirements as well as the time based coding, which includes time spent face-to-face as well as activities that a physician does in review, reporting, dictation, or preparation to see the patient, on the date of service.
  3. Final Medicare Ruling: Add on codes G2211 on hold until 2024, however can still be assigned a PFS payment STATUS INDICATOR of B (bundled) until 2024.

2020 Salary Survey

Dear colleagues,

It has come to my attention that many of the hospital systems are not compensating rheumatologists for any increase in RVU value that CMS has just put in place starting January 1 to help compensate for cognitive specialists and to help increase recruitment into these underserved fields. This was approximately a 15% increase. For those who listened in on the post ACR talk that Karen Ferguson and I did we discussed this issue at that time. Karen had a table that she can share with anyone who is interested that updates the RVU/ code. I have checked with CSRO and there may be no legal recourse unless there is specific language in your contract. One Hospital system stated that they were waiting on data from MGMA which is terribly faulty and seriously under- valued. The last time we did a salary survey in 2017, MGMA was approximately 50% below the actual compensation in our state. However, the hospital systems use MGMA numbers to generate your salary. It is imperative that we collect good data and have a significant number of responders. PLEASE COMPLETE THE SURVEY BY MARCH 31.

Take the Survey NOW

This is completely confidential, and we will not associate names with the data. We need ALL rheumatologists in the state to answer to make the survey valuable to all, especially those who are employed.

Thank you,
Jeff Peterson, MD
WRA President

Save the Date for WRA’s 14th Annual Conference September 17-19, 2021

Dear colleagues,

The Washington Rheumatology Alliance cordially invites you to join us for our outstanding annual conference September 17-19, 2021, which will be held again  at the intimate Sleeping Lady Mountain Resort in the beautiful Cascade Mountains of Washington State.

Click here to learn more about exhibitor opportunities and to register as an exhibitor.

We understand that we are living in uncertain times right now. While we are moving forward with conference planning under the assumption that life will return to relative “normal” this fall, please let us know if you think you are likely to attend our conference in-person this September. Send an email to our executive director, Emily Jones, at admin@warheumatology.org. We strive to meet the needs of our members and attendees; your input is invaluable as we continue to plan.

Thank you for your support of WRA,

Jeff Peterson, MD
WRA President

Genentech Stance on Most Favored Nations (MFN) Model

On December 15, 2020, Genentech led a discussion about how the Most Favored Nations (MFN) model threatens provider and patient access to existing and future medicines; we share your concerns that this could have a detrimental impact on your practice and ability to treat patients. Genentech agrees that we have to work together across the healthcare delivery system to enable all Americans to receive appropriate and affordable care. As we do this, we must protect and sustain patient access to scientific innovation in the U.S. so that people with serious diseases continue to benefit from the breakthrough medicines they depend on. Never has this need been clearer than during the current COVID-19 pandemic.

Below is more information on the MFN model, Genentech’s position, as well as that of other organizations.

If you would like to independently advocate against this model, I suggest that you reach out to your physician specialty societies and ask them to:

  • Engage policymakers, in Congress and in the current and incoming administrations, to stop the implementation of MFN;
  • Communicate their concern to CMS via written comments; and
  • Consider joining or pursuing litigation challenging implementation of MFN. The most expedient way to get societies involved in existing cases is for them to contact representatives at PhRMA (PHRMA_alliance@phrma.org) or BIO (info@bio.org).

Additionally, you can reach out to your federal and state representatives, to request that they weigh in opposing the model with their peers, and existing and incoming administration officials.

Downloadable Resources from the Arthritis Foundation

The Arthritis Foundation has free downloadable brochures and fact sheets through the AF Store​ that you can save to your office desktop. The brochures and fact sheets can be e-mailed to patients or you can print copies in-office and hand out to patients as needed. The downloadable materials are a convenient way to provide your patients, who may not be comfortable taking printed materials from your office as a result of the Covid-19 pandemic, the information they are looking for. Instructions are available here.

If you are in need of a bulk order of printed brochures or fact sheets, please contact your local Arthritis Foundation staff member at Washington@arthritis.org for assistance.

The Arthritis Foundation also created a Covid-19 Resources flyer that has a list of great patient resources to help them navigate the pandemic and stay connected.

Biosimilars Could Generate $100 Billion in Savings Over Next Five Years, New Report Finds

WASHINGTON, D.C. — A new report from the IQVIA Institute for Human Data Science has determined that biosimilars are on track to reduce drug costs by $100 billion over the next five years if their use rises. The future of this lower-cost drug market, however, is still uncertain.

According to the report, three recently-launched biosimilars may reach 60 percent volume share by the end of their second year on the market, which would generate an estimated $80 billion in savings in the next five years, including $16-36 billion in 2024 alone. Click here to read the full article.

The Biosimilars Forum is a nonprofit organization incorporated in Washington, DC, created to advance biosimilars in the United States with the intent of expanding access and availability of biological medicines, and improving health care. The Biosimilars Forum provides evidence-based information to inform and support public policies that encourage awareness, access, and adoption of biosimilars.

Coronavirus: What Chronic Illness Patients Need to Know

From CreakyJoints:

We’ve been hearing many questions and concerns from our global patient community about the continued spread of coronavirus across the U.S. and around the world.

And while people with disabilities and chronic diseases have even more of a right to feel worried or downright panicked, there is a lack of good information speaking directly to these issues for patients — until now.

CreakyJoints spoke with multiple rheumatologists and infectious disease experts to try to track down answers that are as specific to this community as possible.

Here’s what we have learned so far. We will update you if critical information changes and we will continue to monitor the situation closely. Read the full article.

Get More Tips for Staying Healthy 

The contents of this website are for informational purposes only and do not constitute medical advice. CreakyJoints.org is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.

Regence Rituxan to Ruxience has been Reversed

Regence Policy Reversed: The decision from Regence to mandate the switch from Rituxan patients to Ruxience has been reversed and Regence will approve Rituxan patients currently on treatment to continue for 1 year. If you have already submitted the authorization for the patients, then just re-submit their name, DOB and member # via fax to your pharmacy dept. If you haven’t yet submitted an auth, then please submit auth as you normally would.

The pieces that were challenged by Arthritis Northwest Regence’s policy with were:

  1. The article (download and keep for your files) clearly stating that biosimilars can be substituted only if approved by FDA as “interchangeable.” In addition, substitution can only be allowed if the prescriber has not designated on the prescription that substitution is prohibited.
  2. The concern that my physicians felt regarding “Switching” a stable patient to a non FDA indicated treatment when there are other alternative biosimilars on the market that are indicated for RA.
  3. The Washington State Step Therapy Legislation #1879 which clearly outlines the exemption process for immediately granting the request if patient is stable and doing well on treatment.

This is a major “win” in keeping our physicians at the forefront of healthcare. Allowing physicians who are in the position for making the right decision of treatment for the best clinical outcome and accountability for total cost of care, always delivers the best possible patient centered care.

Cancellation Notice of the 2020 WRA Annual Conference

Dear colleagues and industry representatives,

After much trepidation and thought I’ve decided to cancel this year’s WRA annual conference. Response from our survey suggested that turn out would have been about half normal and our sponsors were nervous given the continued coronavirus activity. I just couldn’t guarantee everyone’s safety. Our speakers and our sponsors have been notified and they have agreed to wait until next year. All of the funding that has been put forth to this meeting will be rolled over to next year, too. As always, I look forward to seeing everyone at the WRA meeting in Leavenworth next year. Please save the date for September 17-19, 2021.

Thank you for your continued support,

Jeff Peterson, MD
WRA President

Interstitial lung disease exacerbates rheumatoid arthritis activity, related conditions

Patients with interstitial lung disease demonstrated a higher proportion of comorbidities and rheumatoid arthritis activity, as well as rheumatoid arthritis-related conditions, according to a presenter at the EULAR 2020 Virtual Congress.

“Interstitial lung disease is a common extra-articular manifestation of RA, and is known to be associated with increased morbidity and mortality,” Gary Craig, MD, of Discus Analytics and Arthritis Northwest, both in Spokane, Washington, told attendees in the session. “Studies have shown substantial variability in the prevalence, clinical characteristics and risk factors of RA-associated ILD, or RA-ILD.” Click here to read the full article.