In early May, the ACAAI Strike Force met with U.S. Representative Robert Onder, MD, FACAAI (R-MO-03), an allergist serving in the 119th Congress. His political experience includes being a member of both the Missouri House and Senate.
Dr. Onder is quick to acknowledge and express his appreciation for the support he’s received from allergists around the country. His main opponent in last summer’s primary was a United Healthcare lobbyist. As the first allergist in Congress in more than a decade, Dr. Onder is an important voice for allergy. He is an advocate for our specialty, our patients, and our practices.
He trained at Washington University School of Medicine in St. Louis and had a private practice for about 32 years. Congressman Onder no longer practices due to Congressional ethics rules, which restrict his professional career while in office.
Dr. Onder is working to convince United Healthcare to rescind its policy — which adopted Medicare’s definition of a dose — that a dose equals 1cc aliquots of allergen immunotherapy extract. That, coupled with United Healthcare’s policy change on biologics, is devastating to allergy practices.
He’s met with United Healthcare lobbyists and some executives to drive this point home. He accentuated many of the points made in our Payer Education Campaign. He also emphasized that allergists will not be able to continue providing the service to UHC beneficiaries if they are not reasonably compensated.
Allergies are serious conditions. Allergy treatments are cost-effective, have a positive effect on quality of life, and on attendance at work and school.
Dr. Onder is a co-sponsor of H.R. 879, which will increase payment adjustments under the Medicare Fee Schedule. He also co-sponsors legislation to amend the surprise billing law (No Surprises Act) to prevent insurance companies from misconstruing and contorting the surprise billing law to deny payment.
Payers are using various tactics to delay and discourage payment, by implementing step therapy, copay accumulators, and excessive requests for records. Some insurance companies are requesting the entire medical record with every claim. Dr. Onder feels it’s important to keep pushing back at insurance companies.
“We’ve got a lot of work ahead of us with prior authorization reform and timely payments,” said Congressman Onder. “The (U.S.) health care system’s a mess. Reforming health care is one of the reasons I ran for Congress.”
He thinks the future of allergy is coupled with the future of independent practice. He knows that the Medicare cuts are devastating and are behind the dramatic consolidation in health care. Over the last twenty years, hospital reimbursement has gone up 47%. Physician reimbursement, accounting for inflation, has gone down more than 26%. He feels the trends have not been good for our profession or our specialty.
Dr. Onder believes physicians make good politicians and advocates. None of the bills, laws, regulations, or resolutions is easy to understand. Physicians are used to explaining difficult-to-understand diseases and treatments for their patients and they apply the same translating techniques to Congressional language.
Every day, physicians advocate for their patients with insurance companies, schools, and even legislators. Dr. Onder encourages you to call, write, or email your member of Congress about the Medicare Fee Schedule. Right now, members of Congress are receiving a lot of emails and calls from people about other government issues. Your call about the Medicare Fee Schedule really will stand out.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
