“It was the best of times; it was the worst of times…” wrote Charles Dickens in “A Tale of Two Cities.” It is an apt description of what is happening in medicine as a whole as well as in the allergy/immunology space today.
We’re practicing medicine in a time of incredible innovation. Recent developments have expanded options for patient care. Therapeutic wins include Neffy®, SMART inhalers, and omalizumab’s expanded use to prevent some food allergy reactions, to name a few. There is growing recognition of type 2 inflammation and its effect on allergic conditions. Physicians and parents can take steps to prevent food allergy in infancy.
With progress in the ability to identify allergy and asthma phenotypes, precision medicine is coming to the forefront. Biologics have been a game changer for helping patients find relief – for asthma, and more recently, for atopic dermatitis. Future areas of discovery, such as gene editing, offer promise. It is an exciting time to be an allergist/immunologist!
On the other hand, it seems medicine in general and allergy/immunology are currently under siege, and it can feel as if now is the “worst of times.” Medicare reimbursement rates haven’t kept pace with rising practice costs and inflation. Reimbursements for allergy shots, both from Medicare and commercial payers, have fallen short – to the point that some allergy practices might not find it financially viable to continue to offer them.
Commercial payers are imposing administrative obstacles on allergy practices that divert our attention from patient care. These include influence and actions of pharmacy benefit managers, an increasingly burdensome prior authorization process, and issues with Medicare Advantage.
Another blow to medicine is the recent budget reduction the Trump administration has outlined for indirect costs to NIH-funded research. Research is the lifeblood to medicine, and these cuts will negatively affect life-saving studies. While a federal judge blocked the cuts, the outcome is as yet undetermined, pending the resolution of litigation filed by groups representing universities, hospitals and research institutes.
How are we taking action? We have sent letters to government officials sharing concerns about NIH funding cuts and the NIH’s new grant application policy that resulted in the cancellation of a long-standing research grant in the area of eosinophilic disease based on a technicality. (And other research grants may be affected by this process.) We also signed on to a letter with other medical organizations to urge Congress to reverse Medicare payment cuts and provide a meaningful payment increase for physicians. Our Payer Education Campaign is addressing the alarming trend of insurance companies implementing unreasonable requirements in order to approve immunotherapy for our patients.
Facing challenges is nothing new for allergy/immunology. When I accepted the gavel to become ACAAI President last fall, I noted that we are constantly fighting headwinds – but it is ultimately our job as leaders to navigate around them and find clear waters. We are fortunate to have an allergist and ACAAI Fellow, Dr. Bob Onder, as a member of the House of Representatives. Dr. Onder understands the issues we face and promises to work with other members of the Congressional Doctors Caucus on solutions.
We’ll be navigating the issues I noted above in our visit to Washington, DC this week. Tomorrow, members of the ACAAI Strike Force will be meeting with members of Congress from the Congressional Doctors Caucus and committees with jurisdiction over our advocacy priorities.
We, as physicians, are best able to relate the challenges of being in medicine today and advocate for change. I look forward to informing members of Congress on the challenges physicians and our patients face and working with them to find solutions.
James M. Tracy, DO, FACAAI
ACAAI President
