2025 Reforms Attempt Big Changes to the Healthcare Business

Featured News, Rheumatology Updates
Monday, January 13 2025
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As the 2025 legislative session begins, private practice physicians—especially those in specialized fields like rheumatology—must stay informed about new laws that could significantly affect their practices. Key topics, including reimbursement models, telemedicine regulations, and prescription drug pricing reforms, will shape how physicians manage their operations, deliver care, and adapt to evolving healthcare policies.

By understanding these legislative changes, you can proactively address challenges and position your practice for long-term success. This article explores the 4 critical areas of legislation to monitor and their potential impact on medical practices, particularly in specialties like rheumatology.

Legislative Areas to Watch

1. Reimbursement and Payment Models

Reimbursement rates for Medicare and Medicaid continue to be a top concern for private practices, especially those offering specialized treatments like biologic infusions and injection therapies. In 2025, legislative proposals could significantly impact how physicians are reimbursed, with a growing emphasis on Medicare Advantage plans and alternative payment models (APMs) (Centers for Medicare & Medicaid Services).

Potential Impacts on Reimbursement:

  • Medicare Cuts: Reductions in reimbursement rates for infusion therapy or biosimilars could pose financial challenges, particularly for practices reliant on high-cost treatments (American College of Rheumatology).
  • Value-Based Care Rewards: While value-based care models may offer higher reimbursements for improved patient outcomes, they require upfront investments in infrastructure, staffing, and administrative processes to meet performance metrics.
  • Administrative Burden: Adapting to these changes may increase operational complexity, as practices will need to adopt new technologies and streamline workflows to remain compliant.

Proactively understanding these reimbursement shifts and preparing for changes will help practices mitigate risks while maintaining financial stability. Consider tracking updates from organizations like the American College of Rheumatology or CMS to stay ahead of these developments.

2. Telemedicine and Virtual Care Regulations

Telemedicine has become an indispensable tool for private practices, especially in specialties like rheumatology, where managing chronic conditions often requires regular follow-ups and monitoring. However, evolving laws in 2025 could reshape how telemedicine is delivered and reimbursed, presenting both opportunities and challenges for specialized care providers (Telehealth.HHS.gov).

Key Areas to Watch:

  • Reimbursement Parity: Ensuring telemedicine visits receive the same reimbursement as in-person consultations remains a legislative priority. For rheumatologists managing complex treatments like biologics or DMARD therapy, reimbursement rates will determine whether telemedicine can remain a viable option for remote care.
  • Cross-State Licensure: Changes to state licensure rules could allow rheumatologists to expand their reach and provide virtual care to patients in underserved or rural areas who may not have access to a local specialist.
  • Technology Investments: Rheumatology practices may need to adopt or upgrade virtual care platforms to comply with new regulations, particularly if telehealth policies require advanced documentation or integration with value-based care metrics.

Challenges for Rheumatology Practices:

While telemedicine offers flexibility, certain aspects of rheumatology care—such as physical joint exams or infusion therapy monitoring—require in-person visits. Reduced telehealth reimbursement rates or stricter regulations could limit the practicality of using virtual care for these critical services.

By staying informed about telemedicine legislation and preparing to adapt your practice, rheumatologists can continue to provide quality care while navigating regulatory shifts. Organizations like CMS, ACR, and Telehealth.HHS.gov offer valuable resources for tracking updates and ensuring compliance.

3. Workforce and Staffing Laws

Staffing shortages and workforce challenges continue to create significant operational hurdles for private practices, particularly in specialized fields like rheumatology. Legislative changes in 2025 could further shape hiring, retention, and labor costs, forcing practices to reassess their staffing models and operational budgets.

Key Workforce Challenges:

  • Nurse Staffing Ratios: Proposed laws mandating higher nurse-to-patient ratios could increase operational costs, particularly for infusion centers and clinics that require specialized nursing care. For rheumatology practices, this could mean additional expenses to maintain compliance without sacrificing patient care quality.
  • Labor Laws and Paid Leave: Changes to paid leave policies, minimum wages, or non-compete clauses could impact the ability to hire and retain qualified staff, especially in smaller practices with limited resources. High turnover may disrupt continuity of care, particularly for patients undergoing long-term therapies like biologics or disease-modifying antirheumatic drugs (DMARDs).

The Impact on Rheumatology Practices:

Staffing shortages are especially challenging for rheumatologists who rely on skilled nurses and medical assistants to deliver complex treatments. Recruiting and retaining qualified personnel becomes even more critical when administering infusions or managing patient education for autoimmune diseases like rheumatoid arthritis and lupus.

How to Prepare:

  • Evaluate Staffing Needs: Assess whether your current staffing levels align with anticipated legislative changes. Consider partnering with staffing agencies or outsourcing administrative tasks to reduce the burden on in-house employees.
  • Monitor Labor Law Changes: Stay informed about updates to paid leave and wage requirements to adjust your budget and staffing policies proactively.
  • Invest in Training: Prioritize ongoing training for your existing team to improve retention and enhance skillsets, particularly in areas like infusion therapy and patient management.

By proactively addressing staffing challenges and staying informed about workforce legislation, rheumatology practices can maintain high-quality care while minimizing disruptions caused by labor shortages and regulatory changes.

4. Prescription Drug Pricing and Formularies

Prescription drug pricing remains a major concern for rheumatology practices, where treatments like biologics and disease-modifying antirheumatic drugs (DMARDs) are essential but costly. In 2025, lawmakers are expected to address pricing reforms, transparency, and national formularies, which could significantly impact both patients and providers.

Key Legislative Proposals to Watch:

  • Price Transparency: Reforms may require drug manufacturers to disclose pricing details, helping patients and practices better navigate costs (Health Affairs).
  • National Formularies: Proposed standardized drug lists could lower costs but might limit access to certain therapies, creating challenges for personalized treatment plans.
  • Cost Reductions: Efforts to lower the cost of biologics and biosimilars may increase patient access but could also alter reimbursement structures for practices.

Impact on Rheumatology Practices:

Pricing reforms present a double-edged sword for rheumatologists. While lower drug costs can make essential treatments more accessible for patients with conditions like rheumatoid arthritis, restrictive formularies may reduce flexibility in treatment options, adding administrative complexity for practices.

The Impact on Independent Practices and How to Prepare

These legislative changes directly affect private practice physicians. Reduced reimbursement rates for biologic infusions or telehealth visits could create financial challenges. If lawmakers implement value-based care metrics, rheumatologists must upgrade their practice management systems to meet new requirements and secure reimbursements (CMS.gov).

Workforce and Treatment Access

Operational costs will also rise if staffing laws increase wages or staffing ratios. Rheumatologists must evaluate whether their practices can absorb these costs or if they must pass them on to patients, potentially affecting their competitive edge. Additionally, changes in drug pricing could affect treatment plans, limiting patient access to biologics and forcing practitioners to consider alternative therapies (National Physician Advocacy Institute). Here are a few ways to prepare: 

  • Stay Informed. Rheumatologists must keep up to date on legislative changes. Organizations like the American College of Rheumatology and the American Medical Association (AMA) offer essential resources to help physicians navigate these evolving regulations (ACR Advocacy, AMA).
  • Get Involved in Advocacy: Actively advocate for policies that support equitable reimbursement, fair telemedicine access, and affordable drug pricing. By advocating, rheumatologists can help shape legislation that benefits their practices and patients. Both national and state-level advocacy efforts will be critical as these issues evolve in 2025 and beyond (American College of Rheumatology).
  • Adapt Your Practice: Get ahead of legislative changes by reviewing your billing systems, adopting telemedicine technologies, and preparing for potential staffing regulations or drug pricing shifts. Taking proactive steps—like partnering with a medical group or medical services organization—will help minimize disruptions to your practice and continue providing high-quality care (American Medical Association).

The 2025 legislative session brings significant challenges and opportunities for private practice rheumatologists. By staying informed, engaging in advocacy, and preparing for changes in reimbursement, telemedicine, staffing, and drug pricing, rheumatologists can ensure that their practices remain financially stable while delivering the best possible patient care.