I thought that ACR members might appreciate an unsolicited experiential report of the recent board of directors (BOD) meeting from the perspective of a practicing rheumatologist. Because this was my first meeting, I was filled with many impressions. Although I will share some highlights of the meeting, this article will not be a catalogue of all the issues that were discussed, because on March 24th members were sent via e-mail a summary of the board meeting. Instead, this report will focus on a process with which members may be unfamiliar.
The meeting was held over three full days, Thursday through Saturday, from February 19–21, 2009, in Miami Beach, Fla. When you add an additional day for travel, this quarterly meeting was a four-day major commitment of time and energy for the approximately 30 volunteer physicians and allied health professionals and 19 ACR staff who participated. Thankfully, I am told that the three other meetings this year will not be as long.
The agenda notebook sent to me for reading prior to the meeting filled a very thick binder that occupied half of my carry-on bag and added greatly to its weight. Despite the location of the meeting—in a hotel with a beautiful sandy beach on the Miami Beach ocean boardwalk—we had very little opportunity to enjoy the weather because the meeting ran from 8 a.m. to 6 p.m. each day. This was not an activity for people with sore backs or difficulty sitting in chairs for hours at a time.
At the meeting, the 13 board members, 11 committee chairs, six executive committee members, and ACR’s legal counsel and executive vice president sat around the inner U-shaped table; the staff and other invited guests and speakers sat around the outer table. The executive committee members and executive vice president were backlit by the bright Florida sun piercing through a wall of windows behind them. This had the effect of creating halos around their heads, and I wondered if this effect was intentional.
Eager Discussions
One was immediately struck by the diversity of rheumatology backgrounds and constituencies present: education, research, and practice were all well represented. Sherine Gabriel, MD, president of the ACR, did her best to keep the meeting moving along, but compulsive rheumatologists seemed eager to discuss the nuances of every issue, and her job was extremely difficult, if not impossible. This trait, compulsiveness, which is common among rheumatologists, must be some type of passively acquired immune response that is activated whenever a rheumatologist is in close proximity to another rheumatologist. Of interest, there were no shy members, and all the board members actively participated in the sometimes lengthy debates.
As one might have expected, this was a business meeting that ran on an agenda with more time allotted to items of greater controversy or importance. The ACR divides its activities into three categories: survival functions, core functions, and discretionary functions. One of the survival functions is the yearly scientific meeting, and there was considerable discussion about how to improve the quality of the meeting. SessionSelect, a reproduction of scientific presentations available online after the meeting, was judged a great success, although it was expensive. Rosalind Ramsey-Goldman, MD, DrPH, chair of the Committee on Education, submitted a discretionary project to fund SessionSelect, and I hope it will be funded again for this year’s meeting.
Likewise, the poster tours had such high demand with great reviews that they will be expanded this year. Dr. Ramsey-Goldman also announced her committee’s commitment to increase the number of practicing rheumatologists on the meeting planning committees from the current 20% to 33%, which should help ensure that the meeting fully addresses the needs of our practice members.
Checking on Quality, Task Forces
Perhaps the largest block of time was devoted to a discussion of quality issues. Quality of Care Committee Chair Daniel Solomon, MD, MPH, reviewed ongoing strategies that the ACR has pursued to help reduce the work of reporting quality measures. The committee budget and projects were presented and debated. The issue of an ACR quality-recognition program was reviewed at great length. The thinking here is that rheumatologists, not carriers, may be best qualified to decide who provides quality rheumatologic care. Because this was such a controversial item that raised many difficult questions, it was felt a task force was needed to examine the feasibility.
We heard a presentation from the American Society of Clinical Oncology on how they approach quality in oncology and later heard that the Rheumatology Clinical Registry will be rolled out later this year. This will be an online tool that members can utilize to help record and store data for American Board of Internal Medicine practice improvement modules (also known as PIMs), Medicare Physician Quality Reporting Initiative, and various other quality-measure reporting requirements.
There were a number of task force reports presented, including Pain Management and Diversity. After strengthening the language, we approved a position statement submitted by the Antinuclear Antibody (ANA) Task Force regarding the proper methodology for the ANA test. The position emphasizes the preeminence of the immunofluorescent ANA as the gold-standard methodology. The adoption of this position by the ACR should help advocacy efforts to encourage clinical laboratories around the country to improve their methodology. The issue had come up because a practice member, John Goldman, MD, had complained to the ACR that many laboratories in the country were performing the ANA with methodology that did not have the specificity or sensitivity of the immunofluorescent ANA.
Reports from American Medical Association delegates, Arthritis Foundation, ACR Research and Education Foundation, and ARHP were heard. Sharad Lakhanpal, MB, MD, chair of government affairs, reported the ACR advocacy issues for this year and the date for the Advocates for Arthritis event which was held March 9–10 in Washington, D.C. Karen Kolba, MD, chair of the Committee on Rheumatologic Care (CORC), gave her update on all the various CORC subcommittees and issues confronting practicing rheumatologists.
ACR and the Medical Home Model
The BOD members also discussed the Medical Home Model. The ACR has been asked by the American College of Physicians (ACP) to support the Medical Home Model. The ACP, American Academy of Family Physicians, American Academy of Pediatrics, and others have proposed a major overhaul of the American healthcare delivery system, emphasizing primary care. In this Medical Home model, where the primary care provider becomes the central healthcare provider, it is hoped that healthcare would be better coordinated, more efficient, and more effective. There was spirited debate over the plight of primary care and also perceived shortcomings in that model from a rheumatology standpoint. For instance, it was noted that rheumatologists already provide primary care coincident with specialty care for patients with serious complex immunologic diseases. The Medical Home model, as currently constructed, would discourage that activity if reimbursement policies required that the patient go back to the primary care physician for every primary care problem. Patient care would suffer in that scenario.
Each of the chairs then presented new discretionary projects for funding consideration. The projects were graded by each board member. The grades will be tallied, projects ranked, and decisions made at the next BOD meeting in May as to which projects will be funded based upon the available funds. Because every project seemed thoughtfully developed and important, it is unfortunate that there will not be enough money to fund all of them.
A practicing rheumatologist has few other opportunities to meet and get to know many of the ACR staff and board members that represent other constituencies and functions within the organization. Thus, the lunches, breaks, and dinners were critical to network. It gave me the opportunity to present a “practice” perspective on issues to staff and other board members, as well as to hear other viewpoints that affect all of us involved in rheumatologic care.
The breadth and depth of the ACR’s activities became more apparent to me from attending this meeting, along with the remarkable abilities and intellect of the people responsible for these activities. Flying home from the meeting, I reflected upon the progress the ACR has made over the past six years of my personal involvement. What previously was an organization devoted primarily to education and research has evolved to become the guardian shepherd of our specialty. Rheumatology faces many challenges, and my involvement in the ACR’s attempts to confront the challenges facing the practice of rheumatology has been one of the most sustaining and fulfilling accomplishments of my professional life. To my colleagues in practice who feel the ACR does not do enough, I say the ACR needs you to get involved. We need your ideas and, just as importantly, we need your passion for our profession. We need a few good men and women.
If you have concerns that you think should be brought to the BOD’s attention, feel free to contact me at [email protected]. If I cannot directly help, I will try to find within the organization the person who can.
Dr. Denio is a rheumatologist at the Center for Arthritis in Chesapeake, Va.
