It is hard for me to believe that I wrote my first column for The Rheumatologist over a year ago. The breadth and depth of issues addressed by the American College of Rheumatology in the past year have been incredible, and those that required the special attention of the president have been more than I might have anticipated.
Global Reach
My wife Jeanne and I knew from the beginning of our service that this would be a year of unprecedented travel for us. We have brought the good wishes of the ACR to rheumatology meetings on four continents and visited 11 countries in our travels. Our objectives were to see first hand the challenges and rewards of the practice of rheumatology around the world, to forge friendships with the people and associations we visited and to learn more about how the ACR might be engaged in the needs for education and other collaborations around the world.
Actions Taken
As I prepared my final column, which is an annual report of sorts, I reviewed the list of action items from meetings of your Board of Directors since the last Annual Meeting. One of the overarching themes of the year’s work was information technology. This was a personal theme in my own professional life as well. Just prior to becoming president-elect, I joined Columbus Arthritis Center (CAC) and began using an electronic health record (EHR). It was daunting to transfer 30 years of experience with my patients to the EHR during my first six months at CAC, but I succeeded. I still miss the intrinsic beauty of my paper charts, meticulously organized and efficiently dictated, but I knew nostalgia would not help me be an effective rheumatologist in the future or serve as president of an association preparing its members for the new era medicine has entered.
The ACR Board of Directors also faced important IT issues and approved spending the necessary funds to build an IT infrastructure that aligns with the needs and goals of the ACR. This initiative included engaging an experienced consultant to fully assess the status quo and then help us develop a process to manage and modernize our systems. The process began with convening a working group of our fabulous staff to imagine and actualize the systems we need going forward, including migrating our association data to a modernized cloud-based server system.
We also hired a technical project manager to guide the process internally. We allocated substantial funds to re-architect (I have learned a lot of new words this year, too) our website and move to a new content management system. We are anticipating the debut of a website I am sure you will love. If all goes as planned, you will not be aware of the content management systems changes except to notice a better overall experience. It will make internal operations more efficient.
Given our need for top-to-bottom improvements in information technology and the costs associated with modernization, the Board approved expenditures over its proposed annual budget by more than a million dollars, funded from our accrued assets. This is a rare event in our history, but was necessary to provide the service you will need from the ACR.
The ACR also continued to build the RISE Registry by hiring a new partner to help us actualize this project. RISE has been envisioned, planned and built over the past several years. In June, we officially launched our registry. This is a major step forward. RISE promises a single data-entry system, helping our members assess individual compared with peer performance. It does this by gleaning important de-identified data about multiple patient variables and outcomes from the data you enter as you document your care of patients. As a certified registry, it can satisfy your requirements to report quality and outcomes to the Centers for Medicare and Medicaid Services. It will serve as a repository of patient data that will be valuable not only to practices, but also for research. Please consider becoming part of this valuable asset. Visit the RISE information center at the Annual Meeting or contact [email protected] to learn more.
New Projects
In addition to international diplomacy and technology, the ACR continues its routine business of Advancing Rheumatology! In the quality-of-care arena, the Board authorized new projects, including a pilot project to examine how to more effectively involve patients in guideline development; and development of new guidelines related to reproductive health, perioperative management of rheumatic medications in total joint arthroplasty and glucocorticoid-induced osteoporosis. We are also continuing our fruitful collaboration with EULAR on a project to develop new lupus classification criteria. We have sophisticated volunteers and staff who help create and validate vigorous, evidence-based recommendations for care, criteria for disease classification and several other projects.
Position Statements
The Board approved numerous updated position statements from the Committee on Government Affairs and the Committee on Rheumatologic Care. These statements clarify our policies and help us deal with the government, insurance companies and other entities. They are available to you on the ACR website. We also undertook the process of appointing Richard Bucala, MD, PhD, as the new editor of Arthritis & Rheumatology, and completed numerous other tasks.
Government Affairs
I am so proud of how we have grown in sophistication and effectiveness in dealing with government. You have heard from me about the amazing success we had because our outstanding volunteers were in the right place at the right time, aided by our lobbying firm and RheumPAC, in delaying implementation of ICD-10. As you know, we also testified before a congressional committee on the Patient Access to Care bill and were the only medical professional organization to testify at that hearing.
We have been a powerful voice with CMS and with insurance companies. Our hardworking CORC members and Insurance Subcommittee members have been tireless in defending your needs and those of your patients.
The strategic plan brings together previously separate staff in practice and government affairs with those in quality of care to create important cross-pollination of creativity as these functions become more interrelated in new healthcare systems. An impressive staff works under one organizational roof now.
Cooperation
We have witnessed unprecedented cooperation by the ACR with other organizations that have the needs of our patients at heart. This cooperation is best exemplified by our strong advocacy alliance with the Arthritis Foundation, our tireless partner in supporting and protecting patients. We also formed a coalition with other medical specialty societies to compel the federal government to recognize the unique contributions cognitive specialties (such as rheumatology) bring to patients. We also have joined voices with other specialties to push for maintenance of certification that makes sense and is evidence based.
I am proud about the progress our Affiliated Societies Council has made in bringing local and state organizations under a larger tent to cooperate on mutual goals. More than ever, it is mandatory that we all push in the same direction in Advancing Rheumatology! All organizations in rheumatology must work together. The ACR hired a new staff person just to minister to the needs of organizations at the state level, where important legislation regulating biosimilar medications and Medicaid is being made law.
The Annual Meeting
For many people, the Annual Meeting and the ACR are the same thing. “Are you going to ACR this year?” is the way we inquire about whether you will join us in Boston. The meeting is a complex undertaking to create, requiring the work of countless volunteers, ACR staff and temporary staff. In January, I attended the first two days of the Annual Meeting Planning Committee’s work. I was overwhelmed by the wealth of science we present in a compressed amount of time. I was bewildered by how this large group of people emerged from the meeting with the complicated schedule of sessions we all love. How we can meet the expectations of a wide variety of scientists and practitioners from around the globe and prevent important content from overlapping with other important content for each of these groups seems like magic to me.
Attacks Thwarted
During this year, the ACR tackled multiple attacks on the ability of rheumatologists and rheumatology health professionals to operate effective and profitable enterprises. Whether it is the daily care of patients or work in the laboratory, our ability to do what we love and what patients need is being pummeled. We have seen a federal government that seems uninterested in supporting the medical scientific community.
The funding by the federal government of rheumatology research is dwindling, and this compromises the careers of promising scientists. The portion of NIH grants awarded to rheumatology is unacceptable. The Committee on Research has vigorously requested more information on the grants-making process to better understand how these grants are distributed and to ensure rheumatology is fairly treated. Our advocates constantly press the need for more support for research.
CMS and other insurers are threatening our ability to give quality care to our patients. Some Medicare contractors have threatened to deny the professional administration of certain medications that can be self-administered by able patients. CMS will not understand that some patients simply cannot afford the cost of biologics covered under Part D and must use Part B to access effective treatment. Some Medicare contractors want to deny the costs associated with the infusion of the complex medications we use so effectively and safely to improve people’s lives.
We have even seen one insurer try to ration biologic care based on the deals they can achieve with manufacturers, not on the basis of what is right for the patient. A scheme was proposed to change stable patients to a different biologic medication based solely on the cost to the insurer. The ACR adamantly and successfully opposed this irrational threat to our patients.
One of the overarching themes of the year’s work was information technology. We are anticipating the debut of a website I am sure you will love.
A Privilege
This has been a wonderful and challenging year. I have cherished the honor and privilege of serving you. The counsel of an outstanding Executive Committee, including Bill St.Clair, Karen Smarr, Joan Von Feldt, Sharad Lakhanpal, Dave Karp and Eric Matteson, has fortified me in my mission. Our Board of Directors has been courageous in taking on difficult work, and I deeply appreciate their support and dedication.
The entire ACR staff has been pivotal in my ability to lead, and if I mentioned each of their contributions, there would be no room for anything else in The Rheumatologist this month! To mention just a couple: Mark Andrejeski leads a hard-working and talented staff; I highly regard his guidance and friendship. Julie Anderson is an extraordinary association executive whom I value deeply and who made the work of the president and the executive committee possible. Thank you, Julie. Presidents come and go, but the staff sustains the ACR.
Dr. Joseph Flood is president of the ACR and a rheumatologist at the Columbus Arthritis Center and adjunct professor of internal medicine in the Division of Rheumatology at The Ohio State University College of Medicine and Public Health, both in Columbus. Contact him at [email protected].
