A recent statement about biosimilars, for example, tackled concerns over non-medical switching of prescription drugs. “This is an important issue because cost containment should not be the only focus in the care of patients,” notes Dr. Soloman. “Constant switching from one drug to the next based on cost is a dangerous practice in as much as it can affect the patient’s overall outcome [because] it is not based on clinical indications. The statements always put patient care, the rheumatologist’s expertise and their joint decision-making relationship at the forefront.”
CORC meets regularly to discuss the pros and cons of the issues before it, to identify good practices and policies, and to determine how best to present key points. The committee comprises rheumatologists and interprofessional team members from across the country who routinely treat patients, so they bring broad perspectives to issues considered for position statements, notes Dr. Snow.
The statements always put patient care, the rheumatologist’s expertise & their joint decision-making relationship at the forefront. –Dr. Soloman
“We craft the statement, finalize it and submit it to the ACR Board of Directors for discussion,” he says. “As the CORC chair, I answer questions from the board regarding the statement and why we think it’s needed.”
Ultimately, the ACR Board of Directors votes whether to approve the statement. If not approved, it goes back to CORC for additional discussion and possible revision. In some cases, the scope of a statement may shift or expand through this process. The ACR’s newest position statement, on infusions in community rheumatology practices, was initiated in response to member concerns about the practice of white bagging, which limits how physicians can acquire provider-administered drugs. Through discussions, CORC and the Board ultimately developed a broader statement about infusions in a community practice setting.
Statements also evolve over time with changes in science and changes in practice, Dr. Snow says. All are reviewed every four years or sooner if a circumstance arises that requires updates or changes to a position statement.
For some position statements, the review may entail a quick discussion and a few hours to update wording before submitting for board approval. Others may take months to research and debate, craft language and revise before the statement is ready for final review, says Dr. Snow.
Occasionally, CORC moves to retire a position statement, as the committee did recently with a statement on maintenance of certification. This topic had generated a lot of frustration and debate in the past, but those concerns have been addressed and the process is much improved now, says Dr. Snow.
