Through the development of position statements that lay out the ACR’s official stance on issues related to the management of rheumatic and musculoskeletal conditions, the ACR Committee on Rheumatologic Care (CORC) helps outline policies that affect the practice of rheumatology and the well-being and care of patients. Advocacy for rheumatologists and their patients is a high priority for CORC, which addresses concerns related to drug costs and safety, patient access to care, professional support and more.
Dr. Soloman
Nehad Soloman, MD, FACR, Arizona Arthritis & Rheumatology Associates, Phoenix, and a current member of the ACR Board of Directors, recently served on the committee and describes it as one of the most critical arms of the ACR organization. The committee “continues to work tirelessly on behalf of the rheumatology community on major issues that affect day-to-day practice and has led efforts to thwart various threats to our ability to practice medicine effectively,” he notes in an email.
Current CORC chair Marcus Snow, MD, FACR, assistant professor, the University of Nebraska Medical Center, Division of Rheumatology, Omaha, cites the ACR’s position statement on biologics as an example. “Biologics are part of our toolkit to treat patients,” says Dr. Snow. “Because they’re very expensive, insurance companies and pharmacy benefit managers try to put restrictions on their use.” The position statement outlines concerns, along with key points to guide policy development, regulation and the administration of these complex medications. It also underscores the importance of maintaining access to treatments that are medically necessary for many patients with rheumatic disease.
Dr. Snow
Establishing Positions
The ACR’s position statements cover a variety of issues related to access and coverage, research, treatment and the role of rheumatology in patient care. All are publicly available on the ACR website for reference by rheumatologists, government agencies, such as the Centers for Medicare & Medicaid Services (CMS), and other interested groups and stakeholders.
Not sure a position statement is important to your practice? Dr. Snow says an ACR position statement can be a useful reference for rheumatologists to cite when appealing denied patient insurance claims, for example.
The process of developing a position statement typically starts with the identification of a need or issue that affects the practice of rheumatology or patient care. Members of CORC may initiate discussion within the committee, and they also welcome suggestions from the rheumatology community about issues that are turning up in practices, notes Dr. Snow.
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.
Improving the Practice of Rheumatology
Rheumatologists face different challenges depending on various factors, including their type of practice and whether they practice in urban or rural areas, notes Arundathi Jayatilleke, MD, CORC member and director of the rheumatology fellowship program at Temple University, Philadelphia.
Dr. Jayatilleke
“The ACR is working to represent all its members,” says Dr. Jayatilleke, who co-authored a position statement on telemedicine. “So when we make these position statements, we try to incorporate all of those points of view” while also prioritizing the needs and interests of patients.
She has found her experience serving on CORC to be both worthwhile and enjoyable, and would recommend it to other rheumatologists.
“In general, just having people become more comfortable with volunteering and serving on the committee is important,” says Dr. Jayatilleke. “It’s great to get some experience … and to have a good mix of people with different perspectives on all the committees.”
Dr. Soloman got involved with the committee through a colleague’s recommendation. Before that, “frankly, I didn’t even know that these positions existed for non-academic rheumatologists,” he states. “I found the experience to be quite rewarding and I believe that the committee’s focus has been geared to championing grassroots issues that affect all rheumatologists.” He recently cycled off CORC and now serves as a member of the Board of Directors.
The work done by CORC helps show that you have a voice in the field of rheumatology, says Dr. Snow.
“There are a lot of frustrations that can pop up in practicing medicine, and when I joined the committee I didn’t realize how refreshing it is to try to be part of the solution,” he says. “You can try to make things better and we are able to do that at times.”
ACR members interested in bringing an issue to the committee or volunteering to serve on it can contact the ACR at [email protected] for more information or reach out to Dr. Snow or any other member of CORC. Nominations for ACR volunteer positions are also now open for any ACR member interested in serving on CORC or other committees.
Catherine Kolonko is a medical writer based in Oregon.
