Ex nihilo nihil fit

Members, guests, and staff, it has been my utmost honor and privilege to serve as President of the American College of Rheumatology this past year. I would like to thank, first of all, my family for their love, guidance, understanding, and patience during the numerous trips requiring time away from home. As I was preparing this talk, I realized that, with time, many of the problems that face us as rheumatologists change very little from year to year but affect different segments of our membership to varying degrees. Therefore, when looking for a title for this address, the term “Ex nihilo nihil fit” from Shakespeare’s King Lear came to mind: “Do nothing and nothing is what you get” or, more loosely translated, “Do nothing and you will not fail.” (1). From the onset of our organization in Philadelphia almost 70 years ago and the transition to the American College of Rheumatology 15 years ago, the ACR has never adopted this philosophy. As a diverse organization we encompass practitioners, clinician educators, both clinical and basic researchers, as well as rheumatology health professionals from varied sectors of the health care delivery system, all of whom have unique problems. Over the next few minutes, I would like to review where we have been and where, in my opinion, we should be going as an organization. I will do this in the context of phone calls received by the President over the past year from various segments of our organization. The first has to do with a call stating the ACR has done nothing with regard to proposed Medicare changes in reimbursement for infusion therapy. The caller wanted the ACR to lobby for maintaining the status quo. On the surface this seemed to be a reasonable request to the caller. Further discussion led to the following insights for the caller: In a previous time of legislative cutbacks, the ACR under the leadership of one of our past Presidents, Ron Kaufman, had the foresight to know that changes occur most frequently from within. The ACR became involved in all the important committees that report to the Centers for Medicare and Medicaid Services. Through hard work and education of other committee members, reimbursement to rheumatologists increased when other specialties remained flat or decreased. This was based on the practice expense of rheumatologists and the time required to see our patients. CPT codes that more clearly reflect the types of injections we do were put into effect to again facilitate reimbursement to rheumatologists that was previously being denied. Is reimbursement fair? Of course not! However, it would have been worse if we did not, as an organization, proactively get involved in the thankless task of interacting on the various national committees to educate others in what we do as rheumatologists. With regard to therapy, our position has been consistent and vocal. The message has always been equal access to therapy for all patients. As a result of research done by our members, patients have access to therapies that, for the first time, have remarkable benefit. Is it right that patients on Medicare without a prescription plan do not have access to injectable therapies? Of course not! The policy of covering only infusion therapies denies Medicare recipients access to other potentially efficacious therapies. Like it or not, medicine has become a business. Just like other businesses, we cannot remain in business if we lose money because time and costs are not reimbursed; thus, the impetus by the College to get fair reimbursement for infusions, whether done by rheumatologists or other specialists. Will reimbursement remain the same? Of course not, but it will more accurately reflect what we do as rheumatologists. The College needs to make its membership more aware of what it Presented at the 67th Annual Scientific Meeting of the American College of Rheumatology, October 27, 2003. Raphael J. DeHoratius, MD: Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania: President, American College of Rheumatology, 2002–2003. Address correspondence and reprint requests to Raphael J. DeHoratius, MD, Jefferson Medical College, Thomas Jefferson University, Room 613 Curtis, 1015 Walnut Street, Philadelphia, PA 19107-5099. E-mail: raphael.dehoratius@jefferson.edu. Submitted for publication October 29, 2003; accepted October 29, 2003.