We are privileged to be practicing medicine in a time of unsurpassed scientific advances and innovative therapeutics. We are also practicing during a time in which government and managed care policies affect our ability to implement these advances for our patients. When you call upon a government official, or managed care decision maker, you will frequently be asked: “Who are you with?” or “Whom do you represent?” If you represent only yourself, there is little chance you will be heard, or have much impact. If NYSRS’s leaders and representatives can represent all the state’s rheumatologists, they will be heard, and they can and have had impact. With the state and federal government in the arena of formulary development and management, rheumatologists must educate policy makers about the diseases we treat, how they affect our patients, and the importance of access to care.
Recently, for example, based upon an article published by the AAOS, the New York State Medicaid formulary dropped coverage for hyaluronans. We are working to reverse this unfortunate decision. NYSRS has as of its 2014 meeting formed a Payer and Policymaker (P&P) Committee, chaired by Howard Blumstein MD, who also chairs the ACR Affiliate Societies Council. The P&P Committee will meet again at the Annual Meeting on May 29-31, and will report its activities during the business meeting. NYSRS also played a significant role in working with our Medicare Carrier, NGS, to deflect the implementation of the “SAD” ( Self Administered Drug) list, which would have forced all Medicare beneficiaries currently receiving the IV option of a biologic to switch to the subcutaneous version, regardless of whether they were willing to self administer, or whether financial consequences would force them off treatment. NYSRS also was active together with other state societies in the effective push back against the United Healthcare “no grandfathering” policy initiative in the summer of 2014 that would have forced many of our patients to switch biologic therapies, even those having a good response, without the grandfathering in of current treatment.
There are challenges that confront our subspecialty that affect every rheumatologist, regardless of professional orientation. By organizing, those of us who have joined NYSRS have been better able to effectively work together and make our positions, thoughts and opinions known. We hope that all rheumatologists in New York State will join us this year. In an increasing number of other states and communities, rheumatologists are coming together in formally structured organizations, to enhance their ability to work together effectively. The leadership of the American College of Rheumatology has recognized the importance of state societies, and allocated significant resources to support state societies through the Affiliated Societies Counsel (ASC).
I am honored to have served as your President. I have spent many hours over the past year committed to NYSRS, and commit to continuing to devote my passion and energy to this organization. I believe we have become a statewide organization of colleagues and friends – who teach one another, and help one another, and I know we share the same collegial goals: working on behalf of our patients, whether in the same way or in many different ways.
Max Hamburger, MD