ACR members are spread out across the U.S., but we all work in the same place: the land of fee for service. FFS, as it’s known to policy nerds, poses certain problems for cognitive subspecialists like rheumatologists. For instance, much of the work we do—calling providers and patients, coordinating care after hours—often isn’t compensated. And some of the tasks we perform, prior authorizations being at the top of the list, take up ever-increasing amounts of time and energy but seem far removed from patient care.
The result? It feels like our day-to-day activities are more and more about money—getting an expensive medicine paid for or justifying our bill—and less and less about taking care of patients. In fact, it has been observed that administrative burdens may actually impede our ability to provide high-quality care.
Rheumatologists are not the only ones who think FFS has problems. But those who pay for healthcare see the cost of FFS as the burden. Indeed, CMS has determined that FFS is so expensive that it poses an existential threat to Medicare and Medicaid. Importantly, in their estimation, these programs are not simply strained by the baby boomer bulge working its way through the system. Rather, CMS has decided that the very structure by which physicians and hospitals are reimbursed drives up the cost of care.
So the powers that be have decided that we are going to move. We are moving from the land of FFS to a place called “value-based care.” And even though we know that FFS has problems, we resist. In particular, we question whether value-based care as promoted by CMS will truly encourage the delivery of high-quality care to our patients.
Individual rheumatologists have had a range of responses to being moved from FFS to value. Some retire. Some lobby Congress. Some join a larger group in hopes that a dedicated infrastructure will provide shelter. Most of us focus on our patients and grumble about how it’s difficult to practice amid the tumult. But a few rheumatologists have done something different: a few have engaged CMS in a conversation.
And this is where things get interesting. It turns out that CMS knows where it wants rheumatologists to go, but doesn’t know how they should get there.
The ACR would like to provide a map. A group of ACR members, under the auspices of the Committee on Rheumatologic Care and with the invaluable support of other ACR committees, including Government Affairs, Quality of Care and the RISE Registry, are currently engaged in a conversation about how rheumatologists can inform the definitions of quality and cost such that a value-based payment system would be better than FFS for patients and physicians. We started this conversation with the understanding that we can either influence the path we take, or the path will be selected for us by people who have never practiced rheumatology, much less run a rheumatology practice.