The ACR team conveyed three distinct messages to Dr. Berwick. First, team members highlighted the ACR’s involvement with quality initiatives and developing outcome quality measures. They also discussed the loss of consultation codes, which disproportionately affects cognitive specialists such as rheumatologists, and the idea that ACOs should not be solely hospital-centered, but should include specialists such as rheumatologists.
“I believe Dr. Berwick was impressed that the ACR was very much involved in the quality arena, that we were developing a registry, had process measures, and at some point wanted to come out with outcomes measures,” Dr. Borenstein says.
Dr. Uknis told the CMS Administrator about the ACR’s history of quality programs, including those developed with the American Board of Internal Medicine for maintenance of certification. “He was interested in working with us to transplant our efforts into measures that CMS could incorporate into their quality programs,” she says. The ACR representatives stressed, however, that actual outcomes would need to be measured in years, rather than months, in order to show improvements.
Dr. Laing noted that his impression was that Dr. Berwick “would prefer to have different specialties develop quality metrics from within, rather than what everyone is afraid of—having them imposed from without.”
Regarding CMS’ elimination of consult codes, Dr. Laing told Dr. Berwick that, “without those codes, there is nothing in the CMS fee schedule that recognizes professional expertise. That’s a tragedy.“ Although Dr. Berwick thanked the ACR for its comments, “he didn’t respond per se,” Dr. Laing says. “He said he appreciated our bringing it forward, but it was a noncommittal reply. I think, however, that it was important for our message to be heard at that level. And I believe he heard it.”
In discussing ACOs, Dr. Borenstein provided three examples of patients he cared for where he made the diagnosis even though they had seen an internist in order to highlight the potential cost savings associated with seeing an appropriate specialist. “We were making the point that a patient-centered home wouldn’t really work unless individuals who had specific problems were able to see specialists early on,” he says.