The study report highlights one rheumatology practice that tested other strategies to reduce wait time for early arthritis patients with success.
“Within several months of implementing this strategy, the wait time for an appointment in the department fell from about 60 to 25 days,” according to the workforce study report. “Nine months after implementation, wait times declined to two days. The department also saw improvements in cancellation rates which fell from about 40% to 20%.”
Likewise, the report cited a chronic care model developed in the 1990s as one that has been used by some rheumatologists. This model suggests that care needs to be changed from episodic to continuous treatment. One idea proposed is to encourage the implementation of the chronic care model into current medical education curriculum. “Through this implementation, students will learn how the biology of chronic disease evolves and the [effects] of treatment as well as how physicians can efficiently use available treatment and other resources.”
The ACR workforce report suggests that physician specialists can improve their ability to treat patients by creating a multidisciplinary team approach to care management and, as part of this team, should hire a nurse practitioner or a physician assistant to perform routine duties that are now covered by the rheumatologist.
Another factor cited in the study report is the effect of Medicare coverage on practice. Changes in Medicare payment policy and the policies of other insurers for rheumatology services are important considerations. These include a cut in Medicare reimbursement for drug costs for on-site infusion services from 95% to 85% of the wholesale price as of January 2004. At the same time, as part of the provisions of the Medicare Modernization Act of 2003, Congress increased reimbursement for practice expenses by 32% in 2004. Beginning in 2005, a formula called the average sales price is used to calculate reimbursement. The report states this new formula increases payment to physicians to 106% of the average sales price.
However, “the change in reimbursement for on-site infusion is likely to result in decreased reimbursement of infusion drugs for rheumatoid arthritis. This may result in rheumatologists needing to reduce the number of sites where a patient can receive infusions as well as the size of the staff at the sites,” the report notes.
Teamwork on Patient Histories
Dr. Harrington notes that one particular area in which rheumatologists can use the NP or PA to help is in taking the patient’s medical history. First, he stresses, patients must bring all of their records—including lab results and X-ray films—with them to the initial appointment. Second, many rheumatologists are still doing their own narrative histories with patients, but having a PA or NP do this can save an average of 10 minutes per patient and close to double the number of patient appointments available in a day.
