“Within rheumatology, there are simple activities that should be done with every patient that are not always being done, such as tests carried out at baseline and subsequently every eight weeks for patients on methotrexate,” says Dr. Kazi. “Most rheumatologists just need a reminder. So, when a quality system is put in place, the reminder pops up at the right time. Ultimately, this type of approach will improve care for all patients.”
Dr. Kazi acknowledges that his experience through the VA has been relatively pain-free because the investment in a VA-wide electronic system to gather data and monitor performance and outcomes was spread over hundreds of physicians and multiple locations. In addition, the VA currently offers its physicians bonuses for good performance and has no penalty system.
“It’s important that the ACR offer its members a tool that can help them to efficiently meet the requirements of quality-based programs regardless of where they practice,” he says. He stresses that obtaining buy-in—convincing members that this is the way medicine will be practiced in the future—is the most important goal.
Quality Measures that Make Sense
The ACR is no stranger to the concept of quality care for rheumatic disease. For many years, the College has been at the forefront of authoring guidelines and recommendations for the diagnosis and treatment of rheumatic diseases. However, once the ACR recognized that quality measurement requirements would be linked to rheumatology reimbursement, the ACR saw a significant opportunity to gain a foothold in crafting measures that make sense.
As the quality movement gained momentum, the ACR realized that the implications of this movement are much wider than just developing criteria and treatment guidelines. In rheumatology, in particular, the ACR has the opportunity to establish evidence-based guidelines, which will then be used as the basis for performance indicators designed to measure the quality of care that is delivered.
To this end, the ACR has embarked on a comprehensive program to establish its leadership in the quality field on issues pertinent to the treatment of rheumatic disease. The initiative aims to continue to develop recommendations for the care of patients with rheumatic diseases and quality performance indicators, or QPIs, for most rheumatic diseases, as well as to educate rheumatologists and rheumatology health professionals about the quality movement.
The College will also reach out to key stakeholders (private insurers, employers, federal agencies) to educate them about the ACR’s activities, encourage adoption of the ACR’s measures, and support rheumatologists who care for patients according to the ACR’s recommended approach. The ACR recognizes that collaboration with outside organizations is vital to its goal of representing the interests of rheumatologists in the quality movement.
Mending Quality’s Bad Rap
Mark Robbins, MD, a rheumatologist with Harvard Vanguard Medical Associates in Boston, expressed possible reasons why many of his rheumatology colleagues might mistrust the linkage of quality measurement to physician reimbursement.