“Physicians have seen quality measurement and improvement initiatives that initially begin as bonus incentive systems deteriorate into reimbursement withholds or financial penalties for noncompliance,” he says. “In addition, physicians remain skeptical on the validity of quality indicators chosen and even whether action on these indicators truly leads to improvements in clinical care.
“Colleagues also ask me how, in a time-bankrupt environment—where we have little or no time to devote to anything else, much less this—they are supposed to devote more time from clinical care to quality reporting, or how such a system will address issues of differences between physicians and practices in patient severity of illness, which could skew their outcomes data,” he continues. “These are both valid concerns.”
Dr. Robbins sees ACR’s role as critical to ensuring that measures are chosen and their implementation in practice is both clinically and administratively reasonable. “Quality measurement and reporting will be another burden for the practice, but the best edge we can gain is for the ACR to develop measures that are intuitive and not too burdensome to capture,” he says. “In the end, would you rather have a group of your colleagues select and validate the measures or your local healthcare insurer?”
The ACR recognizes that developing QPIs will be a large task requiring long-term commitment and significant funding. Most importantly, the College understands that the success of its effort will depend heavily on the participation of ACR members—from supporting the ACR’s involvement in the quality movement to contributing practice data to provide a robust database on rheumatology care and outcomes, which will serve as a means to validate the quality measures.
For this reason, the ACR’s Quality of Care Subcommittee—which is chaired by Larry Anderson, MD, a rheumatologist and director of quality improvement of MaineHealth in Portland, and is part of the Quality Measures Committee—is examining options for data gathering and reporting. Its goal is to make an inexpensive, easy-to-use tool available to all members that will be provide decision support, and permit members to contribute their anonymized data to a central ACR database to analyze outcomes. Options under consideration include creating a Web-based registry that rheumatologists can log in to and working with some of the leading electronic medical record vendors to adapt one of their products for use.
A Quality Triumph
Murray Passo, MD, clinical director of rheumatology at Cincinnati Children’s Hospital, is a pediatric rheumatologist at an institution regarded as a pioneer in the quality movement. Six years ago, Children’s Hospital joined a Robert Wood Johnson Foundation initiative to improve the quality of acute and chronic patient care. The results can be clearly demonstrated in quantitative terms.
