Our purpose in this perspective is to describe clinical process changes for rheumatology practices that will have a high impact on the value of our services and support a brighter future for the patients we serve as well as our practices and our specialty. These ideas are drawn from physicians and nurses who manage various chronic diseases within high-performing specialty practices and health systems, and who contributed to our recently published book, Great Health Care: Making It Happen.1
Why Focus on Redesign?
The Centers for Medicare and Medicaid Services have launched a four-year initiative that mandates step-wise adoption of “certified” electronic health records (EHRs), electronic prescribing, a shift to more demanding ICD-10 diagnostic coding, reporting of quality measures through the Physicians Quality Reporting System, and the documented meaningful use of information technology (IT) to improve the processes and outcomes of care for Medicare, Medicaid, and other patients. Initial financial incentives will be provided, followed by payment penalties for not participating. These changes will be difficult at times, failures will be possible, and their adoption will transform practice as we know it.
The ACR has initiated educational, policy, and support programs to brace rheumatologists for the requirements mandated by the Patient Protection and Affordable Care Act and the Health Information Technology for Economic and Clinical Health Act. The question remains as to whether rheumatologists will respond to these imperatives, are prepared to perform the work of change, and understand what priorities are most important to make us successful. The large percent of our specialty in independent, single-specialty practices contribute to these daunting challenges.
“The Biggest Bang for Our Buck” Changes
Changing clinical processes in real time and the work involved in doing so are challenging. Most of us were not taught the clinical process methods required to accomplish meaningful redesign of complex systems, unlike managers in other U.S. industries who use them routinely to continuously improve performance. We wrote Great Health Care to provide this information for physicians treating chronic diseases as well as faculty and trainees charged by the Accreditation Council for Graduate Medical Education (ACGME) to prepare for system-based care and continuous quality improvement. We suggest the following priorities based on our own experiences and those shared by our contributing authors. These priorities are often interdependent, and once addressed, they should be pursued over time to their full advantages.
Standardizing Clinical Processes
Jerry Yee, MD, Mark D. Faber, MD, and Sandep Soman, MD, of the division of nephrology and hypertension at the Henry Ford Health System in Detroit, Mich., begin their chapter in our book like this: “What follows is how our group of nephrologists transformed the delivery of healthcare to our patient population with chronic kidney disease over eight years. This required significant changes in our mindset and attitudes. The changes primarily involved adopting a highly automated and protocol-driven style of care that was geared toward efficiency without a sacrifice in quality.”