High-Impact Rheumatology Practice Redesign

How should rheumatologists get started in practice redesign?

• Begin by recognizing that redesigning our practices and health systems is an unavoidable necessity.
• Form an improvement team, meet regularly, and begin using continuous improvement methods to redesign your practice processes.
• Assess your practice’s strengths and weaknesses in these high-impact aspects of practice: process standardization, clinical data and disease management, team practice, IT resources, access to care, and system-based interdisciplinary care.
• Choose one or more problem areas, measure current performance, begin improving, and keep going.
• Develop an RA patient list, and begin calculating and documenting each patient’s disease activity in an Excel spreadsheet or in a disease management software program.
• Look for opportunities to participate in building interdisciplinary management programs with other interested colleagues in your health system. Hospitals will be increasingly at risk financially for “accountable care,” and those of us who help them in meeting their requirements will be rewarded.
• Try, learn, and try again.

We hope you will join us in redesigning the rheumatology practice.

Dr. Harrington recently retired from the division of rheumatology at the University of Wisconsin School of Medicine and Public Health in Madison, and is a partner in Joiner Associates LLC. Dr. Newman is director of the department of rheumatology and vice-chair of the division of medicine at Geisinger Health System in Danville, Pa.

References

1. Harrington JT and Newman, ED, eds. Great Health Care: Making It Happen. 2012. New York: Springer.
2. Phillips LS, Twombly JG. It’s time to overcome clinical inertia. Annals Intern Med. 2008;148:783-785.
3. Smolen JS, Aletaha D, Bijlsma WJ, et al. Treating rheumatoid arthritis to target: Recommendations of an international task force. Annals Rheumatic Dis. 2010;69:631-637.
4. Deal CL, Hocker R, Harrington T, et al. The United States rheumatology workforce: Supply and demand, 2005-2025. Arthritis Rheum. 2007;56:722-729.
5. Maddison P, Jones J, Breslin A, et al. Improved access and targeting of musculoskeletal services (TEAMS) programme. BMJ. 2004;329:1325-1327.
6. Harrington JT, Newman ED. Rheumatology and the patient-centered medical home: Is it the end of the tunnel or an oncoming train? The Rheumatologist. 2010;4;1:16-18.