As a QCDR, RISE taps into electronic health records and captures the entirety of a practice’s patient population; thus, physicians using it don’t need to take extra steps for reporting through the MIPS pathway. RISE is valuable because rheumatologists are too small a market for information technology vendors to create additional carve-outs, says Dr. Adams.
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“You can measure the quality of your work across many clinical quality measures and compare your performance against your practice partners and regional and national peers,” says Dr. Kazi, who adds that, in terms of MACRA, “We have a recipe for this, but we haven’t cooked the meal yet. We have patient numbers, ZIP codes, practice size, insurance information, all of which can provide elements needed to benchmark the cost of episodes of care each year.”
And RISE presents rheumatologists the chance to chart their own course on the MACRA sea.
“We really need to demonstrate the value of rheumatology by having our own information, so we’re not dependent on others defining what’s important,” Dr. Kazi says. “If we do it ourselves, it gives us a voice we don’t otherwise have, backed by data and numbers.”
In addition to adapting RISE, Dr. White says the ACR is exploring other opportunities for rheumatologists in a new reimbursement environment. For example, although the Bundled Payments for Care Improvement Initiative (BCPI) is not currently a qualified APM, Dr. White says he suspects “the concept behind it will drive emerging APMs as we move forward, especially in subspecialty diseases.”
For example, a rheumatologist may receive a fixed sum to care for a patient in their first year following a rheumatoid arthritis diagnosis. “But we need a lot more information before we can figure out what’s tenable and what’s not,” Dr. White adds.
Or, rheumatologists may consider a specialized medical home model, which could potentially be considered by CMS as an APM. Rheumatologists would need to assume accountability for patient-level outcomes and spending, since rheumatology patients have chronic, lifelong illness and “rheumatologists function as primary care physicians,” for many of them, Dr. White says.
“We’ll see what emerges,” he adds.
ACR representatives recently met with Congressional staff to share concerns and ideas, and Dr. Adams says the feedback they received was “encouraging.”
However, the cost to rheumatologists, particularly those in small or solo practices, must be taken into account, Drs. Herzig and Adams both say.
“Some doctors will look at their Medicare income, see what percentage of Medicare they have in their practice and decide whether a 4% cut is worth it or not,” Dr. Herzig says. “What doctors need to know is they need to have real control of their budget. If they know what their budget is and look at what percentage of Medicare is their budget, they can figure out what that means to them.”