Measuring Quality of Care Is Here to Stay—and the ACR Can Help

Imagine a patient comes into your office with active RA or lupus. You diagnose her and prescribe medications for her active disease—rash, arthritis, and so forth—but you do nothing to address possible long-term complications. You don’t prescribe calcium or vitamin D to prevent osteoporosis, you don’t get a bone density scan, and you don’t order labs to check risk factors for heart disease.

Does this sound odd to you? Of course it does. Rheumatologists routinely deal with situations that require them to think about both acute and longer-term issues, both of which are vital to the well-being of their patients.

Addressing patients’ immediate concerns while ignoring their long-term needs is not good clinical practice. But, how often do you apply these same principles to the business side of your practice?

Understandably, your days are spent dealing with immediate, pressing issues—seeing as many patients as possible, keeping up with the demands of running your practice, attempting to stay abreast of the latest in rheumatology research and patient care, trying to meet RVU targets; and handling administrative, research, and education responsibilities. It is a struggle to prioritize and eventually address everything that needs your attention, and it is tempting to only give consideration to the most immediate concerns and crises. Finding the time and energy to proactively plan for the future can be difficult.

Professional organizations deal with a similar challenge to face present-day needs while also planning for the future. However, if it is to be successful, an organization must also plan for the future of the organization and its members. The ACR is no exception.

Apply This to Quality

One area where this is especially true is quality. Rheumatologists and rheumatology health professionals deal with daily demands from payers and others to demonstrate that they provide high-quality care for their patients. Provider rating systems and tiered networks where patient co-pays are determined by a provider’s designated “quality” level are becoming more numerous, and these programs are not always transparent or based solely on the best clinical care. Practitioners are being asked to participate in pay-for-performance (P4P) or, at minimum, pay-for-reporting programs, but these programs don’t all have the same requirements or use the same measures. Practitioners and their staff can easily spend considerable time that might otherwise be spent on patient care just trying to document and deal with the requirements of these programs.

The ACR is dedicated to helping its members with these issues. Although we don’t have all the answers—we’re learning as you are—rest assured that your professional association is advocating on your behalf.

ACR staff and leadership have met with insurers to discuss—and to try to influence—their programs. The ACR has been involved in discussions with national quality organizations that develop and endorse measures. Finally, the ACR has conducted interactive, informative meetings with other professional societies dealing with similar quality issues. The ACR continues to build these relationships, which will ultimately benefit individual members in the years to come.

The ACR’s message on quality is simple: Delivering high-quality patient care is paramount to rheumatologists and rheumatology health professionals.

Although payers and others are increasingly holding providers accountable for the quality of care they deliver—a trend the ACR believes is here to stay—payers should not impose P4P or other reporting programs on providers that contain anything but a standard set of provider-approved and nationally recognized measures. Any performance-reporting program from payers should include adequate compensation to providers in exchange for their participation. The ACR’s positions on quality measurement will be outlined in a 2009 white paper, which will be posted in draft form for member comment and, once finalized, distributed to payers and other interested parties.

Introducing the ACR Rheumatology Clinical Registry

To help its members measure the quality of care they deliver—whether for reporting or their own tracking purposes—the ACR will roll out a Rheumatology Clinical Registry (RCR) in 2009.

The RCR will be offered to members at no charge and will allow them to participate in the Centers for Medicare and Medicaid Services Physician Quality Reporting Initiative through more efficient registry-based reporting rather than through claims. The RCR will be interoperable with the ACR Performance Improvement Modules, so it will be especially easy for the almost 50% of ACR members who must recertify to use both the RCR and the PIMs and only enter their data once. Finally, the ACR is working to make the RCR interoperable with electronic medical records for the benefit of those members who use them.

The ACR understands that you will have to continue to put out your daily fires, but you are invited to be proactive alongside the College in addressing the issues of the future before they become your present day crises.

Over the next few months, you will hear more about the RCR and other ways the ACR is proactively dealing with quality issues that will affect you more and more in the future.

For more information about the ACR’s quality activities or the RCR, contact Amy S. Miller, senior director of research, training, and quality, at amiller@rheumatology.org.