Dr. Paget’s EAC at the Hospital for Special Surgery is considered by many to be a model EAC. He says he got referrals with the help of a $1-million private donation. “Each medical group or center will have its own way to set up an EAC,” he says. “What we focused on was clinical and basic research, and on getting the word out.” His team developed a Web site, designed programs for patients, met with managed care and third-party payers to develop practice algorithms, and met with community organizations to recruit and educate patients. The hospital public relations staff arranged local news stories, and an advertising agency was hired to prepare educational ads for the public.
However, Dr. Paget says physicians don’t need a large financial windfall to start an EAC. “It’s very simple to do some of the things I’ve mentioned. My personal feeling is that what’s necessary is a partnership with pharmaceutical companies (particularly ones making drugs for arthritis), with academic medical centers, the American College of Rheumatology, and the Arthritis Foundation. They are already getting the word out, but more needs to be done.”
EAC with a U.S. Twist
Noting that a European-style EAC is not ideal in the U.S., Dr. Cush says “the vast majority of rheumatologists need alternative ways to take early RA patients in their practices.” He suggests using one or more of the following models:
- A once-a-week clinic;
- A physician extender (nurse practitioner, physician assistant) for intake/screening;
- Chart reviews to prescreen and avoid wasted time;
- Physician-to-physician phone calls for consultation;
- Flexible scheduling (hold spots, then fill with regular patients if early RA patients don’t come); and
- “Meet and Greet Rapid Slots” scheduled on top of regular office visits, where a patient fills out a questionnaire, the rheumatologist does a joint exam and makes a spot decision, then asks the patient to come back for tests and/or an appointment.
“The reason to have an EAC,” says Dr. Moreland, “is for a system in place for academic centers to do research and develop databases. In private practice, an EAC may help rheumatologists see patients sooner, rather than later.”
Sue Pondrom is a medical journalist based in San Diego.
