With MACRA as the impetus, we should move quickly to address and adopt other changes in RA care, including examining and redefining healthcare professionals’ roles to promote a more patient-centric care model and to address the two major concerns of our patients: pain and functional impairment.
A measure of physical function distinguishes active from control treatments as effectively as formal joint counts or laboratory tests, and is more significant than abnormal laboratory tests or radiographic scores in the prognosis of most severe long-term outcomes of RA, such as work disability, costs, joint replacement surgery and premature death. While measurement of physical function by U.S. rheumatologists in routine care has increased over the years to 36%, the only quantitative data in routine care medical records remain laboratory tests and bone densitometry.
Rheumatologists may provide as much benefit to patients as any other type of doctor. However, that benefit cannot be documented effectively only with laboratory tests and imaging tests. Quantitative scores for physical function and pain obtained on patient self-report questionnaires are needed. Availability of these relevant scores could lead to the reduction of more expensive traditional measures, thus improving the physician’s MACRA profile. Collection of self-report data is feasible in the waiting area; the patient performs most of the work and saves time for the doctor, while improving documentation and doctor-patient communication.
All rheumatology healthcare professionals must incorporate quantitative measurement to best serve our patients’ needs and document effectiveness. Now that healthcare professionals are being held directly accountable for expenditures of healthcare dollars as part of the formula that determines our Medicare payments, we must become more directly engaged in costs using such strategies as bundling of services for disease states, including RA and SLE.
Examples of RA issues that we must steward include disease-modifying regimens for specific patients and at different stages of disease and how these treatments are monitored and modified. These are questions that remain controversial despite more than 20 years of drug availability.
The time is now. MACRA is here. Let us meet the challenge head-on and improve care for patients while improving the activities of our profession.
Terence Starz, MD, is a clinical professor of medicine in the Division of Rheumatology at the University of Pittsburgh School of Medicine and is in practice at Arthritis and Internal Medicine Associates–UPMC in the Western Pennsylvania area.
Theodore Pincus, MD, is affiliated with Rush University Medical Center in Chicago.
