WASHINGTON, D.C.—With the 2008 presidential election refocusing attention on healthcare reform and purchaser-driven pay-for-performance (P4P) initiatives prominent in the news, speakers at the Rheumatology Quality Stakeholders’ Summit here urged the ACR to accelerate its development of quality indicators in rheumatology.
A Quality Head Start
The ACR already has developed starter sets of quality indicators for RA, osteoporosis, and gout. The ACR also plans to launch a quality-management tool (which will include a central data registry) for rheumatic disease and drug monitoring measures in October 2008 at the ACR Annual Scientific Meeting.
“Your task is to develop a list of validated measures in one year for every disease you treat,” said Robert Brook, MD, ScD, vice president of RAND, a nonprofit research organization, and director of RAND Health in Santa Monica, Calif. “Determine where the holes are, and go to AHRQ [the federal Agency for Healthcare Research and Quality] and get them studied.” The ACR then needs to maintain and implement this comprehensive, clinically detailed set of quality-care indicators. “This is going to be a fundamental change. … I hope you force this agenda in a way that makes consistent sense,” added Dr. Brook.
The timing of the summit, held on Sept. 20, 2007, now seems prescient. On Sept. 28, Health and Human Services Secretary Michael Leavitt announced that the Centers for Medicare and Medicaid Services (CMS) will use Medicare data to generate physician quality performance–measurement results, which will be released at the community level. The quality measures will be consensus-based measures adopted by the AQA Alliance, a national coalition of health quality stakeholders, and endorsed by the National Quality Forum (NQF), a not-for-profit organization that creates strategies for national healthcare quality and reporting. Leavitt said release of the quality information supports CMS’ value-driven healthcare initiative, which seeks to create a system of better care at lower costs.
Rheumatologists can and should develop their own quality indicators—rather than having them superimposed by an outside entity—but the challenge is formidable, said Daniel H. Solomon, MD, MPH, associate professor of medicine and associate chief of Harvard Medical School’s Division of Pharmacoepidemiology and Pharmacoeconomics in Boston, and a member of The Rheumatologist’s editorial board.
“We’ve attempted to be proactive, but the landscape is changing rapidly,” said Dr. Solomon, who chairs the ACR’s Quality Measures Subcommittee. “It’s a tremendous task for a small specialty society. We want to make sure that what we do is practice friendly. The goal is to integrate quality measures into recertification programs.”
I think we have lots of data showing that we have room for improvement….It’s well documented that measurement leads to improvement.
Process Tracking to Outcomes Measures
Dr. Solomon, Dr. Brook, and other speakers noted some unique challenges to developing quality measures within rheumatology. Currently, most rheumatology quality measures are process measures rather than outcomes-based measures, such as whether a diagnosed RA patient is being treated with a disease modifying antirheumatic drug (unless there is a contraindication or inactive disease, or patient refusal is documented). The reason for focusing on process is that many rheumatologic diseases are chronic and require long-term management. Measuring outcome is difficult in the usual time-frame for this type of assessment. Management also involves many fewer procedures than, for example, cardiology. But, noted Dr. Solomon, “We want to move from process measures to outcomes-based measures.”