Value of Patient Care Services in Rheumatology Gets Boost

Improved Performance

Rheumatologists can begin by measuring and analyzing the care they deliver to patients, especially in the area of outcomes, a necessary step to improve value and inform cost reduction. Patient outcomes are inherently disease-specific and multi-dimensional, encompassing a wide spec­trum of subjective and objective measures of disease activity, physical function and quality of life that must be validated for use in the clinical setting.

The ACR Quality of Care Committee is leading the way in developing more meaningful rheumatology performance measures, including concept development for an outcome measure over the next year. At the same time, the ACR has built the RISE Registry, which was launched last summer and enables providers to collect and analyze patient data at the point of care through electronic health records and to create customized dashboards for use in performance improvement.

What are the challenges? There are many logistical and financial barriers that will impede the ability of some practices to rapidly adapt to this new culture of performance improvement. Capturing data about costs is difficult with the complexity of reimbursement—an obfuscation of costs owing to differences between what is billed and what is paid—and the inadequacies of current information systems. Moreover, the delivery of patient care by a rheumatologist typically interfaces with multiple organizational units, such as the primary care provider, other specialists and hospitals.

The reality of this multifaceted structure for healthcare delivery raises the question of accountability—who is responsible for what outcomes—and brings to light the need for team-based care. Many physicians are not used to working in teams and sharing data. However, failure to face these challenges has consequences. If we don’t take creating value in healthcare seriously, it will impede innovation, foster micromanagement of practices (higher costs and less efficiency) and limit value-added services. Nobody wants to end up here.

Make Value a Priority

There is a light at the end of this tunnel. The ACR has created tools to begin measuring and analyzing patient outcomes. Improving the value of rheumatology care has to be a high priority. Waiting years for research to show the value of rheumatology care is not the answer.

Rheumatologists need to make progress on increasing value in their practices now to win the confidence of other stakeholders. We can’t afford to sit on the sidelines and let others define value for us.

E. William St.Clair, MD, is president of the ACR and chief of the Duke Division of Rheumatology and Immunology. Dr. St.Clair, a rheumatologist, has 25 years of experience as a clinical investigator. Contact him at [email protected].