ACR leaders met with Centers for Medicare and Medicaid Services (CMS) Administrator Donald Berwick, MD, November 15, 2010, to discuss key issues affecting rheumatology, including quality measurements, the elimination of consultation codes, and accountable care organizations (ACOs).
ACR President David Borenstein, MD, ACR Government Affairs Committee Chair Tim Laing, MD, and ACR Treasurer Audrey Uknis, MD, all reported that the meeting was very positive and that Dr. Berwick was engaged in the issues and open to discussion.
“He was willing to say we had helped his understanding,” Dr. Borenstein says. He was pleased and somewhat surprised to hear Dr. Berwick say the ACR had informed him about things he didn’t know. “You don’t hear that very often in Washington, D.C.,” Dr. Borenstein says.
“He was interested in what we had to say,” Dr. Uknis adds. “He was paying attention to the important points we made about the differences in the practice of rheumatology and our chronically ill patients in general, the special needs of our patients and of rheumatology practitioners.”
ACR Participates in Healthcare Meeting
On December 17, 2010, Drs. Borenstein and Laing attended a special meeting with President Obama’s healthcare advisor, Ezekiel Emanuel, MD, PhD, and Dr. Berwick that included representatives from prominent healthcare organizations and medical societies. During the first part of the meeting, the attendees discussed quality, safety, and efforts to prevent hospital readmissions.
“I pointed out that we try to keep people out of the hospital [in the first place] so they don’t need to be readmitted,” Dr. Borenstein says.
Dr. Laing noted that one statistic shared with attendees was that, by 2015, 9% of all hospital payments would be tied directly to quality and safety.
The second part of the meeting covered ACOs and how they would be organized. “We pointed out that we needed a different kind of organization or entity for specialists such as rheumatologists,” Dr. Borenstein says. The response was that ACOs can come in different forms and don’t necessarily have to be hospital centered. “Physicians need to think inventively on how an organization might be developed so that outpatient specialists are involved,” Dr. Borenstein says.
Dr. Laing added that, “the administration here is clearly interested in engaging the medical profession and I encourage all our members and all physicians to reach out and comment to them. My impression is that they don’t really know what the landscape is going to look like once these ACOs start to form.”
Key Messages
The ACR team conveyed three distinct messages to Dr. Berwick. First, team members highlighted the ACR’s involvement with quality initiatives and developing outcome quality measures. They also discussed the loss of consultation codes, which disproportionately affects cognitive specialists such as rheumatologists, and the idea that ACOs should not be solely hospital-centered, but should include specialists such as rheumatologists.
“I believe Dr. Berwick was impressed that the ACR was very much involved in the quality arena, that we were developing a registry, had process measures, and at some point wanted to come out with outcomes measures,” Dr. Borenstein says.
Dr. Uknis told the CMS Administrator about the ACR’s history of quality programs, including those developed with the American Board of Internal Medicine for maintenance of certification. “He was interested in working with us to transplant our efforts into measures that CMS could incorporate into their quality programs,” she says. The ACR representatives stressed, however, that actual outcomes would need to be measured in years, rather than months, in order to show improvements.
Dr. Laing noted that his impression was that Dr. Berwick “would prefer to have different specialties develop quality metrics from within, rather than what everyone is afraid of—having them imposed from without.”
Regarding CMS’ elimination of consult codes, Dr. Laing told Dr. Berwick that, “without those codes, there is nothing in the CMS fee schedule that recognizes professional expertise. That’s a tragedy.“ Although Dr. Berwick thanked the ACR for its comments, “he didn’t respond per se,” Dr. Laing says. “He said he appreciated our bringing it forward, but it was a noncommittal reply. I think, however, that it was important for our message to be heard at that level. And I believe he heard it.”
In discussing ACOs, Dr. Borenstein provided three examples of patients he cared for where he made the diagnosis even though they had seen an internist in order to highlight the potential cost savings associated with seeing an appropriate specialist. “We were making the point that a patient-centered home wouldn’t really work unless individuals who had specific problems were able to see specialists early on,” he says.