Rheumatologists significantly improve quality of life and lower healthcare costs for patients with rheumatic disease. Having enough rheumatologists and rheumatology professionals can optimize patient outcomes and help fully realize the economic benefits of rheumatologic care within health systems.
These two positions on rheumatology may not be surprising to those working within the specialty, but they may be valuable for others to appreciate.
The white paper, The Clinical & Economic Value of Rheumatology: An Analysis of Market Supply and Utilization in the United States, was the product of a taskforce of ACR members who worked with ECG Management Consultants to analyze the value of care given by rheumatologists.1 ECG has worked with other specialties, such as primary care, to help quantify their economic value.
The Value of Rheumatology Working Group helped to guide the purpose and content for the white paper.
Rheumatology Facts
The white paper is full of impressive facts and insights about the specialty (see sidebar), including some that may surprise even rheumatologists, according to those who helped to create the report.
Dr. Battafarano
“A rheumatologist will appreciate that the national estimated billing, in the form of professional and ancillary direct and downstream billing, is $3.5 million per rheumatologist per year,” says Daniel F. Battafarano, DO, MACP, MACR, chair of the ACR’s Workforce Solutions Committee and adjunct professor of medicine, UT Health-San Antonio, Texas.
Additionally, a single rheumatologist impacts the local and national economy downstream through job creation, wages and benefits, and state and tax revenue, Dr. Battafarano says, adding that the size of the impact varies by individual state.
Dr. Snow
The benefit of rheumatologic care to patients, their workplaces and society is another theme of the white paper that may surprise some, says Marcus Snow, MD, chair of the ACR’s Committee on Rheumatologic Care (CORC) and an associate professor in the Division of Rheumatology, University of Nebraska Medical Center, Omaha. “Our work keeps people working and active, which can have downstream effects for years,” he says.
Planting the Seeds
The need for the white paper and ACR position statement came about as many large employers chose not to update their Relative Value Unit (RVU) reimbursement in 2020, even though the Centers for Medicare & Medicaid Services (CMS) changed billing rates to boost those in cognitive specialties, including rheumatology, in response to advocacy by the ACR and its partners in other specialties, says Dr. Snow.
“As rheumatologists, we often feel that we are undervalued in larger organizations. Seeing various large organizations across the U.S. enact similar compensation plans reinforced this,” he explains.
Dr. Downey
“This mismatch has the potential to create budget deficits for the rheumatology departments and divisions, which does not reflect the true worth of having rheumatology services as part of an academic center or health system,” says Christina D. Downey, MD, member of the Value of Rheumatology Working Group, chair of the Government Affairs Committee and an associate professor of medicine in southern California. Dr. Downey is corresponding author of the white paper.
Dr. Caricchio
“The intended use of these is to inform our members of the current national trends for rheumatology practices and to give them something to show to their administration when negotiating for support for their departments and division,” says Roberto Caricchio, MD, member of the Value of Rheumatology Working Group and professor of medicine and Myles J. McDonough Chair in Rheumatology, UMass Chan Medical School, Worcester, Mass.
As chair of the CORC, Dr. Snow and fellow committee members brainstormed ways to quantify and demonstrate the value of rheumatologists. The idea for an economic analysis as well as a white paper and position statement began from ACR staff, he says.
Other Goals & Intentions
In addition to sharing the white paper and statement with medical organizations, they may be useful in other ways as well.
“The demonstration of how rheumatologists actually save money in the care of patients is important. As we move to continued value-based contracts, this will be more and more important to quantify,” Dr. Snow says.
They also will bolster advocacy efforts, such as educating members of Congress about the need for more fellowship slots in the U.S. to meet the needs of constituents, Dr. Downey says.
Another potential target area is addressing the current rheumatology workforce shortage, Dr. Battafarano says. “The white paper further justifies the importance of rheumatology care to support primary care outpatients in healthcare systems and with payers and the need to integrate rheumatology care routinely into primary care networks,” he explains.
Ms. Kerby
Even non-clinicians may appreciate the information to help understand the value that rheumatology providers bring, “not just as a clinical resource but also as a meaningful contributor to the business of healthcare,” says Tessa Kerby of ECG Management Consultants.
Those who were part of the Value of Rheumatology Working Group acknowledge the support they received to bring the publications to life. “The ACR and its Board of Directors deserve a great deal of credit for conceiving and funding this project,” Dr. Snow says. “Without their support, it would have never happened.”
Vanessa Caceres is a medical writer in Bradenton, Fla.
References
- Downey C, Snow M, Caricchio R, Moody J, Kerby T, Battafarano D. The Clinical and Economic Value of Rheumatology: An Analysis of Market Supply and Utilization in the United States.
- American College of Rheumatology. Position Statement: The Clinical and Economic Value of Rheumatology.
