For example, prior to the quality program, only 44% to 50% of juvenile RA patients at Children’s Hospital received guideline-directed uveitis screenings; now 95% get these screenings on schedule. In addition, patient data have been entered into a Web-based registry, so children with juvenile RA (and their parents) can look up their own labs, medications, and other medical information online to help them monitor and self-manage their illness.
Dr. Passo also understands the reluctance of many rheumatologists to embrace the quality movement. “Doctors feel they’re already going above and beyond,” he says. “They think this is just one more thing that’s going to exhaust their resources—which is what I had feared, as well.” But he says that what they learned at Children’s “has become ingrained in everything we do on a day-to-day basis. It’s part of our culture.”
Importantly, pay-for-performance “remained in background,” notes Dr. Passo. He wasn’t sure that the pediatricians and faculty even recognized this was a component of the program. “All of our efforts were based on improving outcomes for kids with different diseases across the institution,” he says.
Specialists Get Ready
Dr. Anderson says large employers and the government want to identify high-quality, low-cost physicians and hospitals. “Specialists control 80% of all healthcare spending in this country. As specialists, we will be held increasingly accountable for the effectiveness and efficiency of our care.”
The Quality of Care Subcommittee is looking at options for data collection and reporting tools that will enable documentation of the quality of care. In addition to physician-based tools, the subcommittee is also looking at tools that can capture patient-generated data, such as a patient’s degree of pain. Ideally, pre-visit patient information gathered electronically and displayed appropriately to the physician may improve the efficiency of the office visit.
Dr. Anderson is a strong supporter of the quality movement, but he is well aware of the potential risks. “There are challenges in finding the balance between executing evidence-based care and protecting time to continue practicing the art of medicine, so important to all of us in rheumatology,” he says. He believes that ACR needs to carefully follow what the private payers are doing, and to work with entities such as the AMA, the National Quality Forum, the National Committee for Quality Assurance, and AQA Alliance to ensure that ACR’s measures are being adopted and that the measures are clinically relevant and feasible for implementation.
