Cost Control & MIPS
Although access is critical, cost control remains a priority for insurers and legislators. Recently, I received an in-depth look at MIPS, and although it sounds good in theory, the system will eventually grade physicians based on a formula that includes cost per capita. What about those physicians at academic medical centers who routinely care for high-acuity patients? What about rheumatologists who work in underserved areas, caring for more complex cases than the average rheumatologist? Due to higher cost per capita, these physicians may not be Tier 1 for many insurers, resulting in higher co-pays for their patients.
In my situation, I provide a significant proportion of the pediatric rheumatology access in East Tennessee, so children with refractory or severe presentations, such as anti-TNF resistant JIA, refractory juvenile dermatomyositis, pediatric microscopic polyangiitis and macrophage activation syndrome associated with juvenile SLE, are all cared for in our clinic. Access has improved, but it appears we have a new problem because we have a higher cost per capita, which may not sit well with the insurers.
Providing feedback on legislation is crucial in situations like this, because the result may be financial penalties for physicians who are willing to step up and help those who need it most. That’s what RheumPAC does for us. It provides a means for us as individuals to amplify our voices as we provide our feedback.
One Small Movement
Our small movement in East Tennessee is just one piece of this huge movement for improved access and quality care. Writer/journalist Malcolm Gladwell said in The Tipping Point, “That is the paradox of the epidemic: that in order to create one contagious movement, you often have to create many small movements first.” In this small movement, I invest my resources into my community and into RheumPAC. I encourage you to pursue your own small movement and consider investing your time or financial resources into RheumPAC to help us all accomplish our goals in this epidemic.
Brett Smith, DO, is a rheumatologist at East Tennessee Medical Group in Alcoa, Tenn., and at East Tennessee Children’s Hospital in Knoxville, Tenn. He also serves on RheumPAC and on the Board of Directors for the Tennessee Rheumatology Society.
