At present, “three out of the four [MIPS categories] can be achieved by RISE,” says Dr. Kazi, also a rheumatologist at the University of Texas Southwestern Medical Center. “It can facilitate population management and figure out who the patients are that are neediest or most expensive; eventually, it can be used for resource utilization and practice improvement activities. … We would grow it if the membership demands it. The vendors are ready to manage the demand.”
As a QCDR, RISE taps into electronic health records and captures the entirety of a practice’s patient population; thus, physicians using it don’t need to take extra steps for reporting through the MIPS pathway. RISE is valuable because rheumatologists are too small a market for information technology vendors to create additional carve-outs, says Dr. Adams.
“You can measure the quality of your work across many clinical quality measures and compare your performance against your practice partners and regional and national peers,” says Dr. Kazi, who adds that, in terms of MACRA, “We have a recipe for this, but we haven’t cooked the meal yet. We have patient numbers, ZIP codes, practice size, insurance information, all of which can provide elements needed to benchmark the cost of episodes of care each year.”
And RISE presents rheumatologists the chance to chart their own course on the MACRA sea.
“We really need to demonstrate the value of rheumatology by having our own information, so we’re not dependent on others defining what’s important,” Dr. Kazi says. “If we do it ourselves, it gives us a voice we don’t otherwise have, backed by data and numbers.”
Other Opportunities
In addition to adapting RISE, Dr. White says the ACR is exploring other opportunities for rheumatologists in a new reimbursement environment. For example, although the Bundled Payments for Care Improvement Initiative (BPCI) is not currently a qualified APM, Dr. White says he suspects “the concept behind it will drive emerging APMs as we move forward, especially in subspecialty diseases.”
For example, a rheumatologist may receive a fixed sum to care for a patient in their first year following a rheumatoid arthritis diagnosis. “But we need a lot more information before we can figure out what’s tenable and what’s not,” Dr. White adds.
Or rheumatologists may consider a specialized medical home model, which could potentially be considered by CMS as an APM. Rheumatologists would need to assume accountability for patient-level outcomes and spending, since rheumatology patients have chronic, lifelong illness and “rheumatologists function as primary care physicians” for many of them, Dr. White says.
