Both private and governmental payors are linking payment to documentation of key quality measures, such as those seen in Medicare’s Physician Quality Reporting Initiative (PQRI). To assist in PQRI reporting and rheumatologists’ own quality-improvement efforts, this month the ACR will release a Web-based quality-measures recording and reporting tool called the Rheumatology Clinical Registry (RCR).
Initially the RCR will have four main functions:
- Help members to meet registry reporting requirements to qualify for the PQRI bonus;
- Be interoperable with ACR practice improvement modules, which can be used in the American Board of Internal Medicine’s (ABIM’s) rheumatology recertification process;
- Assist practices in implementing a standardized patient history; and
- Enable participants to benchmark their practice against others nationwide.
“As individual physicians, we are going to be held to certain standards whether we think they are a good idea or not,” says Stanley Cohen, MD, president-elect of the ACR and a rheumatologist in private practice in Dallas. “Short term, we want to give members the tools needed to respond to these standards in a less labor- and time-intensive manner. Longer term, it will allow physicians to become used to accumulating and looking at data to improve practice delivery.”
Easily Accessed
The RCR is a Web-based tool easily accessed by anyone with a computer, Web browser, and Internet connection. The tool’s individual screens have drop-down boxes that can be checked off either at the point of contact or after the visit. The RCR generates clinical reminders based on ACR-approved quality measures for rheumatoid arthritis, gout, osteoporosis, and drug safety, as well as American Medical Association– and Medicare-approved osteoarthritis indicators. Data that are used across several parts of the registry or from one visit to the next persist and need only be entered once.
For practices not using computers, paper forms can be printed, completed by the patient or physician, and returned for entry into the RCR. Each record will be confidentially and securely stored, and can be accessed from any Internet-connected computer.
“A modest additional payment is already being paid by Medicare to physicians who document completion of certain quality indicators through the PQRI program,” says Dr. Cohen. “We want to make sure our members have the tools needed to respond to these changes with minimal effort and expense.”
Reporting Functions
The RCR also incorporates a report-generating function. In addition to providing easy filing of PQRI reports—saving time and helping to ensure that complete, accurate PQRI quality data are submitted—modules allow individual physicians or practices to track their adherence to quality-improvement goals. As more practices adopt the RCR, information should become available to benchmark physicians and practices against their peers internal to the practice, regionally, and nationwide.
“Right now there is just a carrot for achieving quality measures, the 2% bonus on all Medicare payments under PQRI,” says Salahuddin Kazi, MD, chief of rheumatology at the Presbyterian Hospital of Dallas. “But not that far into the future, reporting outcomes and quality measures may become a stick with penalties attached. The registry is one way for rheumatologists to not only become accustomed to what soon may become required, but also to help us control formulation of quality elements used within the specialty.”
One Physician’s Experience
Donald Krause, MD, is medical director for quality improvement at St. Joseph Hospital in Bangor, Maine, and a practicing rheumatologist. He tested an earlier version of the RCR. “It was very easy to use, even though much had to be done manually because of the limitations of our office information system,” he says. “It took my medical assistant about four minutes per patient to identify appropriate patients, insert a checkoff sheet for the diagnosis into the chart, and enter information into the system following the visit. I especially liked that I could make sure that all of the quality indicators were done while the patient was still in front of me and correct anything missing immediately.”
With a newer electronic medical record (EMR) system that allows him to sort patients by diagnosis, the input time should be greatly reduced. RCR users without such EMR assistance will be able to use recently added upload functionality within the RCR to pull patients from their billing systems by diagnosis, alleviating some of the initial data entry in much the same way.
Dr. Krause also increased personal compliance with quality indicators and practice guidelines while using the RCR. A self-audit that he compiled saw his completion of indicators increase from 85% immediately before enrolling in the RCR to nearly 100% following RCR use. In addition, the RCR increased his efficiency by standardizing care for individual patients.
“We all think we are doing [well] and all think we are doing everything right,” he says. “But when we start looking at specific areas, there may be places where we could do better. I think the RCR will improve clinical care.”
Join the RCR Now!
If you would like to use the RCR in your practice, visit www.rheumatology.org/rcr for more information.
Early Stages of Program
Right now, the RCR is a first step towards what the ACR eventually hopes to achieve. Interoperability with EMR systems is an important ACR goal for the RCR—and demand from rheumatologists who use EMRs will help facilitate that functionality. Rheumatologists interested in contacting their EMR companies to encourage interoperability with the RCR should contact the ACR for information and advice on how to approach their EMR vendors.
When the RCR is established, with a pool of physician users and patient data, individual practitioners and physician groups will be able to evaluate their practice patterns in comparison with aggregated data from colleagues across the country—similar to the data and nationwide metrics already available to oncologists and cardiologists. It is the ACR’s hope this will lead to improvements in care delivery.
“We are at a disadvantage [in relation] to our European colleagues who have the benefit of patient registries,” says David Borenstein, MD, treasurer of the ACR and a partner in Arthritis and Rheumatism Associates in Washington, D.C. “The best way for rheumatologists to assess how well treatments work is to have a means by which we can collect, tabulate, and analyze data from large populations. To stay at the forefront of our discipline, it is vital to have access to this kind of information.”
As the RCR matures, it will also assist the ACR in promulgating its own quality measures and leading the rheumatology quality debate. “We have developed a number of quality indicators, but what is lacking is data showing that they alter patient outcomes,” says Dr. Cohen. “As we start to accumulate data, we will be able to determine their utility. Our hope is that this will lead to the ACR developing quality standards in conjunction with other national organizations and the end of multiple insurance companies handing down multiple standards” with which rheumatologists must comply.
Kurt Ullman is a freelance writer based in Indiana.