“I think this is exactly what a specialty group should be doing in 2007–2008,” said Lewis G. Sandy, MD, senior vice president for clinical advancement at UnitedHealth Group in Minnetonka, Minn., of the ACR’s quality initiative. “Purchasers understand that there’s a lot of waste in the system. They’re paying for it. Purchasers are driving this whole movement.…If this is going to work, it’s not something that should be imposed onto physicians,” said Dr. Sandy.
During the summit, the issue of the ACR partnering on quality measures with one or more like-minded groups came up several times. “The ACR can drive this in a meaningful way,” said Dr. Sandy. “We would be more than willing to work with you to help make that happen.”
Dr. MacLean suggested that the ACR consider partnering with an established quality-measurement organization, such as the National Committee for Quality Assurance (NCQA). But Dr. Solomon pointed out that if the ACR does partner, it needs assurance that the quality measures it has set will not be changed or subtly tweaked. “The last thing we want to see is modification by an end user,” he told Thomas Lynn, MD, medical director of Symmetry Products, Ingenix, Eden Prairie, Minn.
Private Sector Wants Rheumatology Input
One approach to a consensus in the private sector on what constitutes P4P quality measures is for employers to link together and use the same quality data. Already about 100 employers have done this in a nonprofit program called Bridges to Excellence (BTE). “The disconnect between cost and quality is really troublesome to employers,” said Edison Machado, Jr., MD, MBA, BTE national accounts manager. “Bridges to Excellence tries to link performance with cost. It’s a part of the value-based purchasing movement.”
Dr. Machado noted that physicians are by nature competitive and they like being recognized by their colleagues, which is fundamentally what P4P does. “Employers are ultimately driving toward an outcomes-based result,” said Dr. Machado. “Our programs are based primarily on patient record data, not claims data.” The BTE programs are rooted in NCQA programs for excellence.
And, Dr. Machado added, “What we hear from employers is that organizations such as yours should establish quality measures and then define what high-quality care would look like as developed by your colleagues. Employers are looking for better outcomes for their employees … and also lower costs.”
Arthritis measures are of great interest to employers because arthritic diseases interfere with functional status. He cited RA as an especially important one for employers because it tends to strike employees in their working prime—ages 25 to 55. He also cited carpal tunnel syndrome, gout, and lupus as of high interest to employers. Dr. Machado said BTE would be receptive to working with the ACR on quality-measurement standards, but cautioned that it takes one to two years to get such a program up and running. He noted that its program on back pain took two years to develop.
