Take the Reins

Among physicians these days, introducing the subject of quality and the entity known as the quality movement is a bit like talking about U.S. politics: There are a wide range of views. When the subject of quality is raised, there are the “true believers” who think the quality movement is the only option to standardize and improve medical care in the United States while addressing the reality of spiraling healthcare costs, and there are the “hard skeptics” who are convinced that the quality movement is just another scheme to squeeze more out of already embattled clinicians and restrict treatment options to the cheapest alternatives. Many members fall somewhere between the two ends of the spectrum.

A recent poll of ACR members on the quality movement found that these broad views are reflected by our membership. It’s not difficult to see why some physicians would be skeptical. The worthwhile aims of the quality movement may appear at odds with those of its big endorsers such as the Centers for Medicare and Medicaid Services and private insurance—especially from the perspective of a community-based, small-practice clinician. Invariably, among clinicians, the discussion turns to pay-for-performance (P4P) and horror stories of incentive systems that mutated into penalty systems based on arbitrary assessments of “quality of care.”

Expand the Quality Discussion

In a way, it’s unfortunate that discussions of quality are often reduced to discussions of one or two implementation tactics such as P4P and physician rankings because there is great potential to use this movement to promote improvement in care for chronically ill patients. On the other hand, realities such as P4P do make clinicians sit up and take notice of the quality issue that will have a profound influence on how medicine is practiced in the United States in the not too distant future (in fact, it’s already here in some regions).

For some time, the ACR has been monitoring the emergence of the quality movement and planning the College’s representation of the rheumatology community within the quality sphere. We have embarked on a long-term initiative to develop quality performance indicators for rheumatologic disease. This will ensure that our members will be measured on provision of care that is based on judicious review of scientific evidence by rheumatology experts. We have built into this initiative several complementary activities. This will ensure that the interests and positions of rheumatologists are represented when discussions around implementation, adoption, and enforcement of quality programs take place.