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VBCR - December 2016, Vol 5, No 6 - Best Practices
Alice Goodman

Washington, DC—Rheumatology practices in the United States vary widely in their performance in meeting key quality measures for patient care, and these variations may affect physician reimbursement under the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) laws, the results of a study presented at the 2016 Annual Meeting of the American College of Rheumatology (ACR) suggest.

The study was based on data from the ACR’s Rheumatology Informatics System for Effectiveness (RISE) registry, which is a national, electronic health record–enabled quality improvement archive. The goal of the study was to examine variations in performance with regard to quality measures in rheumatology practices across the United States.

“These data represent not what rheumatologists say they are doing, but what they actually do. We saw variations in almost every quality measure except using disease-modifying antirheumatic drugs,” said presenting investigator Jinoos Yazdany, MD, MPH, Associate Professor, Division of Rheumatology, University of California at San Francisco.

RISE collects information on clinical quality measures using ACR guidelines that are vetted through a consensus process and extensive measure testing. Measures cover rheumatoid arthritis, osteoporosis, gout, preventive healthcare for comorbidity, and drug safety. At present, approximately 700 rheumatologists are enrolled in RISE, Dr Yazdany said. At the meeting, she presented data at a plenary session on patients seen between July 2014 and July 2016 in 63 practices, with a total of 294 clinicians using RISE to benchmark their performance on quality measures.

Across the board, the percentage of eligible patients receiving recommended care within each practice by meeting key measures for patient care was lower for osteoporosis and gout compared with other quality measures. For gout, overall 36% of patients were being monitored for serum urate levels and treated to target of <6.8.

“A small number of practices were doing well, with 100% of performance on this measure, but this is an opportunity for improvement,” Dr Yazdany noted.

Variations were seen in rheumatoid arthritis measures. Only 52% of patients received a standard assessment of disease activity.

“Some practices were perfect, at 100%, while others were at 0% on this measure. This shows that about half of the practices have not adopted measures that allow treating-to-target,” Dr Yazdany commented in a separate interview with Value-Based Care in Rheumatology.

Only 50% of patients with rheumatoid arthritis received a standardized functional status assessment, such as the Health Assessment Questionnaire or the Patient-Reported Outcomes Measurement Information System.

Results were as follows on 3 measures of drug safety: 61% of practices were performing tuberculosis screening before initiating the first biologic, 4.7% of practices were using ≥1 high-risk medications in elderly patients, and 0.1% were using >2 high-risk medications in elderly patients.

“Rheumatologists are doing a really good job on not prescribing high-risk medications in the elderly,” Dr Yazdany said.

Another example of how rheumatologists are doing well is in screening for tobacco use and tobacco counseling; 85% of patients in RISE had appropriate screening, she noted.

“We did find significant variations in performance across most measures. Some practices have achieved a high level of performance and are poised to succeed under MACRA. The good news is that we have seen substantial improvement in performance on many of the measures since RISE was started in 2014,” Dr Yazdany stated.

“For example, for the RA [rheumatoid arthritis] disease activity assessment measures, average performance in practices was in the 40% range in 2014 and now has reached 65%. These are very encouraging data. I’ve never been more excited. Now we have data showing that rheumatologists are motivated to improve and do the right thing for patients,” she concluded.

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Last modified: February 1, 2017
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