Researchers find that improvements in osteoporosis, preventive and gout care are needed.
During a presentation on Nov. 15 during the American College of Rheumatology annual meeting in Washington, D.C., Jinoos Yazdany of University of California, San Francisco, shared performance measures collected by the Rheumatology Informatics System for Effectiveness (RISE).
Researchers collected and analyzed data from 346,358 patients who were seen between April 1, 2015 and March 31, 2016 by 223 clinicians from 49 practices. They examined quality measurement data from rheumatoid arthritis, drug safety, gout, preventive care and osteoporosis cases. Quality measure performance was definded as the percentage of patients getting recommended care. Almost all the rheumatologists (90%) were in a group practice, with 8.8% in solo practice and the remaining 1.2% working in a large health system. Patients were on average 58 years, 75.2% were female, 25.6% were racial or ethnic minorities and 65.8% had commercial insurance.
Researchers found that performance on quality measures significantly varied by practice, with 12 of the 17 measures having a maximum observed performance of more than 99% across those practices. They found the greatest room for improvement on quality measures in osteoporosis, preventive care (body mass index screening and counseling) and gout, at the practice and individual clinician level.
“We also found that some practices have achieved a very high level of performance. As rheumatologists aim to improve quality of care and prepare for upcoming MACRA payment reforms, RISE will, by design, allow participants to measure, benchmark, and continuously monitor performance improvement,” the researchers wrote.
Clinicians’ average performance of national benchmarks exceeded targets set by the Centers for Medicare and Medicaid Services (CMS) in six of nine measures. Those measures included medication documentation per visit, with an average of 97.3% of practices meeting that target, and a CMS benchmark of 88. Another example was a 64.7% average for DXA measurement or treatment in women 65+, with a CMS benchmark of 41. In these CMS benchmarks, clinicians also exceeded targets for drug safety and not imaging for low back pain. They didn’t meet the benchmarks in preventative care (per visit BMI documentation/follow-up plan), averaging 49.1% versus the 58 benchmark. They also failed to meet the 69 benchmark for blood pressure management, with a 58.8% average instead.
Researchers stated that the RISE registry can help physicians and practices measure and monitor their performance improvement as the Medicare Access and CHIP Reauthorization Act (MACRA) payment reform system changes arrive.
Dr. Yazdany and her co-authors have ties with AbbVie, Amgen, Astellas, Biogen Idec, Boeringer Ingelheim, BMS, Celgene, Crescendo, Corrona, Daiichi, Dermira, Eli-Lilly, Galapagos, Imaging Rheumatology, Janssen, Momenta, Mallinckrodt, Novartis, Pfizer Inc, Roche, Sanofi-Aventis, Sun, UCB and Zynerba.
"Practice-Level Variation in Quality of Care in the ACR’s Rheumatology Informatics System for Effectiveness (RISE) Registry," Jinoos Yazdany. Abstract number 2985. 11:45 a.m., Nov. 15, 2016. ACR/ARHP 2016 Annual Meeting.