Session Information
Session Type: ACR Plenary Session
Session Time: 11:00AM-12:30PM
Background/Purpose: The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 has put into place an aggressive timeline for a Merit-Based Incentive Payment System (MIPS) and for Alternative Payment Models (APMs). For rheumatologists to be successful under these payment reforms, it will be critical to understand and improve performance on quality measures. In this study, we used data from the ACR’s Rheumatology Informatics System for Effectiveness (RISE), a national electronic health record (EHR)-enabled quality improvement registry, to examine variation in performance on quality measures across practices.
Methods: RISE’s informatics platform continuously collects data from the EHRs of participating practices, allowing centralized aggregation and analysis of performance on quality measures. Rheumatologists can view their performance on measures using a web-based registry dashboard that is updated every 24 hours. We analyzed data collected between April 1, 2015 and March 31, 2016 on all patients seen by 223 clinicians across 49 practices in which EHR mapping is complete. Quality measures in the areas of rheumatoid arthritis, drug safety, osteoporosis, preventive care and gout were examined. Performance on quality measures, defined as the percentage of eligible patients receiving recommended care, was examined at the practice level.
Results: Data from 346,358 patients was examined. Mean (SD) age was 58 (16.6) years, 75.2% were female, 25.6% were racial/ethnic minorities, and 65.8% had commercial insurance. Most rheumatologists were in a group practice (90.0%); 8.8% were in solo practice and 1.2% part of a larger health system. Performance on quality measures varied significantly across practices (Table). Twelve of 17 measures had a maximum observed performance of >99% across practices. The largest gaps in quality of care at both the practice and clinician levels were observed for osteoporosis, gout and preventive care (e.g. body mass index screening and counseling), suggesting room for improvement in these areas. For 6 of 9 measures for which the Centers for Medicare and Medicaid Services has set national benchmarks, the average performance of RISE practices exceeded targets.
Conclusion: We found significant variation in performance on quality measures across RISE practices, with the largest gaps seen in osteoporosis, gout care and preventive care. 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. Table. Performance on selected quality measures in the RISE registry.
| Quality Measure |
|
|
Performance across RISE practices |
Performance across RISE practices |
CMS Benchmark |
|
Measure Denominator (n) |
Measure Numerator (n) |
Average Performance (%) |
25th, 50th, 75th, 100th percentile |
|
|
| RA: Disease Activity Measurement |
50,416 |
33,076 |
61.9 |
30.6, 70.9, 90.4, 100 |
|
| RA: Functional Status Measurement |
50,416 |
29,546 |
56.4 |
23.6, 65.2, 87.5, 100 |
|
| RA: Disease Modifying Drug Use |
50,236 |
45,804 |
90.3 |
87.5, 91.4, 94.8, 97.5 |
|
| Drug Safety: Tuberculosis Screening Prior to First Biologic Therapy |
15,933 |
8,905 |
54.6 |
31.7, 52.4, 79.0, 99.2 |
|
| Drug Safety: Use of ≥ 1 High-Risk Medication in the Elderly |
78,347 |
3,472 |
5.9* |
6.1, 3.8, 2.4, 0* |
9.0 |
| Drug Safety: Use of ≥ 2 High-Risk Medications in the Elderly |
78,347 |
110 |
0.17* |
0.15, 0.05, 0, 0* |
9.0 |
| Osteoporosis: DXA measurement or treatment in women 65 years or older |
62,924 |
39,790 |
64.7 |
48.9, 60.7, 81.5, 99.3 |
41.0 |
| Osteoporosis: DXA measurement or treatment in high-risk patients |
38,929 |
21,020 |
52.1 |
41.2, 54.9, 60.8, 85.2 |
|
| Osteoporosis: Post-fragility fracture DXA or treatment |
6,269 |
3,657 |
67.3 |
50.0, 66.1, 83.8, 100 |
41.0 |
| Low Back Pain: Lack of imaging within 28 days of primary low back pain diagnosis |
7,843 |
4,853 |
64.4 |
35.1, 65.1, 95.0, 100 |
16.0 |
| Preventive Care: Tobacco screening and counseling |
211,889 |
180,360 |
83.8 |
78.4, 88.8, 91.8, 99.1 |
90.0 |
| Preventive Care: BMI documentation and follow-up plan (per visit) |
211,112 |
96,608 |
49.1 |
34.3, 44.0, 64.1, 94.0 |
58.0 |
| Preventive Care: Blood pressure management |
24,583 |
14,349 |
58.8 |
48.1, 61.2, 69.2, 90.6 |
69.0 |
| Medication Documentation (per visit) |
586,601 |
578,857 |
97.3 |
98.8, 99.5, 99.8, 100 |
88.0 |
| Gout: Serum Urate Monitoring |
5,208 |
1,832 |
35.4 |
16.7, 28.6, 60.2, 84.0 |
|
| Gout: Serum Urate Target less than 6.8 mg/dL achieved. |
925 |
509 |
54.1 |
33.3, 53.9, 82.4, 100 |
|
| Gout: Urate Lowering Therapy |
442 |
228 |
49.9 |
30.0, 50.0, 71.4, 100 |
|
To cite this abstract in AMA style:
Yazdany J, Bansback N, Clowse MEB, Collier D, Law K, Liao K, Michaud K, Morgan E, Oates J, Orozco C, Reimold A, Simard JF, Myslinski R, Johansson T, Kazi S. Practice-Level Variation in Quality of Care in the Acr’s Rheumatology Informatics System for Effectiveness (RISE) Registry [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/practice-level-variation-in-quality-of-care-in-the-acrs-rheumatology-informatics-system-for-effectiveness-rise-registry/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/practice-level-variation-in-quality-of-care-in-the-acrs-rheumatology-informatics-system-for-effectiveness-rise-registry/