ACR Quality Movement Member Survey Report

Dear ACR Member,

As many of you know, the ACR has embarked on a significant initiative to develop quality measures for rheumatic diseases in response to the emerging era of quality-driven medicine. We believe it will be important for the College to be fully engaged in the quality movement in order to be well-positioned to represent our members, your interests and those of your patients. It is essential for members to feel comfortable participating in ACR efforts around quality and understand why and how the ACR is involved.

In July, the ACR sent an e-mail survey to all members asking about your understanding and perception of the quality movement and the ACR’s role representing rheumatology in this movement. The survey was based on initial member feedback from focus groups that we conducted in the spring. It was structured to provide you with common descriptions and interpretations – both positive and negative – of issues related to the quality movement.

We are grateful to all of you who took the time to respond to the survey questions. Your feedback has provided us with a deeper understanding of how you perceive the quality movement and, especially, how we can provide information to help educate and support members as programs related to the quality movement become a part of everyday practice. Most importantly, your outspoken support of the ACR’s involvement in the movement as the group that can best represent those who provide care to patients with rheumatic disease has been very positive. An overwhelming majority of respondents have confidence that the ACR is the entity that should protect the interests of rheumatologists, develop guidelines and preserve good patient care with respect to rheumatic disease. Just one example of this confidence was the statement eliciting the strongest agreement - from a whopping 94% - in the entire survey: “The ACR should actively engage with payors to ensure that they understand what “quality” is from the point of view of treating patients with rheumatic diseases.” Additional survey findings are described below.

Member Experiences with and Perceptions of the Quality Movement

Survey responses indicate that many members are aware of or have experienced some form of quality-driven medicine, along a broad spectrum from treatment guidelines to pay-for-performance systems. Despite or perhaps even because of their experiences, members have some concerns about the impetus for quality-driven medicine. Many members agreed with the statement that “the quality movement is being driven by the need to improve patient outcomes,” but there was also some agreement with the statement “the quality movement is being driven by payors (insurers) who want to cut costs.”

In fact, however, the quality movement as a whole is intended to address over- and under-provision of care and provide physicians with appropriate decision-support tools to make evidence-based treatment decisions with patients. In the end, the true goal is optimal patient care. There is a significant opportunity through the quality movement to improve overall care for patients with rheumatic diseases while emphasizing the role of the rheumatologist in providing that care.A strong component of the ACR quality initiative has been and will continue to be entering into dialogues with payors and other decision-makers to stress the importance of using the standards and quality measures the ACR develops, and to advocate for appropriate reimbursement for provision of quality care.

Effects of the Quality Movement on Patient Care and Medical Practice Issues

A strong majority of members believe that the quality movement will significantly affect how they practice medicine and how they are reimbursed for patient care. However, many members are uncertain whether the quality movement will truly reward physicians for quality patient care and are concerned that the quality movement may instead reward physicians who are compliant. Overall, however, members agree that a positive motivation of the quality movement is to standardize and improve patient treatment.

There is no question the quality movement will impact members’ practices. The challenge for the College is to help ensure that the overall impact is positive, creates opportunities for members to enhance the quality patient care they already provide through use of valid measures, and reimburses them accordingly so their practices remain healthy throughout the process.

Benefits to Patients

Members who responded to the survey have mixed feelings regarding how the outcome of the quality movement will benefit patients. Some members believe that patients will benefit by receiving more cost-effective treatment. However, many members also fear the potential for care to be driven by guidelines that favor efficiency over quality. We understand this concern and will continue to advocate for use of valid measures within systems that promote evidence-based medicine while also allowing for the occasional exceptional situations that warrant physician decisions outside of the stated guidelines.

In addition, most members agree that patients should be educated about the implications of the quality movement from multiple sources, including physicians, patient advocacy groups, the government and insurance providers.

Payor Activity

A slight majority of members reported that payors currently issue guidelines on patient care and are gathering data on outcomes from their practices. However, only a few members found that payors are currently penalizing physicians for non-compliance with their guidelines. We will continue to monitor trends in this area and request that members communicate their experiences to the College.

ACR’s Role in the Quality Movement

Regarding the ACR’s role in the quality movement, we learned two important lessons. The first is that we must intensify our efforts to educate members about our ongoing activities related to quality. Fewer than half of the members who responded to the survey agree that they are informed about the role the ACR is playing in the quality movement. For this reason, we have a plan in place to proactively deliver information to ACR members, including updates on the activities and progress of the Quality Measures Committee as well as our collaborative efforts with other groups involved in the quality movement. In the coming months, you will receive additional e-mails containing updates. We will also include information on our quality-related efforts in a variety of ACR publications and forums.

The second significant finding is that members strongly support the role that the ACR is taking in the quality movement. An overwhelming majority of respondents have confidence that the ACR is the entity that should protect the interests of rheumatologists, develop guidelines and preserve good patient care with respect to rheumatic disease. The statement eliciting the strongest agreement in the entire survey was: “TheACR should actively engage with payors to ensure that they understand what “quality” is from the point of view of treating patients with rheumatic diseases.” There was 94% agreement with this statement. In addition, many members believe that the ACR should support rheumatologists who are receiving push back from payors on what constitutes quality care. We agree and will continue to strongly advocate on behalf of you and your patients.

Finally, members were asked to choose options for potential sources of funding for the ACR’s efforts in the quality movement. The following are listed in order of popularity: grants from independent foundations; insurance industry support; pharmaceutical industry support; voluntary member donations to a quality fund; increased membership fees; and other (of these responses, the majority favored government/federal grants). The ACR will continue to examine the multiple facets of the complex funding issue, taking into consideration these findings.

Thank you

The ACR leadership and staff will continue to employ our best efforts to represent you. I personally want to thank you for your interest and input in this important area of ACR work. I also thank Sherine Gabriel, Chair of the Quality Measures Committee, all of her committee and subcommittee members, and the ACR staff, for their dedication and hard work on behalf of all ACR members as we move forward to improve quality of care in this changing health care environment. We look forward to working with you as we progress through the quality landscape.

Sincerely,
Mary K. Crow, MD
President, American College of Rheumatology

If you have questions or comments about any of the above items, or about the work of the College in general, please e-mail Dr. Crow at .