Helen Hinkle
Office Administrator
Rheumatology Associates of South Texas
San Antonio, TX

As administrators, we are forced to juggle more and more because of the Affordable Care Act and its plans to improve the cost of healthcare in the United States. Measuring quality improvement is a great idea, but shouldn’t we have been doing this all along? These last 20 years in the medical field have taught me the good and the bad side of medicine, and practice administrators fight the fight each day.

The Realities of the Industry

The healthcare industry is moving in a direction that concerns administrators, physicians, and patients alike. Reducing healthcare costs needs to be addressed, but whether the right people are addressing the issues remains to be seen.

As with other administrators, I find myself fighting with insurance plans about coverage for patients on a daily basis. When our clinical staff speaks to insurance plans on behalf of our patients, most of the time the insurance person responding is reading a prompt on a computer screen written by an insurance carrier that never handled a patient in a clinical setting. Are we the only industry that handles business this way? I challenge you to point to another industry where its providers or business owners are expected to take a back seat to receiving payment for services at the time services are provided.

In rheumatology, we also face the issue of quality improvement tracking. Companies are working to develop online data centers that would allow rheumatologists to track 1 or more quality measures in a specific subset of patients—such as patients with rheumatoid arthritis (RA)—for each patient encounter.

Getting Out of the Routine

Finding innovative ways to track patients may seem daunting at first, especially with everything else we do as practice administrators. However, learning more about the different programs available and listening to providers who use these programs can be an eye-opening experience. At our practice, we have spent hundreds of thousands of dollars on our electronic medical record technology; however, it does not have a general overview screen, for example, with patients’ status that can quickly tell you how a specific group of patients, such as those with RA, are doing.

We have all fallen into a routine of seeing a new patient diagnosed with RA, and then scheduling that patient for a follow-up visit 3 to 4 months later—on a recurring basis—for the rest of their lives. Because we are comfortable with this routine, we sometimes forget that not every patient with RA needs to be seen by his or her rheumatologist every 3 to 4 months. The patient may have declined suggested treatment, the patient may be stable, or the patient may be in remission.

Why do we schedule a follow-up appointment so quickly after a visit? This routine affects our schedules because it takes time away from patients who need it the most, including our severely ill patients with RA as well as those who do not respond to their medication.

Focusing on Quality Care


Rheumatologists need to look at their practice as a whole, on a regular basis (monthly, daily), and be aware of laboratory tests and other measures of quality, such as the Routine Assessment of Patient Index Data (RAPID) 3 assessment or the Multidimensional Health Assessment Questionnaire (MD-HAQ). They may not realize how many uncontrolled RA patients they have. Start by attempting a guess at the number of patients in your practice who you believe have their RA under control, and then look at the actual numbers. These data may be surprising…and eye-opening.

We track quality measures with the Physician Quality Reporting System (PQRS) and Meaningful Use. There is a shift from the fee-for-service model to quality improvement outcomes. How or when we will make this shift fully is the unknown, but now is the time to start rethinking the way we monitor and track patient outcomes. After attending a seminar recently on this subject, I saw this in a whole new light, and it has begun a conversation in our practice about how we approach the inevitable: the future of being paid not as a fee for service, but based on the quality improvements we provide for our patients.

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