The ACR's Rheumatology Clinical Registry is a point-of-care clinical data management tool based on evidence-based quality measures aimed at improving care and drug safety for patients with rheumatoid arthritis, osteoarthritis, osteoporosis and gout.

The RCR is:

Who created the RCR?

The ACR developed the RCR in partnership with Outcome Sciences. Outcome Sciences is a company with extensive experience in developing patient registries and medical quality improvement initiatives. The ACR chose to partner with Outcome Sciences because of its experience and proven track record of success with registries and working with other professional medical organizations.

How can the RCR be used in a practice setting?

Practitioners can choose to use the RCR solely online, or by using a combination of online and paper:

• Use a paper form during the office visit to document patient quality of care by answering questions that relate to specific rheumatic disease and/or drug monitoring measures. Some of this information can be obtained directly from patients by using the optional rheumatology patient history form included in the RCR.

• Enter information into a central online databank. All data remains confidential to ensure secure patient population management. If offices are equipped to do so, the forms may also be used electronically in realtime while assessing patients.

• Once clinical data are entered into the RCR, individual pre-populated forms can be downloaded prior to each follow-up visit, enabling a review of the medications, diagnostics and exams that need to be performed and documented in that visit.

The RCR will allow physicians to report changes and updates as well as evaluate results over time, including comparison to national benchmarks.

Performance for a physician’s patient population will be reported to him or her. This information can be used to document performance to payers and/or populate the ACR's AIM practice improvement module fields for those involved in recertification.

What content areas are covered by the RCR?

For the 2009 Medicare Physician Quality Reporting Initiative – or PQRI – the RCR includes measures in these areas:

• Rheumatoid arthritis

• Osteoporosis

• Osteoarthritis

For the ACR's AIM performance improvement module interoperability, the RCR includes measures related to:

• Rheumatoid arthritis

• Gout

The RCR also contains ACR-approved drug safety measures.

• Knowledge of practice strengths and weaknesses

• Access to tools and strategies to improve care

• Clinical decision support, population management and benchmarking

• Registry reporting to more easily meet CMS Physician Quality Reporting Initiative requirements to receive bonus incentive payments for 2009

• Access to a patient history form that can be completed by the patient, the provider and/or his or her staff – in a web-based or paper format

• Interoperability with the ACR's AIM practice improvement modules

For your patients, your data will provide:

• Individual and practice assessment, which will allow you to compare local performance against regional benchmarks and national standards

• Analysis of process-of-care measures

• Feedback to document quality improvement efforts on the part of your practice

For your practice, your data will allow you to:

• Document the quality of care delivered by your practice for interested third-party entities

• Maintain your own data if data are requested or mandated

• Identify areas for improvement in quality and efficiencies of care

• Measure the impact of changes in your clinical practice and improve the delivery of care

• Implement a data-driven quality improvement program

For the rheumatology sub-specialty as a whole, your data may be used to:

• Provide benchmarking data for all RCR participants

• Allow rheumatologists and the ACR to examine comprehensive national data on rheumatic diseases in a way that will ultimately benefit both rheumatology patients and practices

The Bottom Line

The ACR's Rheumatology Clinical Registry provides you, your practice, and your patients and colleagues with:

• A standardized format for examining the care of rheumatology patients

• A tool that can be used to target specific areas for clinical practice improvement

• The ability to obtain an accurate reflection of practice patterns

• The opportunity to participate in a national quality improvement effort for rheumatology that has an impact at the local, regional, and national levels

What is the 2009 Medicare Physician Quality Reporting Initiative?

U.S. Congressional legislation in 2007 and 2008 mandated that the Centers for Medicare and Medicaid Services implement a quality reporting program that would provide incentive payments to providers. Therefore, CMS developed the Physician Quality Reporting Initiative. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during designated reporting periods earn incentive payments of two percent of their total allowed charges for Physician Fee Schedule covered professional services furnished during those periods. PQRI reporting can be done through claims forms or CMS-approved registries and Outcome is a CMS-approved PQRI registry.

More details on the 2009 PQRI, especially as it relates to rheumatologists and rheumatology health professionals, can be found here. CMS makes changes to the PQRI annually. When details are confirmed in late 2009 for the 2010 program, the ACR Web site will be updated.

The American College of Rheumatology (ACR) strongly urges Congress to support legislation revising Medicare payment methodology to ensure appropriate reimbursement for specialists treating arthritis, rheumatic, and musculoskeletal diseases.

Patients Access is Threatened by Severe Cuts

Since 2003, Congress has repeatedly passed temporary fixes to prevent severe cuts to the Medicare physician fee schedule. Rheumatologists and other physicians are expected to face Medicare reimbursement cuts of twenty-one (21) percent or more in CY 2010. These cuts will severely threaten seniors’ access to health care and potentially limit access to care for all Americans.

The SGR Contains Factors Over Which Physicians Have Little Control

The Sustainable Growth Rate (SGR) is part of the formula used to calculate physician reimbursement for Medicare. Unfortunately, the basic premise of the formula is flawed. The SGR formula is linked to the performance of the overall economy, yet the medical needs of individual patients do not shrink whenever the economy slows. When overall spending on services in the SGR exceeds the per capita gross domestic product (GDP), cuts to physician reimbursement are triggered. The SGR also includes the costs of drugs covered under Medicare Part B, a cost over which physicians have no control. Notably, spending on these Part B drugs is increasing at a higher rate than spending on actual physician services. This skews the calculation of the SGR and triggers overly harsh reductions in physician reimbursement.

Ensure Patient Access to Care

Congress must repeal the SGR formula and base payments on the growth of the Medicare Economic Index (MEI). The MEI would ensure that the physician reimbursement payments would reflect inflationary pressures on medical practice costs. Congress must replace the flawed payment methodology in order to avoid continually bandaging a broken system.

Supporting Materials

Printable Issue Brief

Arthritis, the nation’s leading cause of disability, costs the U.S. economy $ 128 billion each year.

The American College of Rheumatology (ACR) strongly urges Congress to increase funding to federal programs engaged in vital research to combat arthritis and related diseases. The ACR is very appreciative of the $10 billion investment into NIH from the 2009 Economic Stimulus package. Congress should build on this success by continuing to strengthen NIH funding. The number of people with arthritis and released diseases is projected to be 67 million by 2030. Support for research programs to combat arthritis and related diseases is essential to the development of innovative treatments which decrease costs and improve the quality of life for these patients.

Researchers continue to study arthritis and its effects. Such studies and programs include:

• Osteoarthritis Initiative (OAI)- The OAI is a nationwide research study, sponsored by the National Institutes of Arthritis Musculoskeletal and Skin Disease (NIAMS), that will help us better understand how to prevent and treat knee osteoarthritis, one of the most common causes of disability in adults.
• The Immune Tolerance Network (ITN)- The Immune Tolerance Network (or ITN) is a non-profit, government-funded consortium of researchers working together to establish new treatments for diseases of the immune system, including the ITN conducts clinical trials of specialized immune tolerance therapies used in the treatment of autoimmune diseases (such as type 1 diabetes, multiple sclerosis, lupus and others).
• The National Arthritis Action Plan (NAAP)- NAAP is a public health program developed by CDC and the Arthritis Foundation, which seeks to improve the quality of life for those living with arthritis, including increasing public awareness, prevention, promoting early detection, minimizing pain and disability and ensuring those with arthritis receive community support.
• AHRQ considers arthritis a priority condition based on its relevance to the Medicare population. The Agency is currently engaged in a research project to study the incidence rates and relative risks of important adverse events for commonly used analgesics among patients with osteoarthritis and rheumatoid arthritis.
• A study currently underway by the Harry S. Truman Research Hospital, Missouri Arthritis Rehabilitation Research and Training Center, called the “Coordination of Care for Children with Juvenile Arthritis,” which will facilitate access to applicable public laws, policies, and programs that can help improve coordination of care for children with JA.
  Several agencies assist in these research studies or programs such as:
  • The National Institute of Arthritis and Musculoskeletal and Skin Diseases
  • The National Institute of Allergy and Infectious Diseases
  • The Centers for Disease Control and Prevention
  • The Agency for Healthcare Research and Quality
  • The Veterans Administration’s Medical and Prosthetic Research Program

Supporting Materials

Printable Issue Brief

Congress and the Obama Administration are committed to passing comprehensive health care reform in 2009. This Spring the Senate Finance Committee released three platform papers outlining options for reform.

• Transforming the Health Care Delivery System: Proposal to Improve Patient Access to Care and Reduce Health Care Costs ACR Comments
• Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans ACR Comments
• Financing Comprehensive Health Care Reform: Proposed Health Savings and Revenue Options

The ACR released The Future of Health Care in the United States in February 2009 outlining ACR priorities in health care reform.

In The News

Industry groups pledge 2 trillion in health savings.

On May 11, President Obama announced that health-care companies and various related groups have pledged to slow projected spending growth by 1.5 percent a year over the next decade. Overall, this will lower U.S. medical costs by about 2.1 trillion dollars. These groups represent drug makers, health insurers, hospitals, labor representatives, medical device makers and physicians throughout the United States. The groups' commitment to reduce health care spending could result in a 20 percent reduction in the projected rate of increase by 2019. This move could save a family of four an annual average of $2,500 within five years. Under the current structure, health-care spending is set to rise at a rate of 6.2 percent in the next ten years. This pledge was endorsed by the American Medical Association, the American Hospital Association, Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, America’s Insurance Plans and the Service Employees International Union.

Supporting Materials

ACR White Paper

SFC Delivery System (Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs)

ACR Response paper 1

SFC Policy Option on Health Care Coverage (Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans)

ACR Response paper 2

SFC Final - paper 3 (Financing Comprehensive Health Care Reform: Proposed Health System Savings and Revenue Options)

Returning Users

To log on to the RCR visit www.acrRCR.org.

Ready To Sign Up?

Practices can register for the RCR at any time by visiting the registration page, where complete details are available.

Read more about registering.

RCR Contact

Amy S. Miller

(404) 633-3777, ext. 813

AIM Contact

Julie Anderson

(404) 633-3777, ext. 338