Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Quality of Care for Rheumatoid Arthritis and Osteoporosis: Results From the U.S. Medicare Physician Quality Reporting Program.
Curtis1, Jeffrey R., Sharma2, Pradeep, Arora3, Tarun, Bharat3, Aseem, Morrisey, Michael, Saag3, Kenneth G., Barnes, Itara
Quality of care and pay for performance are an increasingly visible facet of medical care. In 2006, Medicare enacted the Physician Quality Reporting Initiative (PQRI) program that allowed physicians to report performance measures for osteoporosis; rheumatoid arthritis (RA) was added in 2008. The objective of this analysis was to describe the number of rheumatologists and other physician specialties participating in the PQRI program and to understand physician-reported reasons why recommended care for individual osteoporosis and RA patients was not provided.
Using the national random 5% sample of Medicare fee-for-service beneficiaries from 20072009, we identified all healthcare providers reporting on 1) PQRI Measure 41: percentage of patients with a physician diagnosis of osteoporosis who were prescribed an osteoporosis medication within 12 months (CPTII 4005F); and/or 2) Measure 108: percentage of RA patients prescribed a biologic or non-biologic DMARD (CPTII 4187F). Modifiers allowed physicians to report on circumstances where there were medical, patient-related, or other reasons why the recommended medications were not prescribed; multiple reasons were allowable.
During 20072009, 13% of internal medicine and family physicians reported on prescription medication use for approximately 6,000 unique osteoporosis patients (measure 41); 1012% of rheumatologists reported on this measure. For patients for whom their physicians reported the measure in 2009 (n=5348), 7.3% did not receive osteoporosis medication for medical reasons, 4.3% did not receive osteoporosis medication for patient reasons (e.g. refusal), and 15.4% of patients did not receive it for other reasons (e.g. cost). In total, 26% of osteoporosis patients who had their physician report measure 41 did not receive prescription medications due to a reason provided by the physician.
In 2008, a total of 177 (5.7%) out of 3078 rheumatologists reported on DMARD use for RA patients; the proportion of rheumatologists reporting on this measure increased in 2009 to 10.2%. Among unique RA patients in 2009 (n=1765), 13.3% of patients had their physician report a medical (6.9%) or other (6.7%) reason why they had not been prescribed a DMARD.
Through 2009, approximately 10% of U.S. rheumatologists were reporting on the quality of care for their rheumatoid arthritis and osteoporosis patients enrolled in Medicare. A substantial fraction of these patients had physician-documented reasons for why recommended care had not been provided. Health plans that report on quality of care that fail to provide a mechanism to allow physicians to provide reasons why care was not provided may misclassify up to 25% of patients for whom care is medically inappropriate, refused, or otherwise not feasible.
To cite this abstract, please use the following information:
Curtis, Jeffrey R., Sharma, Pradeep, Arora, Tarun, Bharat, Aseem, Morrisey, Michael, Saag, Kenneth G., et al; Quality of Care for Rheumatoid Arthritis and Osteoporosis: Results From the U.S. Medicare Physician Quality Reporting Program. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :122