ACR Emphasizes Critical Role Rheumatologists Play in Disease Management, Cost Savings

The American College of Rheumatology (ACR) released a new whitepaper, the Clinical and Economic Value of Rheumatology: An Analysis of Market Supply and Utilization in the United States, which discussed the benefits of including a rheumatologist as a part of the health care team for patients with rheumatic and musculoskeletal diseases. These included an increase in the quality of patient care, as well as the positive financial impact rheumatologists have on the economy and health care systems.

Christina Downey, MD

Credit: Loma Linda University of Medicine

“Emphasizing the impact rheumatologists have on the entire medical community is more important than ever, especially as we contend with an impending rheumatology workforce shortage coupled with an expected increase in patient demand for rheumatologic care,” Christina Downey, MD, corresponding author of the paper and chair of the ACR’s government affairs committee said in a statement. “This paper supports our recruitment and sustainability efforts for the specialty by spotlighting the significant contributions we make every day and every year to patient outcomes, hospitals, and other healthcare practices.”

The ACR teamed up with ECG Management Consultations (ECG) to retrospectively analyze adjusted insurance claims data to better understand the direct value (the billings generated from visiting a rheumatologist) and the preventative value (the cost savings from reducing emergency room visits and inpatient admission) rheumatologists have on the economy. Results revealed markets with an increased number of rheumatologists had lower costs per patient for emergency room visits and hospitalization when compared with areas with a low supply. The preventative value of rheumatology care was shown to be $2,762 per patient per year.

Regarding quality of care, patients with rheumatoid arthritis (RA) receiving treatment with disease-modifying antirheumatic drugs (DMARDs) or biologic medication prescribed by experienced rheumatologists had generally improved quality of life, decreased disease activity, and modified comorbidities. Additionally, the number of patients with RA in need of invasive and costly hip or knee replacement surgery has significantly reduced in recent years due to the use of medications expertly provided by their rheumatologists.

Working with a rheumatologist was also shown to reduce 30-day readmission rates in patients with systemic lupus erythematosus (SLE) upon hospital discharge. This is particularly important as the condition is among the leading causes of death of young women living in the United States and patients often experience higher disease activity, morbidity, and mortality. The paper also revealed working with a rheumatologist reduced the rate of gout flare.

Rheumatologists were shown to generate $3.5 million on an annual basis in revenue for healthcare systems. This was calculated using direct and downstream billings linked to a full-time equivalent (FTE) rheumatologist, such as therapy referrals, consultations, office visits, lab testing, and radiology services.

Additionally, the Rheumatology Informatics System for Effectiveness (RISE) was created to track and improve the quality of care administered by rheumatologists in the United States. Information collected through this system provides timely feedback on functional status metrics and the receipt of DMARD treatment for patients with RA.

“We should strive toward a value-based healthcare model that is equitable and sustainable with transparent use of available resources to achieve better outcomes and experiences for every person,” investigators concluded. “It is also important to maintain the wellness of the rheumatology health care team with thoughtful teamwork to prevent burnout. The goals of lower costs and better outcomes with improved access to care for all patients includes noble principles that the American College of Rheumatology strongly values.”