Rheumatic Disease Functional Assessment Pays

NEW YORK — Self-administered disease and functional status questionnaires accurately reflect disease activity in rheumatic conditions and—when incorporated in the chart—can be used to document compliance with Medicare Product Quality Research Initiatives.

In 2009, the Centers for Medicare and Medicaid Services added five PQRI measures relevant to the management of patients with rheumatoid arthritis: 176 (tuberculosis screening), 177 (periodic assessment of disease activity), 178 (functional status assessment), 179 (assessment/classification of disease prognosis), and 180 (glucocorticoid measurement). A sixth rheumatology-relevant measure that was introduced this year is 109 (assessment of pain and function in osteoarthritis), according to Dr. Yusuf Yazici, director of the Seligman Center for Advanced Therapeutics at New York University Hospital for Joint Diseases in New York.

Rheumatologists who can document that they have recorded three of these measures in roughly 80% of their patients in the calendar year are entitled to receive an amount equal to 2% of their total Medicare billings for that year. This is a time-limited incentive program. After the third year, rheumatologists must document adherence to these performance measures, and failure to do so may result in a punitive decrease in their Medicare payment, said Dr. Yazici, who made these observations during a presentation at a rheumatology meeting sponsored by New York University.

In addition to the benefits of providing data to the CMS, keeping functional assessment data in the patients' charts helps to document to private insurers that patients on biologics need to continue therapy with those agents. “In New York, and perhaps some other states, private insurers are requiring proof of improved function before they will pay to cover renewal of biologic therapy,” Dr. Yazici said. When the functional assessment shows no improvement, that data can be used to justify switching to another biologic, he noted.

CMS will accept a number of existing, validated disease activity or functional status tools for PQRI. Dr. Yazici praised this decision for its responsiveness to the requests of rheumatologists.

In his practice, Dr. Yazici favors the RAPID 3 (Routine Assessment of Patient Index Data 3), which is derived from the patient-administered MDHAQ (Multidimensional Health Assessment Questionnaire). Information about the MDHAQ and RAPID 3 tests is available at http://mdhaq.org

Dr. Yazici reported that the MDHAQ is reliable and easy to administer at routine patient care. Using the functional score, pain score, and global assessment on the MDHAQ, the clinician can calculate a RAPID 3 score, which can be used to monitor disease activity.

RAPID 3 correlated well with the DAS28 (Disease Activity Score 28). In one study that compared the predictive value of each assessment tool in 274 patients from three clinical sites, only 1 patient who was classified as being in near remission on RAPID 3 was also classified as having high disease activity on DAS28. Conversely, 10 patients who were classified as having high disease severity on RAPID 3 were classified as being in remission on DAS28.

In Dr. Yazici's practice, every patient fills out the MDHAQ at every visit. “If there is a reason to see the patient, there is a reason for the patient to fill out the questionnaire and for physicians to collect the data, even if the patient has come in for a weekly infusion/injection,” he said.

Dr. Yazici reported being a consultant and/or speaker for Bristol-Myers Squibb Co., Celgene Corp., Centocor Inc., Genentech Inc., Roche, and UCB SA.

If patients need to come into the office for any reason, they should fill out the functional assessment form. DR. YAZICI

NEW YORK — Self-administered disease and functional status questionnaires accurately reflect disease activity in rheumatic conditions and—when incorporated in the chart—can be used to document compliance with Medicare Product Quality Research Initiatives.

In 2009, the Centers for Medicare and Medicaid Services added five PQRI measures relevant to the management of patients with rheumatoid arthritis: 176 (tuberculosis screening), 177 (periodic assessment of disease activity), 178 (functional status assessment), 179 (assessment/classification of disease prognosis), and 180 (glucocorticoid measurement). A sixth rheumatology-relevant measure that was introduced this year is 109 (assessment of pain and function in osteoarthritis), according to Dr. Yusuf Yazici, director of the Seligman Center for Advanced Therapeutics at New York University Hospital for Joint Diseases in New York.

Rheumatologists who can document that they have recorded three of these measures in roughly 80% of their patients in the calendar year are entitled to receive an amount equal to 2% of their total Medicare billings for that year. This is a time-limited incentive program. After the third year, rheumatologists must document adherence to these performance measures, and failure to do so may result in a punitive decrease in their Medicare payment, said Dr. Yazici, who made these observations during a presentation at a rheumatology meeting sponsored by New York University.

In addition to the benefits of providing data to the CMS, keeping functional assessment data in the patients' charts helps to document to private insurers that patients on biologics need to continue therapy with those agents. “In New York, and perhaps some other states, private insurers are requiring proof of improved function before they will pay to cover renewal of biologic therapy,” Dr. Yazici said. When the functional assessment shows no improvement, that data can be used to justify switching to another biologic, he noted.

CMS will accept a number of existing, validated disease activity or functional status tools for PQRI. Dr. Yazici praised this decision for its responsiveness to the requests of rheumatologists.

In his practice, Dr. Yazici favors the RAPID 3 (Routine Assessment of Patient Index Data 3), which is derived from the patient-administered MDHAQ (Multidimensional Health Assessment Questionnaire). Information about the MDHAQ and RAPID 3 tests is available at http://mdhaq.org

Dr. Yazici reported that the MDHAQ is reliable and easy to administer at routine patient care. Using the functional score, pain score, and global assessment on the MDHAQ, the clinician can calculate a RAPID 3 score, which can be used to monitor disease activity.

RAPID 3 correlated well with the DAS28 (Disease Activity Score 28). In one study that compared the predictive value of each assessment tool in 274 patients from three clinical sites, only 1 patient who was classified as being in near remission on RAPID 3 was also classified as having high disease activity on DAS28. Conversely, 10 patients who were classified as having high disease severity on RAPID 3 were classified as being in remission on DAS28.

In Dr. Yazici's practice, every patient fills out the MDHAQ at every visit. “If there is a reason to see the patient, there is a reason for the patient to fill out the questionnaire and for physicians to collect the data, even if the patient has come in for a weekly infusion/injection,” he said.

Dr. Yazici reported being a consultant and/or speaker for Bristol-Myers Squibb Co., Celgene Corp., Centocor Inc., Genentech Inc., Roche, and UCB SA.

If patients need to come into the office for any reason, they should fill out the functional assessment form. DR. YAZICI

NEW YORK — Self-administered disease and functional status questionnaires accurately reflect disease activity in rheumatic conditions and—when incorporated in the chart—can be used to document compliance with Medicare Product Quality Research Initiatives.

In 2009, the Centers for Medicare and Medicaid Services added five PQRI measures relevant to the management of patients with rheumatoid arthritis: 176 (tuberculosis screening), 177 (periodic assessment of disease activity), 178 (functional status assessment), 179 (assessment/classification of disease prognosis), and 180 (glucocorticoid measurement). A sixth rheumatology-relevant measure that was introduced this year is 109 (assessment of pain and function in osteoarthritis), according to Dr. Yusuf Yazici, director of the Seligman Center for Advanced Therapeutics at New York University Hospital for Joint Diseases in New York.

Rheumatologists who can document that they have recorded three of these measures in roughly 80% of their patients in the calendar year are entitled to receive an amount equal to 2% of their total Medicare billings for that year. This is a time-limited incentive program. After the third year, rheumatologists must document adherence to these performance measures, and failure to do so may result in a punitive decrease in their Medicare payment, said Dr. Yazici, who made these observations during a presentation at a rheumatology meeting sponsored by New York University.

In addition to the benefits of providing data to the CMS, keeping functional assessment data in the patients' charts helps to document to private insurers that patients on biologics need to continue therapy with those agents. “In New York, and perhaps some other states, private insurers are requiring proof of improved function before they will pay to cover renewal of biologic therapy,” Dr. Yazici said. When the functional assessment shows no improvement, that data can be used to justify switching to another biologic, he noted.

CMS will accept a number of existing, validated disease activity or functional status tools for PQRI. Dr. Yazici praised this decision for its responsiveness to the requests of rheumatologists.

In his practice, Dr. Yazici favors the RAPID 3 (Routine Assessment of Patient Index Data 3), which is derived from the patient-administered MDHAQ (Multidimensional Health Assessment Questionnaire). Information about the MDHAQ and RAPID 3 tests is available at http://mdhaq.org

Dr. Yazici reported that the MDHAQ is reliable and easy to administer at routine patient care. Using the functional score, pain score, and global assessment on the MDHAQ, the clinician can calculate a RAPID 3 score, which can be used to monitor disease activity.

RAPID 3 correlated well with the DAS28 (Disease Activity Score 28). In one study that compared the predictive value of each assessment tool in 274 patients from three clinical sites, only 1 patient who was classified as being in near remission on RAPID 3 was also classified as having high disease activity on DAS28. Conversely, 10 patients who were classified as having high disease severity on RAPID 3 were classified as being in remission on DAS28.

In Dr. Yazici's practice, every patient fills out the MDHAQ at every visit. “If there is a reason to see the patient, there is a reason for the patient to fill out the questionnaire and for physicians to collect the data, even if the patient has come in for a weekly infusion/injection,” he said.

Dr. Yazici reported being a consultant and/or speaker for Bristol-Myers Squibb Co., Celgene Corp., Centocor Inc., Genentech Inc., Roche, and UCB SA.

If patients need to come into the office for any reason, they should fill out the functional assessment form. DR. YAZICI