WRA Builds Own Bridges, Wary of Others
The Washington Rheumatology Alliance (WRA), whose board met with ORA last year to investigate beginning a grassroots organization of its own, has conducted its first action as a 501(c)3. In September, representatives from the WRA assembled in Portland, meeting with the medical director of the state's largest health care insurance provider, Regence Blue Cross/ Blue Shield. Regence representatives expressed willingness to work with the WRA on physician-directed treatment plans, WRA President Dr. Jeff Peterson said. The new group will establish state-wide standards to help this and other insurance companies in the region develop appropriate policies, similar to ORA's insurance provider / physician liaison program.
However, Peterson reported that Premera, Aetna, and Regence are preparing to begin "quality measures" to determine physician payments. The payers have contracted with "Bridges to Excellence," a company that will utilize costs and outcome measures to calculate payments accordingly, Peterson reported. WRA leadership is worried that because no "outcome" data exists for the rheumatology specialty, Rheumatologists will be graded for the time spent on patients, disregarding the physician's patient demographic.
"In other words, by this model, an excellent physician who manages many difficult patients could still be regarded as a 'bad doctor' and receive less reimbursement simply because he or she spends more money than his or her peers," Peterson said.
The WRA is working to combat these "quality measures" so that physicians can continue to afford to provide the highest standard of care for their complex patient population.
ORA looks forward to combining efforts with Washington and other states in the region to improve access to care for our patients.