Burnout, Not Otherwise Specified: Defining, Addressing Rheumatologist Burnout

Originally published in Helio Rheumatology

Across the country, practicing physicians are experiencing increasing levels of burnout, and rheumatologists are no different, according to national data and experts in the field.

Burnout — which occurs when work or personal pressures exceed an individual’s ability to cope with them — can manifest as physical and mental responses. Long-term, unaddressed burnout among clinicians can have devastating consequences, including chronic health conditions, emotional exhaustion, cynicism, a low sense of professional accomplishment, diminished quality of care and increased likelihood of early retirement.

Reasons for burnout are as myriad as there are physicians describing the problem. However, some of the most common culprits include the rise of electronic health records and a perceived distancing away from what many physicians see as their primary role — patient care.

“Rheumatologists treat patients with chronic and complex diseases,” Colin C. Edgerton, MD, FACP, chairman of the American College of Rheumatology Committee on Rheumatologic Care, and partner at Articularis Healthcare, which has practices in South Carolina and Georgia, told Healio Rheumatology. “It is particularly difficult to manage these complex patients in an environment that does not value the cognitive workload involved.”

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ACR & NPF Highlight Medicare Access Challenges in Capitol Hill Briefing

Originally published in The Rheumatologist

Concerns about how the Trump administration’s ideas to lower drug prices could reduce patient access to medicines led the ACR to speak out on many different fronts.

On June 25, at a briefing hosted by the ACR and the National Psoriasis Foundation (NPF), a packed room of Congressional staffers and reporters learned from rheumatologists and patients about the challenges involved when patients transition to Medicare. The briefing also addressed how the treatment of chronic conditions, such as arthritis, is being negatively impacted by current drug pricing that could worsen if proposed price changes are enacted, explains Angus Worthing, MD, FACR, FACP, chair of the ACR’s Government Affairs Committee.

Drug Pricing & Treatment Access

“The ways the U.S. drug pricing and drug distribution systems affect our patients are quite complex, and I think we were able to raise awareness on Capitol Hill about how to distinguish between the kinds of reforms that can improve our patients’ access to medicines and those that can worsen access,” Dr. Worthing says.

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In Focus: Physician-Led Efforts to Promote Value

Originally published in The Commonwealth Fund

Physicians are proposing new ways of delivering and paying for care that take aim at a key shortcoming of the nation’s fee-for-service system: lack of payment for some high-value services. Their condition-specific models encourage adherence to evidence-based guidelines and reductions in avoidable hospitalizations and testing that has little benefit. Finding payer support for these models has proven challenging for some despite evidence of cost savings or improved health outcomes.

With the share of the nation’s gross domestic product devoted to health approaching 20 percent and a tsunami of aging baby boomers closing in, it’s clear the United States needs to find creative ways to curtail health care spending. Unfortunately, many such efforts led by payers and policymakers — including pay-for-performance, accountable care, and bundled payment programs — have produced only modest savings.

Some physicians have taken up the challenge and put forth their own ideas to achieve greater value for health care dollars. Many leverage grant funding from the Center for Medicare and Medicaid Innovation (CMMI) and elsewhere to test their ideas. Some proposals come in response to Medicare’s call for ideas on how to move away from fee-for-service payment and promote high-value care. Their new care models take aim at common and costly conditions such as cancer, cardiovascular disease, and musculoskeletal problems and seek to achieve savings by encouraging greater adherence to evidence-based guidelines, engaging patients in decision making, and avoiding complications that can lead to unnecessary care. Their condition-specific approaches could benefit patients who have frequent interactions with health care providers and may be vulnerable to complications from treatment.

Since December 2016, physicians — represented by physician groups, specialty medical societies, and others — have submitted 25 proposals to the Physician-Focused Payment Model Technical Advisory Committee (PTAC), which was created under the Medicare Access and CHIP Reauthorization Act of 2015 and tasked with evaluating physicians’ ideas for new payment models.

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Running a Big Rheumatology Practice Requires Learning, Communication

Originally published in The Rheumatologist

If you had asked Ray Waldrup in 1981 what he would be doing in 2018, serving as the CEO of the largest rheumatology practice in the U.S. would probably not have been his first guess. Back then, as a young college student in Georgia, Mr. Waldrup took a job at a national jewelry retailer and quickly worked his way up to sales, then management. Enjoying his success, he ultimately decided to leave school to pursue a lucrative business career.

“Bill Gates and I dropped out of different schools together,” he jokes. “I started making money, and I never looked back.”

The Business of Medicine

Today, he runs South Carolina-based Articularis Healthcare, which boasts 12 locations in two states. The rheumatology group employs roughly 240 people, including 26 rheumatologists, 12 nurse practitioners and physician assistants, and a pathologist.

“We relieve a lot of the business stress for physicians,” Mr. Waldrup explains. “A lot of them profess to understand it, but if you’re seeing patients all day you don’t have time to keep up with the business side.”

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Bringing a Public & Private Practice Perspective to the ACR: A conversation with CORC Chair Colin Edgerton, MD, FACP, RhMSUS

Originally published in The Rheumatologist

Colin Edgerton, MD, FACP, RhMSUS, learned many things during his tenure as a rheumatologist and U.S. Army lieutenant colonel, including how to lead large, facility-based medical operations. Combining this knowledge with his current role as a partner in Articularis Healthcare, the largest single-specialty rheumatology private practice in the U.S., Dr. Edgerton has a unique perspective on the challenges facing rheumatologists in both facility and community environments.

As incoming chair of the ACR’s Committee on Rheumatologic Care (CORC), Dr. Edgerton brings this experience to bear, tackling the technical and economic issues affecting rheumatologic practice.

Meeting Big Changes with Expertise

CORC is charged with addressing the economic, technical and ethical issues of rheumatologic practice. Dr. Edgerton saw similar challenges while working at Walter Reed Army Medical Center in Washington, D.C., and while serving as chief of the Rheumatology Service at Eisenhower Army Medical Center in Augusta, Ga. Leadership in these facilities required political, budgetary and human resource expertise, which translates well into many of the issues and concerns CORC must address. In his current role as a private practice partner, Dr. Edgerton has gained additional expertise in managing contracts and mergers, including the founding of Articularis Healthcare.

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Rheumatology Experts Hold Briefing To Educate Congressional Leaders On Arthritis And Its Effects

Originally Published in Value Based Care Rheumatology

Washington, DC – In late January 2017, experts congregated on Capitol Hill on behalf of the American College of Rheumatology (ACR) and the Arthritis Foundation to hold a congressional briefing titled Arthritis 101, according to a press statement by the ACR. The purpose of the briefing was to inform new and returning leaders in Congress about arthritis and the impact the disease has on Americans and the US healthcare system.

Arthritis is the primary cause of disability in the United States, and has been diagnosed in more than 52 million Americans. Healthcare costs for this condition are approximately $128 billion annually in the United States.

“Millions of Americans living with arthritis and other rheumatic diseases face enormous obstacles when trying to access safe, effective and affordable health care. Now more than ever, we need practical solutions to expand access to care and improve the quality of life for people living with arthritis. We look forward to working with new and returning members of Congress to address some of these cost and access challenges,” said Angus B. Worthing, MD, FACP, FACR, Chair, Government Affairs Committee, ACR, Atlanta, GA, in the press release.

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ACR Hosts Arthritis 101 Briefing on Capitol Hill

Originally Published in The Rheumatologist

On Jan. 31, the ACR partnered with the Arthritis Foundation to host an Arthritis 101 Congressional briefing on Capitol Hill. Panelists educated new and returning members of Congress and their staffers about arthritis and other rheumatic diseases, the cost and impact of rheumatic disease to constituents and the U.S. healthcare system, and current policy challenges and opportunities.

Speaking on behalf of the ACR were Angus Worthing, MD, FACP, FACR, chair of the ACR’s Government Affairs Committee, and Colin C. Edgerton, MD, FACP, RhMSUS, former Army physician and member of the ACR’s Committee on Rheumatologic Care. Other panelists included Shannan O’Hara Levi, a juvenile arthritis patient and Arthritis Foundation advocate, and Cavan Redmond, former CEO of WebMD, pharmaceutical healthcare executive and Arthritis Foundation board member.

The event was co-sponsored by Congressional Arthritis Caucus co-chairs Reps. Anna Eshoo (D-CA) and David McKinley (R-WV) and moderated by former U.S. Senator Tim Hutchinson (R-AR).

The briefing was well attended, with Congressional staffers from both House and Senate leadership present.

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