SAN DIEGO — Productive conversations with payers about utilization and patient journeys will define the future of independent rheumatology in the long term, according to a managing partner of a 12-physician rheumatology practice.
“For quite a while, I have been a little bit pessimistic about the current state of affairs and have been saying to my friends that ‘the sky might be falling’,” Max I. Hamburger, MD, said here at the United Rheumatology Spring National Meeting.
Using the well-known fable of putting a frog in slowly boiling water, Hamburger said “I would submit to you that we, the rheumatologist…we are the frog. And we have been tossed into that water and they have been bringing up the heat for a very long time and though many of us are saying we are doing okay but I am not quite sure.”
Rheumatologists manage the most expensive class of patients in the United States – ahead of oncology, physicians who treat hepatitis C and AIDS, and neurology, he said.
During the United Rheumatology Spring National Meeting, founder and executive chairman, Max I. Hamburger, MD highlighted the importance of independent rheumatology practices beginning a constructive dialogue with payers about the expense of certain drugs and the needs of their patients.
“Inflammation drug spending is at the top of the spend list,” he said and noted that this high utilization is the reason that payers scrutinize and manage the utilization of these drugs.
Conversely, rheumatologists are in the bottom quartile of compensation and their income growth lags most specialties, he said. In 2016, more physicians were employed than in independent practice.
“If we are going to control our future, we are going to have to understand other approaches to how we are compensated,” Hamburger said.
“If we are going to have a conversation with the payers, I needed to learn what their language was and need to learn how to talk to them and so do we all,” Hamburger said. “We do need to find a way to find harmony with the payers” and partner with them noting that they can be quite welcoming “because we can make their life difficult when we resist them but when we take our place responsibly at the table and we take accountability for what we are doing with the drugs that are expensive, we can actually make their lives a good deal better.”
There is a lack of payer understanding of the “patients and where their journey goes…and that is our job to discuss with them and they are welcoming of that.”
Hamburger is the founder and executive chairman of United Rheumatology, which he said was created to “represent and empower the independent practice rheumatologist, to advance the standard of care as we define it. To define our value, to strengthen the relationship between the physician and the patient which seems constantly to be under assault, and support our practice autonomy through a national rheumatology clinically integrated network.”– Joan-Marie Stiglich, ELS
Hamburger M. Sustaining independent rheumatology in turbulent times. Presented at: United Rheumatology Spring National Meeting. April 20-21, 2018; San Diego.
Disclosure: Hamburger is the founder and executive chairman of United Rheumatology.