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The Department of Health and Human Services has announced a campaign for transitioning Medicare reimbursement from volume to value. A budget-neutral Value-Based Payment Modifier has been implemented that provides for differential payment to physicians based upon the quality of care delivered. The value modifier will be based partially on physician participation in the Physician Quality Reporting System (PQRS), which allows for reporting of information on quality of care to Medicare. The information reported includes both medical data and patient-reported experiences with health care providers. Starting in 2017, the value modifier payment adjustment will apply to all physicians who make Medicare part B fee-for-service charge claims. Physicians who do not participate in the PQRS and satisfy reporting requirements may be assessed negative adjustments to their payments. Dermatologists in particular will be impacted by these changes, as skin diseases, especially psoriasis, account for a significant economic burden in the U.S.

Introduction: Quality of life (QoL) is an important issue in psoriatic disease that should be included when assessing therapeutic efficacy of treatments. The objective of this study was to compare improvement in the dermatology life quality index (DLQI) between patients treated with adalimumab and ustekinumab. Methods: Analysis was based on two separate open-label 24-week clinical trials assessing DLQI and the Psoriasis Area and Severity Index (PASI) at four-week intervals in adult subjects with moderate to severe psoriasis treated with adalimumab or ustekinumab. Results: There were no statistically significant differences in the improvement in DLQI and PASI between the adalimumab and ustekinumab groups except at week 12 for DLQI and week 8 for PASI (ustekinumab > adalimumab). Discussion: Both adalimumab and ustekinumab improve QoL, but further research is necessary to determine specific factors that improve QoL and if one medication improves QoL more than another.

The Psoriasis Area and Severity Index (PASI) and Physician Global Assessment (PGA) are the most commonly used tools for the evaluation of psoriasis disease severity in clinical trials. Based on U.S. Food and Drug Administration requirements, many recent trials concerning measurement of psoriasis disease severity have included the PGA as a primary endpoint alongside the PASI. In this commentary, we review the advantages and disadvantages of the PASI and PGA scales, and discuss an example of a psoriasis patient in whom PGA fails to capture clinically significant disease improvement. We argue that despite its limitations, the PASI is a more accurate and descriptive instrument than the PGA for the assessment of psoriasis severity.

Background Psoriasis patients experience a significant decrease in quality of life (QoL). Objectives This study was conducted to prospectively measure changes in QoL of patients with moderate-to-severe psoriasis who are treated with ustekinumab. We performed a review of the literature, and discussed the significance of our results in the context of the controversy regarding the correlation between the Dermatology Life Quality Index (DLQI) and Psoriasis Area Severity Index (PASI). Methods Seventeen patients with moderate-to-severe plaque psoriasis received 36 weeks of ustekinumab and were followed every 4 weeks. Results All patients demonstrated significant improvement, both in terms of QoL and physical assessments. The data suggest a strong linear correlation between mean percent reduction in PASI and mean reduction in DLQI (R2=0.94). Conclusion Psoriasis patients treated with ustekinumab achieved significant improvement of QoL, which correlated with physical improvement. This study demonstrates a strong correlation between mean percent reduction in PASI and mean reduction in DLQI.