In the Future, IBD Treatment Will Focus on More Cost-Effective, Quality Care

With renewed attention on maximizing return on every dollar spent on health care, gastroenterologists need to take a thoughtful approach that takes cost and the overall patient experience into account when they make testing and treatment decisions with patients who have inflammatory bowel disease (IBD), said John F. Kuemmerle, MD, professor of medicine, physiology and biophysics, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond.

Kuemmerle addressed the assessment and treatment of IBD in the context of accountable care during his presentation, titled “Clinical Practice Skills in a Changing World,” at the 2014 American Gastroenterological Association Clinical Congress of Gastroenterology and Hepatology in Miami Beach, FL, on Jan 17. He presented the talk on behalf of the originally scheduled presenter, Jonathan P. Terdiman, MD, professor of clinical medicine and surgery, University of California San Francisco.

“The goal with IBD is to deliver high-quality, high-value care and to maximize the patient’s experience,” Kuemmerle said.

However, “the quality of care of in IBD is quite varied. There is evidence of overuse, underuse, and misuse” of testing and medication, he said. By way of example, he cited previous studies that found 65% of IBD patients received an inadequate dose of 5-aminosalicyclic acid and that 60% of patients using chronic steroids were not offered steroid-sparing agents.

He also said that gastroenterologists have “dragged their heels” in providing data on quality care for IBD. However, tracking IBD care measures is part of the American Gastroenterological Association Digestive Health Outcomes Registry. Clinicians will have to pay closer attention to quality care with the implementation of penalties (as well as incentives) associated with the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative, or PQRI), he added. Electronic medical records and the increasing number of available clinical decision support tools will help gastroenterologists more easily track clinical data for IBD.

Cost consideration and its role in accountable care will also play an increasingly important role in the future. Kuemmerle said that medical bills are the leading cause for personal bankruptcy, and that many bankruptcies occur among middle-aged homeowners—not the population one might associate automatically with bankruptcy. Of those who have gone through bankruptcy due to medical bills, more than 75% had health insurance, he said. This is why cost-effective options—for example, generic drugs—should become a regular part of the diagnosis and treatment process for patients with IBD, he explained.

On a larger-scale level, more than 50 specialty groups, including the American Gastroenterological Association, are part of a program called Choosing Wisely, Kuemmerle said. Choosing Wisely helps specialty societies and its members consider the necessity of certain medical tests.

Gastroenterologists and their staff members also will need to spend more time in the future enhancing the experience that patients have at their clinics. “If you ask patients to come to a venue where they do not feel welcome or listened to, that won’t be effective,” he said. Top priorities within this area include effective patient communication with patients and among staff members.

As part of a clinic’s efforts to create a more positive experience for patients, clinicians and their staff should read what patients say about them online—much in the same way one might read restaurant reviews online before deciding where to eat. “Manage your online footprint,” said Kuemmerle. “You need to know what your patients are saying about you.”