Meeting the Challenges of Value Demonstration in GI Practice

“There are only 2 or 3 things I know for sure. Only 2 or 3 things. That’s right. Of course, it’s never the same things, and I’m never as sure as I’d like to be,” nuggets of wisdom (from the novel Bastard Out of Carolina, Dorothy Allison) that Thomas Murray, Senior Director of Quality Measurement & Improvement, AGA, shared at the 2015 AGA Clinical Congress of Gastroenterology & Hepatology.

Murray attributed Allison, as the specialty of gastroenterology had been known to treat a variety of complex conditions, and over the last decade, tremendous focus has been split for both adult and pediatric gastroenterology and hepatology.

As such, some the challenges the industry encounters encompass addressing data needs and reporting requirements of multiple stakeholders like “multiple EHRs, endoscopy report writers, and other electronic systems with limited or no inter-operability," according to Murray.

Moreover, as procedural and measure specification are ever-changing, specialists are required to meet measure needs for multiple CMS reporting programs, including ACOs and ASCs.

This had proven to be an obstacle primarily because of the limited ease in electronic data transfer as well as governmental efforts to increase patient engagement and involve them in their own health care.

A step in the right direction, one of AGA’s initiatives, the Digestive Health Recognition Program (DHRP), is a quality improvement program and clinical data registry that allowed clinicians to demonstrate and be recognized for superior quality of care in treating inflammatory bowel disease (IBD), hepatitis C virus (HCV), and colorectal cancer (CRC) screening and surveillance.

Murray reflected that as the future for physicians foresees employed PCPs, a redesigned reimbursement system, and public transparency, gastroenterologists will be required to demonstrate that they are not only improving population health, but are also, “Responsible stewards of resources and achieving superior outcomes for conditions where gastroenterologists have specialty expertise”.

The DHRP now comes into play evidently supporting this strategy by potentially easily providing quality of individual and practice-level performance reports to participants.

Additionally, Murray explained the multiple benefits of expanding existing DHRP modules:

• Expand HCV to other viral hepatitis (eg, HBV) topics and to include cirrhosis measures
• Expand CRC module beyond endoscopy process measures to other colorectal cancer screening modalities
• Expand IBD measures to include outcomes measures, where possible; and new process measures, where these measure might be needed

DHRP heavily supports CMS PQRS reporting: PQRS measures IBD and HCV groups, while Qualified clinical data registry governs CRC screening and surveillance. And PQRS holds great significance as “Those who do not meet the 2014 PQRS reporting requirements will be subjected to a negative payment adjustment on all Medicare Part B PFS services rendered in 2016.” Furthermore, if healthcare professionals don’t participate in PQRS, they are then subjected to an additional decrease in their Value-Based Modifier payment.

The focus, Murray noted, is increasing the value of 2015 DHRP by expanding the HCV module to include measures for additional liver diseases and revising IBD measures and developing new IBD outcomes measures.

Sharing the various merits for working with industry, Murray suggested specialists shift gears by “Preparing for anticipated changes in hepatitis C screening and treatment, expanding options for meeting Maintenance of Certification requirements, including ABIM Practice Improvement Modules (PIMs), and engaging with payers by advocating for recognition of DHRP participation as an indicator of quality performance.”