Gastroenterology Quality Benchmarking in 2019 & Beyond: GIQuIC

by Arnold G. Levy, MD |

Understanding the GIQuIC Registry for Gastroenterology Quality Benchmarking Tools

Every gastroenterologist wants to believe that they’re delivering their best care. But are they? That was the question that gastroenterologists, payers and other healthcare stakeholders set out to answer by implementing quality measurement and improvement programs.

For gastroenterologists, a tool for participating in these endeavors is GIQuIC—the GI Quality Improvement Consortium—and its quality benchmarking registry. In this article, we’ll explore the history of GIQuIC and its benefits for gastroenterologists when it comes to quality reporting and benchmarking, and how to use them.

What is GIQuIC?

GIQuIC is a quality benchmarking registry that lets gastroenterologists submit colonoscopy and EGD quality measure data for participation in quality improvement and value-based care programs. Created by the GI Quality Improvement Consortium (GIQuIC), the GIQuIC registry aims to help gastroenterologists improve outcomes by tracking performance over time and comparing with peers.

History and Purpose of GIQuIC

People tend to perform better when they know they’re being observed, a phenomenon known as the Hawthorne effect. This idea prompted gastroenterologist Irving Pike, MD, FACG, FASGE to start developing a mechanism for GI doctors to track their quality measures over time and compare them to peers.

The goal of this initiative was to improve outcomes, provide reliable physician performance comparisons, and meet the increasing expectations of payers and the government for gastroenterologists to demonstrate value-based care.

In 2006, a national task force of researchers identified and validated a set of GI quality measures that correlated with improved outcomes. After determining ways to collect, analyze and report these measures, healthcare IT company Sentara Healthcare created a pilot project where gastroenterologists could report on these quality metrics.

The pilot was a success, so the program’s founders handed it over to the American College of Gastroenterology (ACG) and the American Society of Gastrointestinal Endoscopy (ASGE) to be rolled out nationally. Together, they created the GI Quality Improvement Consortium (GIQuIC) Ltd. as a nonprofit educational and scientific organization.

The national GIQuIC registry went live in 2010, giving physicians from any GI office, endoscopy unit, ASC or hospital the ability to report, whether they are using paper or an endowriter system. Today, it includes data from nearly 10 million colonoscopy cases and approximately 3.5 million of those were reported from gGastro.

In 2014, they added measures for esophagogastroduodenoscopy (EGD) on top of existing colonoscopy measures. These two procedures are the only ones measured in GIQuIC to date, but the consortium is interested in potentially adding more gastroenterology procedures down the road.

Since 2014, GIQuIC has been approved by the Centers for Medicare and Medicaid Services (CMS) as a Qualified Clinical Data Registry (QCDR). A QCDR is defined as a CMS-approved entity that collects medical or clinical data for the purposes of patient and disease tracking to foster improvement in the quality of care provided.

Because of its QCDR status, gastroenterologists were able to use GIQuIC to participate in the Physician Quality Reporting System (PQRS) and are today able to use it as a Qualified Clinical Data Registry (QCDR) for the Merit-based Incentive Payment System (MIPS). Each year, more than 1,000 participants use the GIQuIC program for their quality reporting to CMS.

What Are the 2019 GIQuIC Measures?

As of July 2019, a total of 23 GIQuIC measures can be submitted to the GIQuIC registry. However, GIQuIC is considering adding measures for other gastroenterology procedures and for non-procedure care in the future.

The current colonoscopy GIQuIC measures are:

  1. History and physical documentation
  2. Informed consent documentation
  3. Adequacy of bowel prep
  4. Written discharge instructions – outpatient
  5. ASA category documentation
  6. Indication documentation
  7. Cecal intubation rate with photo documentation: All colonoscopies – screening, surveillance and diagnostic & Screening
  8. Adenoma detection rate – screening: Female and Male
  9. Withdrawal time
  10. Immediate adverse event
  11. Appropriate surveillance interval measures

The current EGD GIQuIC measures are:

  1. Appropriate specimen acquisition in Barrett’s esophagus
  2. Appropriate management of new diagnoses of bleeding esophageal varices
  3. Appropriate endoscopic therapy for stigmata of peptic ulcer disease bleeding
  4. Appropriate anticoagulation management
  5. Appropriate antibiotic prophylaxis
  6. Helicobacter pylori status
  7. Immediate adverse events
  8. Indication documentation
  9. Written discharge instructions – outpatient
  10. Informed consent documentation
  11. History and physical documentation
  12. ASA category documentation

Several of these measures—including appropriate surveillance interval measures, adenoma detection rate and cecal intubation rate with photo documentation—can also be used for MIPS Quality reporting.

Quality Benchmarking and Improvement: Benefits and Options

Collecting, analyzing and submitting quality data can help your organization in a wide variety of ways, from improving outcomes to opening up new business opportunities.

Background: Quality Benchmarking Options

Let’s consider the benefits of quality benchmarking in greater detail. Historical benchmarks, such as CMS benchmarks, are generally two or more years old and may not represent current clinical performance among gastroenterologists. Because the GIQuIC registry provides more current clinical data, it can help you benchmark performance more accurately. It also allows you to run customizable reports to look more closely at certain aspects of the care that you render to your patients.

Additionally, Endoscopy report writer (ERW) systems may also have the capability to track procedural quality measures for quality improvement, and some include advanced analytics tools with similar near-real-time peer benchmarking capabilities. These endowriter analytics tools can allow you to experience the potential benefits of performance monitoring, too.

If the endowriter is integrated with practice management and electronic health records (EHR) software, you may also be able to access reporting on financial, operational and office metrics. This can enable you to extend quality improvement initiatives to your office as well.

Using both the GIQuIC registry in tandem with your endowriter is also an option. For instance, you might be required to use GIQuIC for official reporting and you could also use your endowriter analytics software for tracking additional metrics internally. If GIQuIC is your reporting tool of choice, it can be additionally helpful to use your endowriter analytics to see how you’re doing on your GIQuIC measures before you submit to the GIQuIC registry.

Better Patient Care

When we consider the benefits of quality benchmarking and improvement, the most obvious is improving quality of care. By measuring performance and challenging doctors to do as well as or better than their peers, the gastroenterology field hopes to ultimately improve patient outcomes. From higher colon cancer detection rates to fewer adverse events and higher patient adherence to post-procedure recommendations, improving outcomes can make a big difference for patients.

If you find that you’re not measuring up to the national or regional average, you can evaluate your practice patterns and see if anything needs to be adjusted. This can be especially helpful in teaching environments for monitoring fellows’ endoscopy skill development.

Many of the national quality metric averages have continued to increase since GIQuIC began, which shows how much doctors can often improve their care significantly over time when they know that they are being observed, and when they therefore continuously track and work at improvement. Quality reporting can also help gastroenterologists identify gaps in their care and develop quality indicators to address those gaps.

From a patient perspective, it’s comforting to see an objective measure showing how high-quality your doctor’s care is before you go in for a gastroenterology procedure. Even if a patient doesn’t know what the numbers mean, knowing that you are committed to quality improvement can help instill confidence in your care.

Help Grow Your Business

Improving patient care is its own reward, but it often brings other rewards, too.

When you’re negotiating reimbursement contracts with Medicare and private payers, showing that you have participated in successful quality improvement initiatives can help set the stage for more favorable rates.

From the payers’ perspective, it makes sense that they’d be willing to pay a bit more for better care, especially if your center has cost-effectiveness data showing that you avoid over-utilizing expensive gastroenterology procedures. Some accrediting bodies may even require quality improvement documentation.

Another benefit of quality measure tracking in GIQuIC is the ability to conduct clinical outcomes research. By doing this, you can contribute to improving outcomes on a scale larger than that of your organization, while often being paid well in the process.

And finally, the ability to demonstrate your quality of care may open doors for your ASC to develop a relationship with hospitals and other healthcare organizations to screen their patients for colorectal cancer. This can be a fantastic way to expand your patient base and grow your center’s reputation in the community.

Value-Based Care

If you’re participating in MIPS, collecting quality measure data is a must. You can report GIQuIC measures for the Quality category, as well as potentially contributing to the Promoting Interoperability category.

Some endowriter and EHR software platforms also have the ability to collect and track MIPS measures and generate a report for submission to CMS.

As of 2019, CMS now allows you to use multiple submission methods for a single category if you choose. That means that you could submit some data through GIQuIC and some through your gastroenterology EHR system, and all of it should count towards your final score.

You can weigh these different value-based care participation options based on your ASC’s workflow and preferences.

How Does GIQuIC Registry Participation Work?

Once you sign up with GIQuIC, how do you actually go about submitting data? Well, it depends on whether you use paper or an endoscopy report writer.

With paper, you’ll fill out a form for each gastroenterology procedure you wish to report. The form is populated in the registry itself. The PDF of the data fields is about eight pages long due to the many selections of each data field. To document manually in the registry, it takes about 90-seconds per procedure.

If you use endowriter software, it can help formulate the quality measure data for you automatically based on the data you capture during the procedure. Then, you can upload a month’s worth of data in a few minutes via a data file transfer from your endowriter to the GIQuIC registry. With your consent, GIQuIC then can submit the data to CMS on your behalf for MIPS participation. GIQuIC and your endowriter may both work for quality measurement and MIPS participation.

What Does GIQuIC Cost?

According to the GIQuIC website, GIQuIC charges an annual registration fee for participation, which includes a site license for the registry software. This site license fee has a variable cost depending on the number of physicians at your site.

These are the GIQuIC site license fees as of July 2019:

  • 1-5 physicians = $4,000
  • 6-10 physicians= $5,400
  • 11-15 physicians= $9,400
  • 16-20 physicians= $10,800

For organizations with more than 20 physicians, GIQuIC recommends reaching out to their organization directly in regard to pricing.

Conclusion

As we’ve seen, the GIQuIC registry was created as a way for gastroenterologists to track procedural quality measures and conduct performance improvement initiatives. This can have a wide range of benefits, from improving outcomes to aiding in payer negotiations. Using analytics from your endowriter in tandem with GIQuIC can help you focus on quality reporting and benchmarking that can help ultimately improve patient care.

Arnold G. Levy, MD

Arnold G. Levy, MD

Dr. Arnold Levy’s medical career spans 40 years, beginning in Montgomery County, Maryland, in 1977. In that time, he has cared for patients with a wide range of digestive disorders, performed thousands of endoscopic procedures devoted his time to advancing digestive health care as a member of the National Digestive Diseases Advisory Board and the Board of the National Digestive Disease Information Clearing House and as the immediate past President of the Maryland Patient Care and Access Coalition. He also maintains an academic appointment as an Associate Clinical Professor of Medicine at the George Washington University School of Medicine and Health Sciences.

In 2006 as the healthcare provider environment was growing more complex, Dr. Levy joined forces with colleagues across the Washington Metropolitan area to lead discussions on how to address the challenges in their industry. In 2009 Capital Digestive Care was formed through the merger of seven diverse private practices and Dr. Levy was elected President and CEO where he served until 2017.

Dr. Levy obtained his BA in 1968 and MD in 1971 both with distinction and both from The George Washington University, in Washington, DC.

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