Using data to drive quality outcomes can provide gastroenterologist with a slew of benefits including enhanced patient care and financial bonuses from CMS.
During a webinar hosted by gMed, a Modernizing Medicine company, a gMed team comprised of Julie C. Servoss, MD, MPH, medical director of gastroenterology; Elliot Ellis, MD, team lead of gastroenterology; and Erin Dettrey, PA-C, MBA, product manager of analytics, detailed how GI endoscopists can use data to differentiate themselves from other providers.
The Triple Society Paper
The American Society for Gastrointestinal Endoscopy and American College of Gastroenterology published their first version of quality indicators for colonscopy in 2006. Last year, the organizations updated the indicators GI endoscopists should use in the quality improvement process.
“The indicators’ purpose is to identify poor performers and either retrain them or remove their privileges if they cannot improve their performance,” says Dr. Servoss.
The Triple Society Paper’s task force uses current evidence to focus on certain parameters in quality reporting. Quality indicators for GI endoscopic procedures are given a grade of recommendation based on a scale ranging from 1A to 3. If an indicator has a 1A grade recommendation, that indicates it has a clear benefit and is supported by randomized trials without significant limitations. On the other hand, indicators with a 3 recommendation suggest the indicator has an unclear benefit and is based solely on expert opinion.
Each quality indicator is either classified as an outcome or process measure, and Dr. Servoss emphasizes it is important to note these indicators are not quality measures. “Quality indicators are parameters being used to measure the performance of individuals or groups of individuals to the ideal benchmark,” she adds. Each quality indicator has a performance target gastroenterologists should strive for to meet standards regulators.
“Everybody doing colonoscopies should be put to the same quality measures,” Dr. Ellis said. “It doesn’t matter to the patient if it is a surgeon or an endoscopist. Quality is quality.”
Pre-procedure quality indicators for colonoscopies
|Frequency of Correct Indication||>80 percent|
|Specific Informed Consent||>98 percent|
|Correct Screening Intervals||>90 percent|
|UC and Colitis Intervals||>90 percent|
Intra-procedure quality indicators for colonoscopies
|Frequency of Prep Quality Documentation||>98 percent|
|Adequate Bowel Prep||>85 percent|
|Cecal Intubation with Photography||>95 percent screening; 90 percent all|
|Adenoma Detection Rate||25 percent for all; 30 percent male & 20 percent female|
|Withdrawal Document Time||>98 percent|
|Average Withdrawal Time||>6 minutes|
|Biopsies for Chronic Diarrhea||>98 percent|
|Tissue Sampling for Colitis||>98 percent|
|Attempt at Polyp Removal||>98 percent|
Post-procedure quality indicators for colonoscopies
|Incidence of Perforation||Less than 1 in 500; Less than 1 in 1000 for screening colonoscopies|
|Incidence of Post Polypectomy Bleeding||< 1 percent|
|Bleeding Managed Without Surgery||>90 percent|
|Appropriate Repeat Colonscopy Recommendation||>90 percent|
Using the data to improve processes
Once GI endoscopists have identified the quality indicators, they can use the indicators to evaluate how the practice’s physicians are doing. Then, practices can devise a plan, implement the plan and assess the plan’s outcomes. All these steps encompass the practice improvement cycle.
“The practice improvement cycle is tricky,” Ms. Dettrey said. “You need to understand where you are and where you are going.
To understand a practice’s standing, gMed devised gInsights, which uses data analytics to evaluate a practice’s physicians. The tool can give a picture of where a provider is in relation to other physicians at the practice, other physicians throughout the nation and even different providers in the gMed community. In the system, a provider can see if they are meeting quality standards, which is indicated by a green line. A yellow line indicates you are on the border of meeting standards and a red line indicates failure to meet standard requirements.
“gInsights helps your practice if you need to track measure by measure, year by year, quarter by quarter or even day by day,” Ms. Dettrey adds.
Reimbursement is increasingly linked to quality outcomes, and those practices failing to meet requirements will bear the financial penalties. To stay afloat, GI endocopists cannot forgo the importance of leveraging data, and using the data to drive change in patient outcomes.