6 Quality Measures GI Centers Should Track
Brian Jacobson, MD, FASGE, associate director of endoscopy services at Boston Medical Center and associate professor of medicine at Boston University School of Medicine, helped author the comment letter to CMS for the GI societies.
"Beginning Oct. 1, 2012, ASCs will be required to submit data on five quality measures to avoid a payment adjustment in 2014. CMS had proposed a reporting start date of Jan. 1, 2012, but finalized a later start date in response to concerns expressed by the GI societies and other stakeholders about the proposed aggressive timeline. Therefore, GI surgery centers need to be paying attention to the same quality measures that all surgery centers need to be paying attention to, even if they think they don’t apply," he says.
But there are other measures not yet required that GI ASCs should consider tracking, such as patient satisfaction.
"This is the kind of thing that payors, including CMS, are going to be looking toward," he says,
He says there are also measures that apply specifically to GI centers. Here he outlines six measures that GI centers should consider tracking to benchmark and keep up with the competition.
1. Cecal intubation rates for colonoscopy. Dr. Jacobson says tracking cecal intubation rates is important to prove the skill-level of the ASC’s endoscopists. Cecal intubation is defined by the ASGE as the "passage of the colonoscope tip to a point proximal to the ileocecal valve so that the entire cecal caput, including the medial wall of the cecum between the ileocecal valve and appendiceal orifice."
2. Adenoma detection rates for colonoscopy. Measuring adenoma detection rate is key in determining the success of a colonoscopy. The ASGE has linked higher adenoma detection rates to better and longer examinations, better colonic distention and better colon cancer prevention.
3. Detailed colonoscopy report. Dr. Jacobson says this should include things such as depth of insertion, quality of bowel preparation, number and location of polyps detected and removed. Poor bowel preparation is a major obstacle to quality in colonoscopies, so the quality of the preparation should be noted in the records. The report should also include photos of abnormalities and identification of biopsy specimens.
4. Proper endoscope reprocessing. ASGE guidelines on reprocessing endoscopes recommend the operating channels and external portions of the endoscope be washed, wiped with detergents that contain enzymes and brushed with special cleaning instruments. The guidelines also recommend the endoscope be soaked with an FDA-approved liquid chemical, rinsed with water and alcohol and that the channels are dried with forced air. The guidelines were updated this year and now include guidelines on how long an endoscope can be stored without having to be processed again, as well as additional details on other processes.
5. Proper screening intervals. Dr. Jacobson says the standard interval is at least three years after a polyp has been found. In the future, he says, CMS may measure how often an endoscopist recommends a 10-year interval between colonoscopies with no polyp detected.
6. Belong to a GI registry. "I do think ASCs should think about reporting things through a registry," he says. "I think it makes it easier to participate in quality reporting endeavors that are being set up by CMS and private payors as well. If you get the electronic systems now, you can work out the kinks before it's required."
Two that he recommends considering are the GIQuIC registry, organized by the American College of Gastroenterology and ASGE, and the American Gastroenterology Association's Digestive Health Outcomes Registry.
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