How Can Gastroenterologists Take Part in Population Health Initiatives?
Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses. Next week's question: Does it make sense for gastroenterologists to embrace price transparency?
Question: How can gastroenterologists get involved in population health initiatives?
Maxwell Chait, MD, FACP, FACG, FASGE, AGAF, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): Gastroenterologists should become involved in population health initiatives to define high quality gastroenterology practices for patients, payers and purchasers of health benefits by continuing to develop measures related to the quality, efficiency and outcomes.
Measures are evolving that can facilitate development of a valid means that will achieve this goal, such as government and private sector initiatives supporting value-driven healthcare and avoiding waste and overuse. Better information and quality improvement can lead to endorsement and implementation of measures into routine practice.
Gastroenterologists, payers and other experts need to work together to develop measures in several areas of gastroenterology practice, such as colorectal cancer screening and surveillance, colonoscopy performance and efficiency, inflammatory bowel disease, hepatitis C, GERD, ASC safe surgical guidelines, adenoma detection rate, Barrett's esophagus, endoscopic procedures, potentially avoidable complications, dyspepsia and Helicobacter pylori and obesity.
Gastroenterologists can work with other medical specialties for initiatives in such preventive measures as influenza immunization assessment, pneumococcal vaccination, tobacco use counseling and cessation, documentation of current medications in the medical record and hypertension. Continuing education programs for gastroenterologists should be promoted and based an assessment of the individual physician's knowledge base, supported by the data that identifies educational opportunities for improvement to earn American Board of Internal Medicine (ABIM) Part 4 self-evaluation of Practice Performance Maintenance of Certification (MOC) points.
Patrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): It behooves gastroenterologists to get involved with population health initiatives. As value-based medicine takes a foothold in the matrix of healthcare, it will be up to gastroenterologists to prove that their interventions actually have a major impact on the health of the population that they are serving. In this era of personalized medicine, it is strange to believe that collective health will be the engine which drives healthcare, but market forces are truly dictating this path.
On a local level, gastroenterologists can demonstrate the need for such initiatives as colon cancer screening. Aside from regurgitating data from studies demonstrating the efficacy of the process, physicians can begin to show how they can do screening in an effective as well as cost-effective manner.
It would not be hard to show independent physician associations a vision in regards to providing this important resource for patients. Starting from educational initiatives, physicians can demonstrate how their workflow for colonoscopy screening is superior to others. Perhaps the process of sending a patient from a primary care physician's office to the gastroenterologist can be so seamless that it can actually save time for the primary care physicians and their office staff.
From ensuring compliance with colon purgatory preps, to impeccable/reliable follow-up post procedure care to meet the needs of IPAs from a quality and cost-effective standpoint, a true template can be painted. For instance, demonstrating 99 percent compliance with cecal intubation, and little need for repeat colonoscopies or other studies would be attractive to a potential payer. These modalities can be tracked in a gastroenterologist's practice and the data should be accrued in a format which is interpretable for the intended audience.
By taking this type of approach, gastroenterologists can better position themselves to garner the contracts and rates that they so covet.
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