How can gastroenterologists drive quality improvement efforts in endoscopy centers and GI-driven ambulatory surgery centers?
Bret T. Petersen, MD, a gastroenterologist with Mayo Clinic in Rochester, Minn., recently authored the article "Quality Improvement for the Ambulatory Surgery Center," which appeared in the American Gastroenterological Association's June issue of Clinical Gastroenterology and Hepatology. Dr. Petersen explains why quality improvement is now an essential part of the GI field and how gastroenterologists can take the lead ASC QI projects.
Question: Why do you think quality improvement in the ASC setting is an important focus for GI physicians?
Dr. Bret Petersen: We know there are great differences in performance and outcomes of GI endoscopy across the country, even among colleagues within individual units or departments. Hence, uniform delivery of quality services often requires attention to quality measures and outcomes. Given that many ASCs function independently and do not have parallel or umbrella quality oversight organizations to assist with quality assurance efforts, they may need to engage in this activity on their own.
Q: What are the core quality improvement concepts GI physicians need to understand?
BP: First and foremost is the need for measurement and collation of data pertinent to standardized parameters or outcomes, to understand the level of service and quality that is being delivered. Second, quality measurement and improvement efforts should be focused on issues with anticipated gaps or shortcomings in performance that are associated with important outcomes, from the patient's standpoint, and that are practical and amenable to improvement.
Q: How will quality improvement requirements begin to affect day-to-day practice?
BP: Quality improvement efforts can be directed toward many aspects of the sequence of patient care. Two initiatives that often directly enhance outcomes on a daily basis, and also benefit the financial health of a practice, include those dealing with efficiency and wastage. Efficiency is a wide-ranging term pertaining to patient and staff scheduling, procedure performance, as well as virtually all simple or complex tasks within the unit. Efforts to reduce wastage commonly focus on single-use devices, which may be opened and discarded without clear purpose due to either endoscopist decision making or staff error.
Quality improvement efforts are already important for maximizing reimbursement in the Medicare population, as a result of the PQRS and ASC programs from the Centers for Medicare and Medicaid Services. As quality mandates penetrate the private marketplace, similar quality efforts will likely become important for avoiding financial penalties in the non-Medicare population as well.
Q: Some physicians worry that the reporting aspect of quality improvement is a burden. Do you see this changing?
BP: While burdensome compared to a minimally regulated environment, I believe the growing expectations for quality improvement data should be viewed as a responsibility of the practice. The actual burden in time, organization and oversight will hopefully lessen as measures for national use are more broadly adopted and standardized, allowing their incorporation into the IT infrastructure of our clinics and procedure facilities. This is already happening via the many endoscopy reporting systems that now communicate with GIQuIC, which itself can now submit registry data to CMS on behalf of its participants.
Q: Where do you see the future of GI quality improvement headed?
BP: In the future I expect we will have a slightly larger number of measures for reporting to CMS’s ASC and PQRS programs, more pertinent measures related to the services we deliver, more stringent expectations for the proportion of our practices on which we report and, hopefully, adoption by the private payers of the most pertinent and important measures, such as adenoma detection rate, cecal intubation rate and use of appropriate intervals for colonoscopy.
I think all endoscopists can provide a benefit to themselves, their practices, , and their patients, by proceeding to monitor and improve on the widely accepted measures we already have, without waiting for gradual expansion or strengthening of mandates from federal, state or private sources.
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