The following article is written by Tom Deas Jr., MD, FASGE, FACG , medical director of Fort Worth Endoscopy Center and president-elect of the American Society for Gastrointestinal Endoscopy. He has also served as a member of the advisory board for the GI Quality Improvement Consortium registry.
It's a new day for quality reporting in ambulatory surgery centers. Many have already recognized the benefits and are engaged in tracking and improving performance indicators. For the others, reality is about to arrive as federal regulations take effect that now up the ante for all ASCs.
The proposed rule released by CMS this past July will launch a new quality reporting program covering eight measures beginning in 2012. Under the program, ASCs that fail to report required information will face a reduction in their Medicare payments.
While lack of reporting will not affect payments until 2014, ASCs need to be laying the foundation and developing processes to get ready. It is important to point out that data reports submitted to CMS will be made available to the public, and poor quality performance indicators could have a negative impact on the publics' perception of an ASC.
Within gastroenterology, the quality agenda has been steadily gaining traction. A 2008 independent survey commissioned by ProVation Medical and Caris Diagnostics (now Caris Life Sciences) reveals that nearly nine out of 10 gastroenterologists were already capturing quality indicator data or would initiate a strategy for tracking within two years.
Emerging national trends serve as powerful motivators for endoscopy centers to begin raising the bar on efficiency, effectiveness and reliability in quality measure reporting and benchmarking. One example is the GI Quality Improvement Consortium (GIQuIC), which was established by the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE) to create a national GI endoscopy data registry of quality measures. Hundreds of physicians from endoscopy centers nationwide have already registered to participate in this groundbreaking initiative by collecting and electronically reporting on 84 quality indicators specific to colonoscopy.
GIQuIC at a glance
Among the many quality measures that are tracked, GIQuIC can report on four important measures for improving colon cancer screenings and detection — cecal intubation rate, quality of bowel preparation, adenoma detection and appropriate adenoma surveillance interval. Significant variation with adenoma surveillance interval guidelines currently exists. Benchmarking of colonoscopy performance for colorectal cancer screening provides physicians valuable insight for improving both the quality and cost-effectiveness of their practice.
While many endoscopy centers track performance indicators for internal use, many physicians' practices still operate in a vacuum when it comes to benchmarking against peers. By leveraging the benefits of a national initiative like GIQuIC, they are able to objectively compare their performance measures to other professionals across the country.
Some reports indicate that colonoscopy has only lowered the cancer risk in the left colon. Others suggest that physicians with low cecal intubation rates are less effective in preventing right-sided colon cancer. For this reason it is important for every colonoscopist to know their cecal intubation rate and how they compare with quality benchmarks and their peers.
Participating in a benchmarking registry initiative like GIQuIC requires endoscopy units to establish the processes for tracking and reporting in an efficient and reliable manner. Meeting this challenge head-on will also enable units to ready themselves for future quality and performance expectations.
Improving workflow for better quality tracking
While many ASCs are making great progress, some must play catch-up with their workflow processes, documentation and tracking procedures — especially those that are manually collecting and reporting quality measures. When endoscopy reports are handwritten or dictated, data can be entered manually into the GIQuIC registry. However, it is a more demanding process than using electronic report writers and electronic download of data. The manual entry of data may also be more inconsistent and error prone. The collection of reliable, accurate data is paramount and fundamental to confidence in registry reporting.
The automation process is being developed by a number of leading health IT vendors that are working closely with ACG and ASGE to develop reporting tools that streamline the GIQuIC data collection workflow and reporting process. The overriding goal of these tools is to enable the efficient capture of accurate and complete data with minimal impact on physician workflow and ASC resources.
Fort Worth Endoscopy Center (FWEC), a beta site for GIQuIC, chose ProVation MD and its GIQuIC query tool to achieve the goals for data collection and reporting. The tool streamlines data collection and submission by first guiding physicians through the process of capturing required, conditionally required and optional data elements. The query tool is then used to organize data into a specific format that can be submitted to the GIQuIC registry.
To minimize physician resistance to the change of using a reporting tool, FWEC named physician champions to lead the effort. They found that the best way to encourage adoption of new workflow practices was to present the compelling picture of enhanced care delivery and cost efficiencies that would follow. By participating in GIQuIC via an automated process, physicians could expect improved outcomes, fewer missed cancers, more reliable surveillance intervals and compliance with evidence based medicine. Since current regulations will make these kinds of registry initiatives a requirement going forward, the ability to get ahead of the learning curve makes the transition acceptable.
Early trends at FWEC reveal changes in practice behavior that align with these expectations. Physicians are spending more time examining the colon during withdrawal — increasing average withdrawal time by several minutes for many physicians. In addition, virtually all physicians have changed to a split preparation, which is in line with industry best practices. Practitioners who have been measuring adenoma detection rates are also seeing improvements.
Foundation for success
The decision to deploy an electronic solution that automates the collection and reporting of quality data was the right first step for participation in an initiative like GIQuIC. It has laid the best foundation for physicians at FWEC to measure performance and outcomes against internal and national benchmarks in the most efficient, accurate, and complete way possible. It also allows physicians to leverage the latest in evidence-based medicine while moving forward with national quality initiatives to raise the bar on patient care and outcomes.
The opportunities for ongoing improvements across the specialty begin with efforts like GIQuIC as the data collected specifically advances quality in colonoscopy by documenting and benchmarking performance for cecal intubation, quality of bowel preparation, adenoma detection and surveillance intervals — all of which impact colorectal cancer prevention.
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