The Centers for Medicare and Medicaid Services approved the GI Quality Improvement Consortium as a Physician Quality Reporting System qualified clinical data registry. Irving Pike, MD, FACG, FASGE, Director and President of GIQuIC and American College of Gastroenterology Secretary, and Laurie Parker, GIQuIC, Executive Director, shed light on what this means for the GI field and what lies ahead for the data registry.
Q: What does this approval mean for practicing gastroenterologists?
Dr. Irving Pike: PQRS contains just fewer than 300 individual quality measures. They are important, but a real struggle for specialists, since so many of those measures are primary care based. If the purpose of PQRS is to have physicians focus on quality and transparency, it is not helpful for the GI community to track measures such as smoking cessation or blood pressure. Those are important, but not GI specific. We want to know the quality of endoscopic procedures as well as other GI disease management.
We now have that ability. This is becoming even more important as we get into disease management. We will be able to see how individual physicians care for patients with GERD, Crohn's or ulcerative colitis.
In the past, there was no meaningful way to reward physicians for measuring quality. This is changing. We offer an affordable, efficient and internet-based registry. As GI physicians perform their daily work, they can gather and record the measures necessary to create a quality report. This registry is efficient in terms of time and money for gastroenterologists.
Laurie Parker: PQRS has evolved from its inception in 2007 to 2014. In 2007, it had 74 quality measures. In 2014, it had 285 measures. For specialists, 285 represents growth, but it is still very difficult to meet requirements. This year, you must meet nine measures to successfully qualify for incentives. In 2013, it was just three measures. Now that CMS has approved GIQuIC as a qualified clinical data registry, GI physicians can take advantage of GI-specific measures.
Q: What specification did GIQuIC need to meet to earn CMS approval?
IP: We learned of this opportunity back in summer 2013. In October, we started in earnest on the self-nomination process. We have been in operation since July 2010, therefore we had a head start. We communicated with CMS, HHS and other agencies to understand the requirements a specialty registry would need to meet to be used in lieu of a traditional PQRS registry. We have been building towards this concept for a number of years; it was a matter of CMS introducing this qualified clinical data registry option and knowing the CMS rules and requirements.
• A qualified registry needed to be in existence at least a year before the proposed rule. We made that hurdle.
• It needed to have at least nine quality measures and a validation strategy in place. Quintiles Outcomes built and maintains the registry, which includes data validation. We have well more than nine measures so we only needed to select a menu of meaningful measures.
• Participants need regular feedback. Ours is a real-time registry. As data is submitted, reports are generated immediately, and it changes benchmarks and values within the registry.
By meeting those qualifications, we were able to successfully submit a self-nomination to CMS. Within the first week of May this year, we received a letter from CMS letting us know that GIQuIC had qualified.
LP: Every database interested in becoming a qualified clinical data registry had to self-nominate. CMS wanted to gauge how many registries would be interested. The self-nomination only had to attest to a few general requirements. At the end of March, a more detailed application was due. This application required a validation plan, quality measure details and at least nine measures spanning across three national strategy domains. Registries also needed to have at least 100 participants.
IP: Our registry's membership is recorded by organization, not individual physician. We have around 275 participating organizations across the country. Keep in mind, some of these organizations can be very large. Some organizations have multiple endoscopy facilities with large numbers of physicians, as many as 100 or more. We also have groups as small as a single physician. All together we have more than 2,000 participating physicians.
Q: As a qualified clinical data registry, do you think more gastroenterologists will begin to participate in GIQuIC?
IP: That is hard to say. We are in a period of ongoing growth. Last October, we had 350,000 colonoscopies in the registry and now we are closing in on 700,000. Our growth will continue to pick up, but it is hard to know if it is because of the CMS approval or because of a general move towards quality.
LP: We held an educational webinar as a result of the qualified clinical data registry approval. We had more than 200 participants. We learned from the webinar that PQRS is an underutilized system in the GI specialty because there aren't that many GI-specific measures. We also learned that GIQuIC participants are extremely pleased they will be able to now pass data on to CMS directly from the GIQuIC registry. In the past, this was one of the most frequently asked questions.
Q: Why do you think participation in quality reporting forums, such as GIQuIC, is important for gastroenterologists?
IP: The impetus for starting this process was to provide better quality care to our patients. Reporting to CMS is not the most important reason, the real reason is to provide better care and promote wellness.
Participation does have secondary effects. Five to eight years ago when speaking to a group of GI physicians, I would ask them if they knew their adenoma detection rates. We now know the higher the ADR the greater the protection against interval colorectal cancer, but endoscopists back then did not know. It was cumbersome to collect that data. We have created a methodology that makes it much more efficient. As we see ADR improving, physicians who are measuring it are providing better care to patients and preventing more colorectal cancer.
Up until now, there has been a very modest potential bonus for PQRS participants. This year the incentive is 0.5 percent, but there is also a 2 percent penalty for providers who do not participate. To a sizeable organization, that is a significant amount of money. GIQuIC participation can avoid that penalty.
We also now have a robust research database. This will help in clinical outcomes research. We will be able to improve future outcomes through research based on our hundreds of data fields. There are a lot of benefits to participating that go beyond what is at the root of developing this kind of registry.
Q: Are there plans to expand the number of quality measures tracked in the GIQuIC registry?
IP: Our focus over the next few months will be on making sure we have everything to be successful as a qualified clinical data registry. In addition we are planning a number of potential additions. We are considering specific unit based measurements for facility quality, in addition to individual physician quality. Patient satisfaction measures are also under consideration. Disease measures for inflammatory bowel disease and hepatitis C are also up for consideration. As our board of physician directors continues strategic planning and future development, these will all be on the table for discussion.
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