Healthcare is gravitating toward value-based care and payment. How can gastroenterologists prepare for such a monumental shift in the way healthcare is delivered?
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: What have been a few of the most exciting advances in GI technology over the past few years?
Please submit responses to Carrie Pallardy at cpallardy@beckershealthcare.com by Thursday, September 25, at 5 p.m. CST.
Maxwell Chait, MD, FACP, FACG, FASGE, AGAF, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): Value-based care is changing healthcare delivery and changing physician compensation, driven by CMS, payers and the market. The outcome is based upon the maintenance of the health of a population through value-based cost sharing to increase the amount of health we get per dollar spent, through quality of care, patients safety and cost reduction.
Gastroenterologists need to prepare for the transition. The incentives and penalties have not been large thus far, but this will inevitably change. For GI, most of the quality measures being used are evidence-based, such as polyp detection rate, colonoscopy withdrawal time, cecal intubation rate and quality of bowel preparation. Patient satisfaction will play a significant role. Patients are more informed and demand to be communicated with on multiple levels. It will be important for healthcare professionals to foster communication to ensure positive outcomes Gastroenterologists need to approach ACO's to redesign practices to run more efficiently and engage patients through the use of portals and apps. The reward or penalty is financial. Penalties will increase for not participating in quality programs and eventually eligibility to participate in Medicare could be affected.
Globalization similar to surgical specialties will occur and reimbursements will decrease in many cases. Outcomes and costs of care will be compared among peers. Based on this, insurers will likely pay based on whether or not we can maintain good outcomes at reasonable costs. The immediate benefits of value-based care are financial through cost savings. There will be a larger focus on outcomes and the metrics that measure them. It will force us to become more efficient.
The major GI societies, the ASGE, AGA and ACG, offer instruments for recording and measuring these quality metrics that relate to colonoscopy. The value-based approach will extend into other areas and provide incentives to meet basic quality measures, such as hepatitis C screening. Transparency of this data will increase and gastroenterologists need to be prepared using electronic medical records. As quality becomes linked to reimbursement, value-based care may play a role at the health system level that may evaluate their own physician members based on quality measures. There needs to be different value-based care parameters for different groups of gastroenterologists based on the population or types of conditions they treat, such as inflammatory bowel disease, viral hepatitis, malnutrition, GERD, Barrett's esophagus, obesity, colorectal cancer screening/surveillance and prevention and GI motility disorders. The transition to value-based care will be challenging, but necessary.
Patrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): Value-based care will become an integrated part of the healthcare delivery system, and the field of gastroenterology is no exception. Regulatory agencies are already mandating that certain measures are addressed by hospitals to remain in compliance. Such measures include documenting the interval of 10 years for a "screening colonoscopy" or
justifying the need for colonoscopy within a three-year window since the last one.
In addition, it has already been suggested as part of "best practice" to document the withdrawal time of a colonoscopy. By looking broadly, it is not too farfetched to see that regulatory and insurance agencies will likely begin to look at whether or not these types of measures have been adhered to prior to reimbursing physicians for their services. Even the simple act of referral, which we took for granted, may be impacted by one's performance with these measures.
Websites may display the compliance of individual physicians and insurance companies for instance may recommend only those doctors who adhere closest to these value-based guidelines. It behooves physicians to be proactive and investigate how they can prepare for the future. Looking to national organizations such as the American Gastroenterological Association, American College of Gastroenterology and American Society for Gastrointestinal Endoscopy for guidance is an essential step to ensure success and survival in this up and coming climate. Another resource would be the quality department at your local hospital, which may be able to steer physicians in the right direction as well. Oftentimes, they are aware of mandatory pieces of regulation at the hospital level, but important vignettes may be applied to your office based practice and ambulatory surgery center too. The train for value-based medicine will be leaving the platform soon. Make sure you are on it.
More articles on gastroenterology:
AGA physicians to travel to Capitol Hill to advocate for GI field
FDA grants tentative approval of UCERIS for ulcerative colitis
6 gastroenterologists making headlines
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: What have been a few of the most exciting advances in GI technology over the past few years?
Please submit responses to Carrie Pallardy at cpallardy@beckershealthcare.com by Thursday, September 25, at 5 p.m. CST.
Maxwell Chait, MD, FACP, FACG, FASGE, AGAF, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): Value-based care is changing healthcare delivery and changing physician compensation, driven by CMS, payers and the market. The outcome is based upon the maintenance of the health of a population through value-based cost sharing to increase the amount of health we get per dollar spent, through quality of care, patients safety and cost reduction. Gastroenterologists need to prepare for the transition. The incentives and penalties have not been large thus far, but this will inevitably change. For GI, most of the quality measures being used are evidence-based, such as polyp detection rate, colonoscopy withdrawal time, cecal intubation rate and quality of bowel preparation. Patient satisfaction will play a significant role. Patients are more informed and demand to be communicated with on multiple levels. It will be important for healthcare professionals to foster communication to ensure positive outcomes Gastroenterologists need to approach ACO's to redesign practices to run more efficiently and engage patients through the use of portals and apps. The reward or penalty is financial. Penalties will increase for not participating in quality programs and eventually eligibility to participate in Medicare could be affected.
Globalization similar to surgical specialties will occur and reimbursements will decrease in many cases. Outcomes and costs of care will be compared among peers. Based on this, insurers will likely pay based on whether or not we can maintain good outcomes at reasonable costs. The immediate benefits of value-based care are financial through cost savings. There will be a larger focus on outcomes and the metrics that measure them. It will force us to become more efficient.
The major GI societies, the ASGE, AGA and ACG, offer instruments for recording and measuring these quality metrics that relate to colonoscopy. The value-based approach will extend into other areas and provide incentives to meet basic quality measures, such as hepatitis C screening. Transparency of this data will increase and gastroenterologists need to be prepared using electronic medical records. As quality becomes linked to reimbursement, value-based care may play a role at the health system level that may evaluate their own physician members based on quality measures. There needs to be different value-based care parameters for different groups of gastroenterologists based on the population or types of conditions they treat, such as inflammatory bowel disease, viral hepatitis, malnutrition, GERD, Barrett's esophagus, obesity, colorectal cancer screening/surveillance and prevention and GI motility disorders. The transition to value-based care will be challenging, but necessary.
Patrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): Value-based care will become an integrated part of the healthcare delivery system, and the field of gastroenterology is no exception. Regulatory agencies are already mandating that certain measures are addressed by hospitals to remain in compliance. Such measures include documenting the interval of 10 years for a "screening colonoscopy" or
justifying the need for colonoscopy within a three-year window since the last one. In addition, it has already been suggested as part of "best practice" to document the withdrawal time of a colonoscopy. By looking broadly, it is not too farfetched to see that regulatory and insurance agencies will likely begin to look at whether or not these types of measures have been adhered to prior to reimbursing physicians for their services. Even the simple act of referral, which we took for granted, may be impacted by one's performance with these measures.
Websites may display the compliance of individual physicians and insurance companies for instance may recommend only those doctors who adhere closest to these value-based guidelines. It behooves physicians to be proactive and investigate how they can prepare for the future. Looking to national organizations such as the American Gastroenterological Association, American College of Gastroenterology and American Society for Gastrointestinal Endoscopy for guidance is an essential step to ensure success and survival in this up and coming climate. Another resource would be the quality department at your local hospital, which may be able to steer physicians in the right direction as well. Oftentimes, they are aware of mandatory pieces of regulation at the hospital level, but important vignettes may be applied to your office based practice and ambulatory surgery center too. The train for value-based medicine will be leaving the platform soon. Make sure you are on it.
More articles on gastroenterology:
AGA physicians to travel to Capitol Hill to advocate for GI field
FDA grants tentative approval of UCERIS for ulcerative colitis
6 gastroenterologists making headlines