On Aug. 22, the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy released updated quality indicator recommendations for colonoscopies.
The new indicators included bowel preparation adequacy rate and sessile serrated lesion detection rate in a list of priority quality indicators that should be measured when performing a colonoscopy. The thresholds that some indicators are held to, including adenoma detection rate, were also updated. ACG and ASGE also increased the ADR acceptance level from 30% to 35%.
But the effects of the new recommendations remain unclear, according to a Sept. 12 report from the American Journal of Managed Care. Determining the effectiveness of the guidelines will ultimately come down to individual endoscopists and endoscopy units doing their part to ensure the new measures are followed. However, this can be challenging in the GI space, noted Rex Ness, MD, associate professor of medicine at Vanderbilt University Medical Center, in the report.
"We don’t have a government mandate, we don’t have an insurance mandate," said Dr. Ness. "I think that CMS is perfectly aware of the recommendations that we have made and they have, at times, created incentives for measurement of different quality parameters, but the way that is set up, depending on where you practice, the health care system may be able to meet those quality requirements without actually measuring anything that has to do with any [gastrointestinal] outcomes."
Dr. Ness added that CMS' Merit-Based Incentive Payment System and Quality Payment Program use measurements for reimbursement, and that MIPS should start looking at the ADR. Updating registries to include the new guidelines will be a first step in getting more facilities to report on the measurements, but the ACG and ASGE have no enforcement power over the new indicators beyond recommending them.
"Whether something is going to change from what's currently used as a result of this update, I don't know, and that’s not something that we take into consideration at this level when we're creating the guidelines," said Dr. Ness. "The guidelines are created … to get the best outcome for patients and the rest of that follows on the other groups that are considering these guidelines."