Practice | Safety | Coding | Announcements
EDITORIAL
How To Leverage What You Do Well
I expect you know that physicians will be paid differently in the future. Instead of being reimbursed more for doing more, we will be paid based on how well we demonstrate the quality of care we deliver and how efficiently we provide this care. Bridges to Excellence (BTE), produced by the Health Care Incentives Improvement Institute, enables health-care providers to report quality performance to various health plans. In July, the AGA launched the Digestive Health Recognition Program (DHRP) in partnership with BTE. This program is a way for physicians to demonstrate and be recognized for superior quality of care in the treatment of various digestives diseases.
Although there are several topics around which we could have developed our first DHRP program, the AGA chose to begin with IBD Care Recognition™. This allowed the AGA to design the program around the IBD measures group in the 2012 and 2013 proposed CMS Physician Quality Reporting System (PQRS). The main advantage of this program is that by reporting on 30 consecutive IBD patients, a physician can report for PQRS and simultaneously submit data for the BTE recognition program. It is our expectation that this process creates efficiencies that allow physicians to see how they compare with others and be recognized for excellent care, with a small investment in data collection.
Subsequent to this initial project, we plan the release of additional care recognition programs focused on colorectal cancer prevention, hepatitis C management and other clinically relevant topics that provide gastroenterologists with a variety of options to demonstrate the quality of care they deliver. AGA’s goal is to enable physicians to simultaneously meet PQRS and BTE reporting standards; as an additional benefit, we plan to ensure that gastroenterologists can use the same report to fulfill American Board of Internal Medicine maintenance of certification requirements.
The mandates that external forces are exerting upon us to report quality are onerous; however, DHRP has been designed to reduce the burden with a consolidated reporting structure for submitting quality data. This approach allows participants to collect and submit data once and have these data reported to multiple quality programs. Gastroenterologists now have an efficient tool that has been developed specifically with our needs in mind that is designed not only to improve the quality of care we deliver, but also allow us to receive the recognition of high-quality practice and obtain greater reimbursement.
— John M. Inadomi, MD, AGAF
PRACTICE
Are You Using an EHR to Advance Patient Care?
By Carla H. Ginsburg, MD, MPH, AGAF; chair, AGA Public Affairs & Advocacy Committee
AGA and the Alliance of Specialty Medicine are working with CMS and Congress to improve Medicare's current electronic health record (EHR) incentive program. To make sure we are meeting the needs of members, the alliance has created a survey to help us gather information about your experience with EHRs. By completing the survey, you will help us gather data about how specialists are using this technology to advance patient care. By better understanding your needs, we will be able to advocate that CMS make changes important to your practice.
Take the survey.
Under the EHR incentive program, beginning in 2015, physicians who did not demonstrate meaningful use criteria in 2013 will face reductions in their Medicare payments. This means payments will be reduced by 1 percent in 2015 for those who do not participate, and the reductions will increase each year — 2 percent in 2016 and 3 percent for 2017 and each subsequent year. These penalties are on top of other requirements in the Patient Protection and Affordable Care Act, such as the Physician Quality Reporting Program and the new value-based payment modifier.
We hope to use the data to better understand the utilization of EHRs by our members since it serves as a foundation for other quality reporting initiatives. The data will be analyzed and shared with Congress and CMS, and may be the basis for advocating for modifications and/or delays in the meaningful use requirements. Additionally, this data will help us better understand the adoption of EHRs by gastroenterologists compared with our other specialty colleagues and whether there are cross-specialty commonalities for which we can advocate.
We realize you are busy and appreciate your assistance in providing information about your experience with EHRs, which will assist us in our advocacy efforts.
Take the survey to help ensure the needs of GI are being met.
CDC Recommends All Baby Boomers Get HCV Test
CDC now recommends that all U.S. baby boomers get a one-time test for the hepatitis C virus (HCV). AGA submitted comments to the CDC supporting the proposed HCV screening guidelines for baby boomers and noted several points for consideration, including implementation, cost and workforce issues that result from the recommendations.
To help combat the looming hepatitis C public health issue, the AGA developed I.D. Hep C, a campaign to educate people, especially baby boomers, about hepatitis C and encourage them to speak up and get tested to learn their status. This campaign is funded by Vertex. As part of the campaign, the AGA also released results from a national survey of baby boomers in the U.S. not previously diagnosed with hepatitis C. The survey found that nearly 74 percent of baby boomers have never been tested or are unsure if they have been tested for hepatitis C, and 80 percent do not consider themselves at any risk for having the disease.
CDC estimates that persons born during 1945 to 1965 account for three-fourths of all HCV infections in the country. This report presents CDC recommendations that augment previous recommendations for HCV testing; it recommends one-time testing without prior ascertainment of HCV risk for persons born during this period.
In support of the new recommendations, CDC has several resources available, including the Know More Hepatitis campaign website as well as partner resources promoting the recommendations. Also, the online hepatitis risk assessment has been updated to include the new recommendation for those born from 1945 through 1965.
| Clinical Course in HCV |
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A CME expert column series for clinicians that explores the latest issues related to the ongoing challenges of managing viral hepatitis. Learn more. |
How Will Proposed Payment Rates for 2013 Affect Your ASC?
CMS published the 2013 hospital outpatient prospective and ambulatory surgery center (ASC) payment systems proposed rule in the Federal Register on July 30. CMS proposes to increase payment rates to ASCs by 1.3 percent and to hospital outpatient departments by 2.1 percent.
AGA has prepared a payment analysis for GI codes paid under the ASC and hospital outpatient payment systems.
AGA has also prepared a detailed summary of the rule. Important to GIs is the additional detail provided by CMS regarding the ASC Quality Reporting (ASCQR) Program. Details for the calendar year (CY) 2014 payment determination were finalized last year; however, in this rule, CMS proposes updates and refinements to the ASCQR Program for CY 2015 and subsequent year payment determinations. CMS proposes requirements regarding the dates for submission, payment and completeness for claims-based measures. CMS also sets forth how the payment rates would be reduced for ASCs that fail to meet program requirements beginning in CY 2014 and clarifies its policy on updating measures.
A final rule is expected by Nov. 1, 2012.
Standardization of Endoscopy Reporting: Déjà vu All Over Again?
In this month’s Clinical Gastroenterology and Hepatology column “Practice Management: The Road Ahead,” Louis Y. Korman, MD, Metropolitan Gastroenterology Group, Chevy Chase, MD, discusses the vital need for standardized endoscopy reporting. While physicians often prefer the use of natural language reporting, Dr. Korman argues that there needs to be balance between GIs’ desire to define the information in their endoscopy reports with the controlled vocabulary needed for electronic health records.
With both government and commercial payors transitioning to value-based reimbursements that will link health outcomes with payments, there is a heightened need to collect specific performance measures derived from standardized data elements. Endoscopic findings need to be recorded in a manner that everyone involved in a patient’s care can understand. Dr. Korman believes that the GI community must work together to create standardized reporting that ensures endoscopy records and reports become models for achieving the goal of effective patient care and rational clinical practice. This cooperation is needed to create and maintain the common ground for a sustainable clinical and business model.
Read more.
It's That Time Again: Earn $$$ with PQRS
As we approach the end of 2012, time is running out to report to and earn a bonus from CMS' Physician Quality Reporting System (PQRS). The PQRS program allows clinicians who treat Medicare Part B patients to submit clinical data from a variety of available quality measures and earn a 0.5 percent bonus on all 2012 Medicare Part B allowable charges as a result.
PQRS offers multiple paths to participation, the easiest of which is through submission from a qualified registry. The AGA is offering two registry submission options in 2012, providing a way for you to choose the method that makes the most sense for your practice:
- Reporting the hepatitis C measures group using the AGA Digestive Health Outcomes Registry®.
- Reporting the IBD measures group using the AGA Bridges to Excellence IBD Care Recognition™ program.
Both programs require that you treat a minimum of 30 Medicare Part B patients in 2012 that have been billed for the applicable condition (chronic hepatitis B or IBD). For these 30 patients, you will answer a set of questions that are used to calculate the quality measures in the group. Then, your data are submitted to CMS on your behalf. Participants in PQRS potentially earn a bonus for simply participating, not for quality performance.
Submitting the IBD measures group using the IBD Care Recognition program also gives you the option to submit your results to Bridges to Excellence (BTE) for evaluation. If you achieve a minimum threshold for measure performance, you will receive BTE recognition, which can result in additional monetary bonuses from health payors as well as public recognition as a quality provider of IBD care.
Contact Sam Walters, AGA's director of quality measurement and informatics, for more information about both programs and for help in deciding which approach is best for you.
UpToDate® Associated with Improved Outcomes
A recent study by researchers at Harvard found an association between the adoption of UpToDate® and improved hospital quality performance, reduced length of stay and lower mortality.1 That is one reason why more than 600,000 clinicians worldwide rely on UpToDate to make the right point-of-care decisions.
An UpToDate subscription provides access to reliable evidence-based clinical information in gastroenterology and hepatology, as well as 19 other specialties — now including psychiatry. With more than 9,500 medical topics available from your computer, mobile device or tablet — and a new mobile app for Android™, iPhone and iPad — you are sure to find the answers you need, when and where you need them.†
Join your colleagues and subscribe to UpToDate today. Go to learn.uptodate.com/AGA2012 to try it for yourself and see what a difference it can make in your practice. If you are not completely satisfied, simply cancel your annual subscription within 60 days and receive a full refund in U.S. dollars.*
1. Isaac, T., Zheng, J. and Jha, A. (2012), Use of UpToDate and outcomes in US hospitals. J. Hosp. Med., 7: 85–90. doi: 10.1002/jhm.944.
†iPhone and iPad are trademarks of Apple Inc., registered in the U.S. and other countries. Android is a trademark of Google Inc. An individual subscription is required for access to UpToDate content through mobile apps. The app for Android is available in most countries. MobileComplete, the downloadable local version of UpToDate, is currently available only for iOS devices and is an additional $49 a year.
*30-day recurring billing subscriptions do not qualify for money-back guarantee.
SAFETY
More Action Needed with Unsafe Injection Practices
The Government Accountability Office (GAO) released a report on unsafe injection practices. The recent outbreaks of blood-borne pathogens due to clinicians’ unsafe practices (specifically hepatitis B virus and hepatitis C virus) are mentioned. Also, the report notes that most of the outbreaks attributed to unsafe injection practices have occurred in ambulatory care settings, such as ambulatory surgical centers (ASCs) and physicians’ offices.
GAO recommends that HHS:
- Resume collecting data on unsafe injection practices that will permit continued monitoring of such practices.
- Use those data for continued monitoring of ASCs.
- Strengthen the targeting efforts of the One & Only Campaign for health-care settings not overseen by CMS.
HHS agreed with GAO’s recommendations.
Adverse Drug Event Reporting: A Pain in the Rx
Approximately 500,000 adverse drug events (ADEs) are reported annually to the FDA, and this number is growing rapidly. However, published studies indicate that as few as one in 10 ADEs are actually reported by health-care professionals, largely due to the time-consuming and inefficient processes involved.
Now available to all AGA members, RxEvent is a new online network designed to collect and distribute ADEs. RxEvent provides quick, convenient access for reporting ADEs, including report pre-population and improved follow-up mechanisms.
If you have encountered an ADE, please report it via RxEvent.
CODING
HHS Delays Transition to ICD-10
HHS Secretary Kathleen Sebelius announced the release of a rule that makes final a one-year proposed delay — from Oct.1, 2013, to Oct. 1, 2014 — in the compliance date for the industry's transition to ICD-10 codes. Secretary Sebelius first announced the proposed delay in April, as part of President Obama's commitment to reducing regulatory burden.
Keep up to date on ICD-10 by visiting CMS’ website for the latest news and resources to help you prepare.
| AGA Institute/PAHCS GI Coding Manual |
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Gain a better understanding of the essential elements of GI coding in an easy-to-use format, designed for both the experienced coder and the novice. Order now. |
ANNOUNCEMENTS
FDA Approves Qsymia™ for Chronic Weight Management
The FDA approved Qsymia™ (phentermine and topiramate extended release) capsule CIV with a risk evaluation and mitigation strategy (REMS) to ensure that the benefits of Qsymia outweigh the increased risk of teratogenicity. As part of the REMS, a letter to health-care providers as well as a training program are available to present important information about the safe use of the drug.
Qsymia is indicated as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adult patients with an initial BMI of either of the following:
- 30 kg/m2 or greater (obese).
- 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus or dyslipidemia.
Once available, Qsymia will be dispensed only through certified mail-order pharmacies that provide a medication guide and risk of birth defects patient brochure with every prescription and refill, as required by the REMS. A list of these mail-order pharmacies will be available through the website www.QsymiaREMS.com once Qsymia is available.
Read more information about the REMS for Qsymia or call VIVUS Medical Information at 888-998-4887.
New Subcommittee Helps AGA Prioritize Guideline Topics
In May, the AGA Institute Clinical Practice and Quality Management Committee agreed to create a guideline subcommittee. The subcommittee will have a key role in shaping how the AGA identifies and prioritizes guideline topics as well as how existing medical position statements/guidelines are maintained. The group will be instrumental in keeping the guideline development on a rapid and rigorous development track.
The subcommittee held its first meeting on Aug. 15 and heard directly from the AGA Governing Board about the how the subcommittee’s work will influence the development and publication of guidelines for practicing gastroenterologists. The guideline subcommittee members are:
- John M. Inadomi, MD, AGAF, chair.
- David S. Weinberg, MD, AGAF, chair-elect.
- Sharon L. Dudley-Brown, PhD, CRNP.
- Yngve T. Falck-Ytter, MD, AGAF.
- Joseph Lim, MD.
- Lena Brice Palmer, MD.
- Joel H. Rubenstein, MD.
- Yu-Xiao Yang, MD.
