Measuring, Improving, and Reimbursing for Quality in IBD Management

At a session during Digestive Disease Week 2017, held in Chicago from May 6-9, speakers discussed the ongoing efforts to define, measure, and improve the quality of care for patients with inflammatory bowel disease (IBD).
Published Online: May 07, 2017
Published By: Christina Mattina
At a session during Digestive Disease Week 2017, held in Chicago from May 6-9, speakers discussed the ongoing efforts to define, measure, and improve the quality of care for patients with inflammatory bowel disease (IBD).
 
Gil Melmed, MD, director of Cedars-Sinai’s Clinical IBD division, kicked off the lecture with a story about how his grandmother told him her new doctor was good because he was “such a nice guy.” But the real meaning of quality, Melmed said, is about the care that is actually delivered and whether it meets basic standards of value. As the healthcare landscape changes, reimbursement will be increasingly determined by quality, and there are significant opportunities for improvement, such as preventable complications, waste, and variation across practices.
 
The traditional framework of measuring quality is based on structure, process, and outcome metrics, but more recent quality indicators have begun to include accountability and patient-derived outcomes. After all, Melmed said, patients want to feel their clinician is addressing their concerns during a visit, not just checking a series of boxes. He listed just a few of the quality measure sets currently used in IBD management, from the process- and accountability-focused metrics used by the American Gastroenterological Association (AGA) to the QUOTE-IBD measures created with feedback from patients in 7 countries.
 
For practices just starting to experiment with quality indicators, Melmed suggested picking a single measure and seeing if their system is even set up to capture that measure, or by evaluating the “denominator,” or the number of IBD patients that would be impacted by a potential quality measurement initiative. Still, he emphasized that measurement is not equal to improvement. “Customers don’t measure you on how hard you tried. They measure you on what you deliver,” Melmed said, paraphrasing Steve Jobs.
 
Another entity measuring clinicians on what they deliver is CMS, according to the next presenter, Joel Brill, MD, chief medical officer at Predictive Health, LLC. He outlined the role of advanced payment models (APMs) in IBD and their risks and benefits to practices. Under the Medicare Access and CHIP Reauthorization Act (MACRA), practices will have to choose between entering 3 doors, Brill explained.
 
Behind Door 1 is the Merit-based Incentive Payment System (MIPS), the pay-for-performance option that includes quality reporting requirements. Entering Door 2 means joining an alternative payment model (APM), which rewards practices for managing population health and “being on the right side of change.” Door 3 leads into physician-focused payment models, which involve monetary risk and shared savings without the MIPS requirements, which Brill said let practices be “exempted from being MIPSed to death.”
 
Regardless of which door a practice chooses, Brill said it was clear that “the shift to value-based care is here to stay, and sticking your head in the sand is no longer an option.” He pointed to bundled payment models, which have been embraced by the AGA, as a good step to take while waiting for more APMs to develop, but emphasized that these models must be consistent and replicable.
 


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