Becker's ASC Review

53 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine - call (800) 417-2035 V alue-based care is a term heard across all specialties in healthcare, but value is an abstract term. Physicians, payers and patients each have a stake in defining value- based care and what it means for the future of healthcare. Chairman of the National Affairs Committee for the American College of Gastroenterology and ACG Governor for North Carolina Caroll Koscheski, MD, FACG, tackles the idea and how value-based care will affect the field of gastro- enterology. A board-certified gastroenterologist, Dr. Koscheski is in private practice with a seven- physician group in Hickory, N.C. The physician group owns a three-room endoscopy center and handles all of its contracting with payers. Cost vs. quality Value is a key priority in nearly every industry and this is not the first time healthcare has attempted to put the idea into practice. "Work in past years was pretty much limited to cost management in medicine without any strong efforts on the qual- ity side of the equation," says Dr. Koscheski. "This resulted in the restrictive practice by HMOs and the old gatekeeper models of healthcare delivery that everyone grew to hate." To avoid repeating the past, the elements of cost management and quality need to be given equal weight. "Costs initially seem quite easy to measure, since as physicians we look at this as strictly a fee sched- ule," says Dr. Koscheski. Professional fees vary slightly from practice to practice, more so from market to market. The challenge will be to create the measures that evaluate clinical quality. Quality parameters are constantly evolving and quality, like value, can be a difficult concept to define. "Fortunately in gastroenterology, we have had a number of leaders who have taken this task to heart over the past two decades and beyond," says Dr. Koscheski. There are well-established practice guidelines and metrics for several GI- related illnesses. Proven quality metrics in GI/ endoscopy include: • Adenoma detection rate • Scope withdrawal time • Quality of preparation Useful quality parameters, such as these frequent- ly used ones, will cover a large volume of cases performed. "This is especially important since it will typically encompass a large amount of dollars spent," he says. However, defining proven quality metrics is a large step forward in marrying the concepts of cost and quality. Quality reporting: burden vs. boon Value, regardless of definition, means little with- out demonstration. "Most physicians strive to do quality work for their patients, but we need to show it," says Dr. Koscheski. CMS ASC Quality Reporting Program has begun adopting measure- ment parameters specific to GI. Gastroenterolo- gists also have registries, such as the GI Quality Improvement Consortium and an AGA registry, which gather nationwide quality measures data. Quality reporting, much of which is now neces- sary, takes both time and money. "While there are costs involved, there are no financial rewards for far for participation. It is a very one-sided proj- ect," says Dr. Koscheski. However, there are benefits. CMS now recognizes participation in these registries as a Physician Qual- ity Reporting System measure. Additionally, the commitment of involved physicians provides data that serves as a valuable resource in the GI field through utilization of the various GI registries. Quality data is also becoming a resource for pa- tients. "I have had patients ask me about adenoma detection rates and complications rates," says Dr. Koscheski. Tracking rates such as these at a na- tional and individual level will aid gastroenterolo- gists in identifying areas for quality improvement and demonstrating valuable care. Whether physicians view quality reporting as an un- due burden or useful tool, it is now a vital element of practicing medicine. "There is no question that there will be work in this, but you have to just realize this transformation healthcare is going through will be a lasting change," says Dr. Koscheski. Shift in reimbursement models The drive for value-based care has caused wide- spread discussion of a shift away from a fee-for- service reimbursement model to a value-based re- imbursement model. Despite discussion, little has been done to make this move. "It will most likely start in the hospital setting in large systems," says Dr. Koscheski. "It will take vigorous input from all parties involved: doctors, hospitals, pharmacies, ancillary services, etc." If payers intend to link reimbursement to qual- ity, they will begin to develop quality measures. "I would hope that insurance companies will see that if they are going to succeed, they need to partner with physicians," says Dr. Koscheski. "They need to ask for physician input on devel- oping pure quality measures." Despite the potential for physicians to save pay- ers money through meeting these standards, there remains resistance to a large pay-for-performance model. "In a successful model, one would hope for some form of bonus pay for meeting certain quality and cost goals," he says. This, in fact, is one of the target goals of the new ACO models. Industry support Healthcare continues to change and physicians must work to remain on top of the latest require- ments. "My main advice for the practicing gas- troenterologists is to get connected with their GI societies and read everything that comes across their desk," says Dr. Koscheski. "We are fortunate to have three excellent GI societies that are very reliable resources for this, as well as many other topics in the changing realm of healthcare de- livery." n Dr. Caroll Koscheski of ACG: Value-Based Care in Gastroenterology By Carrie Pallardy Caroll Koscheski

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