We aim to provide the highest quality of care for our patients. But what is health care “quality”? It is a multi-faceted concept, but one widely accepted definition is to “improve desired health outcomes” by providing care that is “safe, effective, timely, efficient, equitable and people-centered” (WHO 2019). AGA aspires to make high-quality care a reality for all patients with gastrointestinal (GI) conditions.
Medicine in the U.S. is transitioning from volume-based care to value-based care, with reimbursement increasingly focused on the quality of care relative to cost. To promote this transition, the Patient Protection and Affordable Care Act (ACA) of 2010 introduced penalties for failure to report quality data to the Physician Quality Reporting System (PQRS), a program instituted in 2006 that expanded Medicare’s hospital-based pay-for-performance program. The pivot to value-based care continued in 2015 when Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), which replaced PQRS with the Quality Payment Program (QPP) and Alternative Payment Models (APMs). These programs directly link the quality of care and patient outcomes to reimbursement penalties and bonuses. In order to determine the quality of care, practices must be able to accurately and meaningfully measure and report the quality of care. Therefore, gastroenterology-related quality measures, both at the hospital- and provider-levels, affect all of us. AGA is the leading GI society working to ensure that gastroenterologists have a voice in determining GI-specific quality measures. In this way, AGA plays an integral role in discussions regarding quality of care in digestive diseases.
The AGA Quality Committee consists of 14 members who represent a diversity of practice types and career experience. The founding mission of the committee was to develop quality measures specific to the care of digestive diseases. A quality measure is a tool that helps quantify the quality of care provided. The most widely known and used GI-specific quality measure is the adenoma detection rate (ADR). AGA stewards additional measures related to inflammatory bowel disease (IBD) and hepatitis C virus (HCV)/liver diseases, among others. Measuring quality of care provides a vital feedback loop that is necessary to facilitate frontline quality improvement and help providers demonstrate value.
Medicine in the U.S. is transitioning from volume-based care to value-based care, with reimbursement increasingly focused on the quality of care relative to cost.
Quality measures are derived from published guidelines, with an emphasis on those most likely to impact patient outcomes and address gaps in care. After conceptualizing and developing a measure, the measure must undergo testing to ensure standardization, reliability and validity. This testing ensures that data necessary for a measure can be collected in a variety of practice settings and that it measures what it is intended to measure. Once fully specified and tested, a quality measure can then be recommended to organizations, such as CMS and private payors, for use in accountability programs, or implemented by institutions and practices to facilitate quality improvement. Implemented quality measures are reviewed periodically to determine if changes in research and guidelines impact the measure. Currently, the AGA Quality Committee has identified candidate quality measures across the spectrum of GI conditions, including colon cancer, IBD, acute pancreatitis, Barrett’s esophagus, hepatitis B and others.
The committee has recognized the need to increase member awareness of this important work. To do so, the committee has begun publishing relevant white papers, with the first publication in Clinical Gastroenterology & Hepatology highlighting three AGA-developed hospital-based quality measures for acute pancreatitis. The committee has also started cross-collaborating on quality measure development with non-GI specialty societies, such as the College of American Pathologists, on measures of shared interest. Finally, the committee is developing educational content regarding quality measure development and implementation that can be accessed by AGA members through AGA University.
Another core role of the AGA Quality Committee is to support quality improvement initiatives among members. To facilitate this, the committee launched the Quality Leadership Council (QLC) in 2019. The QLC is comprised of frontline quality leaders in academic and community practices from around the country. The QLC is as an advisory body to the AGA Quality Committee, providing feedback regarding the practical needs and priorities of practicing gastroenterologists, and collaborating with the committee on measure implementation and quality improvement efforts. We anticipate that ongoing collaboration between these two groups will broaden the scope of AGA in the field of quality.
You can become involved in the quality mission of AGA! We are seeking providers who want to participate in a measure testing collaborative. Interested in finding out more or learning about other ways to work in the important field of quality in GI?Check out our newly updated website: www.gastro.org/practice-guidance/quality-and-performance-measures or contact firstname.lastname@example.org.