November 22, 2019
Why the decision was made, and why GI societies oppose it
Centers for Medicare & Medicaid Services (CMS) have made changes to the reporting requirements for the CMS quality payment programs. Some changes impact GI physicians that participate in Merit-Based Incentive Payment System (MIPS).
Starting in 2020, screening colonoscopy adenoma detection rate is no longer part of the measure set in the MIPS Quality performance category for gastroenterologists. Concerningly, ADR was the only outcomes-based quality measure for GI, so there is no longer an applicable outcomes measure for gastroenterologists.
There is great disappointment in this decision shared by all three GI professional societies, as ADR remains the widely accepted national benchmark on quality for screening colonoscopies. There is a proven correlation between a GI physician’s ADR and his or her ability to reduce colorectal cancer incidents and deaths. The societies continue to support the use of ADR as a direct measure of the effectiveness of a gastroenterologist’s screening colonoscopy.
Four reasons why CMS dropped the ADR measure
CMS provided reasons for their decision to remove ADR calculation from the MIPS measure set, which GI societies have argued were insufficient. CMS cited the following:
- The screening colonoscopy ADR measure does not consider other variables, such as geographic location, that may influence adenoma detection rate.
- The scoring measure for normal screening colonoscopy ADR does not directly align with the 1-100% MIPS scoring measure.
- Because the performance target for ADR for colonoscopies is only 25%, achieving 100% ADR is biologically impossible. It does not correlate with other MIPS measures.
- Screening colonoscopy ADRs do not account for clinicians who miss adenomas but may have a higher ADR based on the number of procedures they perform.
GI societies combat the decision to drop MIPS
The American College of Gastroenterology (ACG), American Gastroenterological Association (AGA) and the American Society for Gastrointestinal Endoscopy (ASGE) drafted a response to the proposal to remove the measure from MIPS.
According to the commentary, the removal of the Measure 343: Screening Colonoscopy Adenoma Detection Rate “undermines the collective desire of CMS and our societies to move towards an aligned set of measure options more relevant to a gastroenterologist’s scope of practice that is meaningful to patient care.”
The fact is that adenoma detection rate is an important quality indicator for colonoscopy success. Higher ADRs indicate that physicians are performing more careful colonoscopies and locating potentially cancerous adenomas.
Many GI physicians use ADR to understand how they can improve their quality of their colonoscopy procedures. If ADR is not measured and ranked against other physicians, GI doctors don’t have other quality measures to understand their success rate.
It’s still important to pay attention and monitor screening colonoscopy ADRs, whether or not part of the MIPS Quality program. Patient care is and should be a priority for all physicians.
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