Health payers are continually marching toward establishing quality reporting requirements to assess provider value and determine whether they are providing the best care for their patients. Preferred provider programs, such as UnitedHealthcare’s Premium program, will be used to distinguish high-value providers. Increasingly, these programs are migrating toward models that establish preferred status for providers, which can mean lower copays for patients, waiver of preauthorization for some services, and inclusion in narrow or tiered networks.
AGA has launched important quality measurement and reporting programs in recent years, with the aim of providing gastroenterologists with ways to report quality performance and earn various incentives from health payers. Through these programs, as well as the American Board of Internal Medicine Practice Improvement Modules, gastroenterologists have access to a broad menu of options to meet reporting requirements, allowing them to distinguish themselves among their peers and earn rewards.
The AGA Digestive Health Outcomes Registry provides a mechanism for reporting ongoing quality performance and improvement. AGA has partnered with UnitedHealthcare to use the registry as a component of the Premium program starting in 2013, and is pursuing other payer relationships that will be structured in the same fashion. Using the electronic medical record and endowriter integration offered as part of the registry, gastroenterologists can automatically feed data into the program. If they opt in to a payer reporting program, their aggregate performance will be automatically reported on their behalf to meet quality reporting requirements.
The AGA’s Bridges to Excellence (BTE) IBD Care Recognition, the first Digestive Health Recognition Program (DHRP) module, is a way to submit a small sample of patient data for assessment. Gastroenterologists who meet a minimum standard of quality performance using the Physician Consortium for Performance Improvement and CMS Physician Quality Reporting System (PQRS) IBD measures become recognized by BTE. This is a national program that counts among its participants nearly every national payer and a large group of regional payers and purchasers. BTE recognition leads to incentives from these payers and public recognition; the program can also be used to submit data to fulfill the requirements of the PQRS. The AGA is currently developing a quality improvement toolkit specifically aimed at helping gastroenterologists meet BTE standards.
It is crucial that gastroenterologists avail themselves of these programs so that they don’t get left behind and leave bonus money on the table. For more information about how you can meet these standards through AGA programs, visit www.agaregistry.org and www.agarecognition.org.
