World Congress at ACG2017

Simultaneous Plenary Session 1C: Endoscopy

19 - Measuring Colonoscopy Value Without Penalizing Polyp Detection

Monday, October 16
4:50 PM - 5:00 PM
Location: Valencia Ballroom D (Level 4)



Award: 2017 Fellows-in-Training Award (Practice Management Category)

Category: Practice Management       

Meredith Clary, MD1, Lauren C. Dedecker, BSc2, William E. Karnes, MD, AGAF1
1H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, CA; 2University of California Irvine Medical Center, Orange, CA
Introduction: Medicare reimbursement emphasizes colonoscopy quality but will soon emphasize value (quality/cost). Moran et al proposed a value score where Quality = adenoma detection rate + sessile serrated adenoma detection rate (ADR+SDR) x cecal intubation rate (CIR) x 100, and Cost = total time (TT) x polyp detection rate (PDR). PDR is a surrogate for pathology cost, but this penalizes those with high PDR and ADR. To avoid "detection penalty" and rewarding "one and done" strategies, we devised an alternative formula for value.

Methods: We utilized prospectively collected data at point-of-care using Qualoscopy (Docbot, Inc) between 6/2012 and 4/2017, from all screening and surveillance colonoscopies by 32 endoscopists (faculty and fellows) who performed > 50 procedures. We devised quality and cost formulas utilizing data accessible from Qualoscopy.

Quality Index (QI) = (ADR+SDR) x (APP+SPP) x CIR x %AdequatePrep x %WT>6 min

APP = Number of adenomas per adenoma-positive participant,
SPP = Number of SSPs per SSP-positive participant, %
AdequatePrep = % of procedures with Boston Prep Score > 7,
%WT>6 min = % of procedures with withdrawal time over 6 minutes

Cost Index (CI) = Sedation x Room utilization x Pathology x Disposables x %Inadequate prep (necessitating repeat colonoscopy)

Sedation = (number of sedation vials opened/procedure) x (% of procedures requiring recovery) x (% of procedures requiring anesthesia),
Room utilization = % of cases > 30 minutes,
Pathology = number of pathology bottles used per polyp,
Disposables = (number of clips/polyp) x (number of assistive devices/procedure (e.g., Endocuff, Amplify, cap)),
Inadequate prep = % of procedures with Boston Prep Score < 5

Value Index (VI) = QI/CI

Results: 5488 colonoscopies were included. Moran et al's Value and our VI measure were poorly correlated (r = -0.25). Among endoscopists with high Value but low VI, ADRs and SDRs were low (12-30 and 1.4-3.2, respectively), with one good performer who was "one and done" (AAP = 1.03), whereas those with low Value but high VI had high ADRs, SDRs and AAPs (47-52, 10.5-18, and 2.3-3.2, respectively).

Discussion: Value proposed by Moran et al penalizes endoscopists with high quality as measured by ADR, SDR and APP while failing to penalize those who are "one and done". We propose an alternative value formula (VI) that captures value drivers without a "detection penalty" or reward for "one and done".

Supported by Industry Grant: No


Value and Value Index (QI/CI) by Endoscopist

Citation: . MEASURING COLONOSCOPY VALUE WITHOUT PENALIZING POLYP DETECTION. Program No. 19. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Meredith Clary

H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine
Orange, California

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