measure) in favor of retaining the two
chosen IBD-specific measures – bone
loss assessment and hepatitis B screening – which apply to only a subset of
IBD patients and have limited potential
to impact clinical outcomes. Although
it is not mandatory to report using the
GI Measures Set, we suspect that many
gastroenterologists will use this set to
guide their initial reporting.
During the 2017 MACRA transition
year, physicians need report only one
quality measure to avoid a penalty.
Even after the “pick your pace” MACRA program testing period concludes
in 2018, MACRA-eligible clinicians
will need to report their performance
only on six quality measures. This
low bar and shifting focus away from
IBD-specific measures is disconcerting for IBD quality enthusiasts. Although MIPS applies only to the 26%
of Medicare-eligible IBD patients
who are at least 65 years old, 22 private payers are likely to adopt similar
There are formidable regulatory
A word about Alternative
obstacles to improving the IBD qual-
ity measures included in MIPS. CMS
requires that new quality measures
proposed for inclusion in MIPS be
fully specified and tested for validity
and reliability by the individual mea-
sure developers (such as AGA). This
is a costly and time-intensive process
that has complicated efforts to suc-
cessfully advocate for inclusion of
GI-specific quality measures in MIPS,
as there is no existing infrastructure
for quality measure testing.
Payment Models (APMs)
APMs represent the non-MIPS
pathway for participating in the QPP.
APMs focus on chronic disease care
coordination and qualify for lump-
sum incentive payments by adhering
to stringent standards and financial
risk-sharing requirements. A detailed
overview of APMs is beyond the scope
of this discussion, as the vast majority
of MACRA-eligible gastroenterologists
will participate in MIPS and there are
currently no GI-specific APMs. Howev-
er, this is an evolving area and Project
Sonar has been submitted to the Physi-
cian-Focused Payment Model Technical
Advisory Committee for consideration
as an APM for Crohn’s disease.23
Quality measurement and reporting
are at a crossroads. Ideally, performance improvement should be an
internally driven process that ad-dresses specific local priorities and
needs. Most medical practices (73%)
believe that current externally driven
quality measures do not represent
care quality and only 28% use their
quality scores to focus their internal
quality improvement activities. 2 The
burden and cost of external quality
reporting demand better alignment
with local priorities as resources are
currently being diverted away from
internally driven efforts that might
have the greatest potential to improve
patient outcomes. 24 The dawn of the
MACRA era presents an opportunity
to shape the future of the IBD quality
movement. Through validating and
prioritizing existing measures and
developing novel, precisely stated,
and high-value metrics, there remains
vast (and measurable) potential to enhance patient outcomes. n
1. September 2016 Medscape survey summary.
Available at http://www.healthcaredive.com/
heard-of-macra/429322/. Accessed March 23,
2. Casalino L.P., et al. Health Aff. 2016;35:401-6.
3. Rubin D. T., et al. Curr Med Res Opin.
4. David G., et al. Gastroenterology. 2013;144:S-
5. Nguyen G.C., et al. Clin Gastroenterol Hepatol.
6. Esrailian E., et al. Aliment Pharmacol Ther.
7. Spiegel B. M., et al. Clin Gastroenterol Hepatol.
8. Kappelman M.D., et al. Inflamm Bowel Dis.
This image was published in David G, Gunnarsson CL, Lofland J, et al. Geographic
variation in care of patients with inflammatory bowel disease suggests unequal
quality of care in the United States. Gastroenterology. 2013;144:S-647, Copyright