Deriving Measures of High Value Pediatric Care

A recent article titled, “How does a gastroenterologist demonstrate value?” (linked to full text) DOI: http://dx.doi.org/10.1016/j.cgh.2014.08.021 provides some insight into what is in store for gastroenterologists as the shift from fee-for-service is influenced by value care initiatives.

Key points:

  • Value = Outcome/Cost
  • Healthcare value = Health of population/Cost
  • “AGA has spent the last 7 years developing measures that focus on outcomes and population management. They are available at http://www.gastro.org/practice/quality-initiatives/performance-measures.”This website provides several measures for hepatitis C, inflammatory bowel disease, endoscopy, and others.
  • For example, endoscopy measures:Measure # 1: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk PatientsMeasure #2: Surveillance Colonoscopy Interval for Patients with a History of Colonic Polyps- Avoidance of Inappropriate UseMeasure # 3: Comprehensive Colonoscopy Documentation

As a pediatric gastroenterologist, it is clear that more efforts will be needed for the pediatric population.  While the authors note that “financial pressures will intensify over time,” at the current time there is extremely wide variation on the use of common procedures; in fact, physicians are typically incentivized to perform procedures even in the setting of low yield.  So the first steps will be to define a high value pediatric GI practice.

Another reference with regard to value care (J Pediatr 2014; 165: 650-51) discusses how infectious disease consultations improve outcomes, can decrease costs (length of stay, complications) and improve usage of appropriate antimicrobials.  Another helpful point: “Although common, curbside consultations have been shown to be associated with inferior patient outcomes compared with official bedside consultations.”  This is often due to incomplete or inaccurate data.

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6 thoughts on “Deriving Measures of High Value Pediatric Care

  1. No feed back?

    On Tuesday, October 14, 2014, gutsandgrowth wrote:

    > gutsandgrowth posted: “A recent article titled, “How does a > gastroenterologist demonstrate value?” (linked to full text) DOI: > http://dx.doi.org/10.1016/j.cgh.2014.08.021 provides some insight into > what is in store for gastroenterologists as the shift from fee-for-service > is inf”

    • My personal take –I think we first need to measure what is current practice. For example, how often are pediatric gastroenterologists doing endoscopy? When one discounts repeat procedures for indications like eosinophilic esophagitis, my suspicion is that pediatric GIs that perform endoscopy more frequently than the average are likely performing a low value service. I’ve recently started looking into this as a quality issue and am trying to derive some of this information for our practice. Once we have a good baseline, we could examine whether outcomes are improved with variation in care (too frequent vs. too few procedures). At some point, if value care takes hold, physicians who are more selective in their use of diagnostic testing will be in a better position.

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