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Quality & Performance Measures

Use AGA’s quality and performance measures to implement AGA guidelines and track the high-quality care being provided to your patients.

AGA’s commitment to quality​

AGA supports gastroenterologists in providing high quality care via improved patient outcomes, increased efficiency and cost-effectiveness.

New hepatitis C quality measures open for public comment

AGA is seeking public comments for two new quality measure specifications on the testing, treating and eradication of the hepatitis c virus (HCV).

Please submit your feedback by June 23.

Current AGA measures

These measures have completed a 30-day public comment period and have been approved by the AGA Quality Committee to progress into the alpha testing phase. Alpha testing confirms that the measure feasible and can be implemented across a variety of practice settings. Beta testing confirms that the measure is valid and measures what it is intended to measure.

Esophagogastroduodenoscopy (EGD) interval for patients with non-dysplastic Barrett’s esophagus

Systematic biopsies during surveillance EGD in patients with Barrett’s esophagus

Thiopurine methyltransferase (TPMT) testing (enzymatic activity or genotype) in all patients that was performed and results interpreted prior to starting azathioprine or 6 mercaptopurine

Postoperative monitoring for recurrence of Crohn’s disease at six to 12 months after surgical resection in patients with Crohn’s disease

Percentage of patients diagnosed with mild-moderate ulcerative colitis that receive a high-(> 3 g/d) or standard- dose mesalamine (2-3 grams/d) or diazo-bonded 5-ASA rather than low dose mesalamine (< 2 g/d), sulfasalazine or no treatment

Percentage of patients aged 18 years and older with a diagnosis of acute pancreatitis who receive oral feeding within 24 hours of admission to the hospital

Percentage of patients aged 18 years and older who are hospitalized with acute pancreatitis and are eligible for enteral nutrition but receive parenteral nutrition (This measure captures the frequency of deviations from the standard of care)

Percentage of patients aged 18 years and older with a diagnosis of acute biliary pancreatitis who undergo cholecystectomy during the same hospital admission

Percentage of patients at least 18 years of age with a diagnosis of gastric intestinal metaplasia (GIM) and Helicobacter pylori (H. pylori) infection who have confirmed eradication of H. pylori at least 4 weeks after completion of treatment.

Measures in development

These measures have met the minimum qualifications for measure development, and were determined to be meaningful and address a quality gap.

Percentage of surgical pathology reports for primary colorectal, endometrial, gastroesophageal or small bowel carcinoma, biopsy or resection, that contain impression or conclusion of or recommendation for testing of mismatch repair (MMR) by immunohistochemistry (biomarkers MLH1, MSH2, MSH6, and PMS2), or microsatellite instability (MSI) by DNA-based testing status, or both

AGA measures in the Quality Payment Program (QPP)

AGA maintains a variety of performance measures specific to gastroenterology and hepatology that are available for public reporting in the QPP. These measure specifications are updated annually by AGA and available utilizing the CMS measures inventory tool or via the links below.

AGA stewards the following measures in the QPP:

Quality ID #185: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use

Quality ID #320 (NQF 0658): Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients

Quality ID #439: Age Appropriate Screening Colonoscopy

Quality ID #275: Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy

Quality ID #387: Annual Hepatitis C Virus (HCV) Screening for Patients who are Active Injection Drug Users

Quality ID #400: One-Time Screening for Hepatitis C Virus (HCV) for all Patients

Quality ID #401: Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis

AGA's proposed pathway to develop and maintain quality indicators

Read a recent article in Clinical Gastroenterology and Hepatology highlighting AGA’s development process of quality indicators that illustrates examples of their use in practice.

How AGA develops performance measures

AGA has been instrumental in assuring that GI has a place at the table concerning quality, influencing the national agenda through developing, specifying, maintaining, testing and implementing quality measures, and through membership and participation in the Core Quality Measures Collaborative (CQMC), the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program and other national organizations.

The AGA Institute Quality Committee (QC) provides clinical and methodological expertise and oversight for the development, specification, maintenance and testing of AGA’s performance measures.

AGA follows a process for prioritizing and developing measures from AGA guidelines. Periodically, the AGA Quality Committee issues calls for new measure topics of interest to AGA members, however AGA primarily develops quality measures from AGA Guidelines following the GRADE approach. Public comment periods are held to receive feedback from gastroenterologists and other stakeholders who are interested in new AGA measures.

How can I get involved: Join the measure testing collaborative

The testing process includes accessing measure specifications for new measures developed by the AGA Quality Committee based on the most recent guidelines, providing detailed, qualitative assessments of measures’ usability and feasibility, and providing de-identified data for analysis. We are seeking a minimum of 30 providers that are willing to participate in an ongoing basis for all digestive disease conditions. To qualify for a particular measure, you will need to meet a 10-patient threshold (the 10-patient threshold is the minimum number of patients that is allowed to be considered reliable for testing).

If you are interested in joining the collaborative, please contact David Godzina: [email protected].

Additional resources

Choosing Wisely® Initiative

Choosing Wisely was created to help physicians, patients and other health care stakeholders think and talk about overuse or misuse of health care resources in the U.S.

  1. For pharmacological treatment of patients with gastroesophageal reflux disease (GERD), long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals.
  2. Do not repeat colorectal cancer screening (by any method) in average-risk individuals for 10 years after a high-quality colonoscopy that does not detect neoplasia.
  3. Do not repeat surveillance colonoscopy for at least five years for average-risk patients who have one or two small (<1cm) adenomatous polyps, without high-grade dysplasia or villous histology, completely removed via a high-quality colonoscopy.
  4. For a patient who is diagnosed with Barrett’s esophagus, who has undergone a second endoscopy that confirms the absence of dysplasia on biopsy, a follow-up surveillance examination should not be performed in less than three years as per published guidelines.
  5. For a patient with functional abdominal pain syndrome (as per ROME III criteria) computed tomography (CT) scans should not be repeated unless there is a major change in clinical findings or symptoms.

Colonoscopy is the most accurate test for cancer of the colon and rectum, proven to detect the disease early and save lives. But even a very good test can be done too often. Here’s when you need it, and when you might not.

Watch modules with scenarios to help you practice guideline-based medicine.

Coding FAQs for screening colonoscopies

We’ve compiled answers to common coding questions many practices have for colorectal cancer screening colonoscopies.