OPPS Proposal Calls for Colonoscopy Complication Reporting

Cheryl Clark, July 16, 2014

A quality measure in CMS's 2015 Outpatient Prospective Payment System proposed rule would count instances of Medicare beneficiaries seeking hospital treatment for adverse events related to outpatient colonoscopies.

For the first time, hospital outpatient centers would be evaluated on the safety of their practitioners' skill in performing colonoscopies if language in a proposed rule from the Centers for Medicare & Medicaid Services becomes final.

Specifically, the new quality measure would count the number of times Medicare beneficiaries had to seek hospital care to treat a complication, such as perforation of the colon, gastrointestinal bleeding, or a cardiopulmonary event, within seven days of an outpatient colonoscopy.

Complications captured would include those occurring during preparation, the procedure itself, and follow-up care.

"We expect the measure would promote improvement in patient care over time because transparency in publicly reporting measure scores will make patient unplanned hospital visits (emergency department visits, observation stays, and inpatient admissions) following colonoscopies more visible to providers and patients," CMS said in the proposed rule.

2015 OPPS Proposed Rule Detailed

It would "encourage providers to incorporate quality improvement activities in order to reduce these visits." Too often there is a disconnect between adverse events from colonoscopies and feedback to the practitioners who performed them, CMS said.

Reporting of these events by facility would enable consumers to make informed choices about where to get cancer prevention screening exams, and physicians and facilities with performance issues could take corrective action, CMS said.

"Providers are often unaware of complications following colonoscopy for which patients visit the hospital," CMS said in its 2015 Outpatient Prospective Payment System proposed rule. "This will encourage providers to achieve the outcome rates of the best performers." There is a wide variation in complication rates among colonoscopy centers nationally.

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