- Email: [email protected]
Tu1075 The Impact of a Value-Based Health Program for Inflammatory Bowel Disease Management on Healthcare Utilization
(ANOVA). Results: 2,009 gastroenterologists received the survey. The response rate was 16.3%. The average age of respondents was 47.8 years with median fellowship completion year of 1998. Ninety-five percent of participants reported working more than 40 hours per week with over 43% reporting working more than 60 hours per week. Ninety-two percent spent 40% or more of their work hours performing procedures, with 14% spending 80% or more of their time devoted to procedures. Colonoscopies comprised over half of procedures for 83% of respondents. Procedure volume significantly decreased with degree of reimbursement reductions (p<0.001). With a 10% decrease, 72% of respondents reported no change in the number of colonoscopies performed. With a 20% decrease, 32% would decrease their procedure volume while 21% of respondents would increase their procedure volume. With a 30% and 40% decrease, procedure volume decreased by 48% and 50%, respectively. In terms of retirement, current plans indicate a cumulative retirement rate of 5%, 9%, and 28.8% at 3, 5, and 10 years, respectively. 44% currently plan to retire after 2030. With a 10% decrease in reimbursement, cumulative rates of retirement shift to 7.6%, 12.5%, and 32.7% at 3, 5, and 10 years, respectively. The change in retirement rates are more stark at a 30% decrease in reimbursement with cumulative rates increasing to 16.2%, 23.5%, and 46.0% at 3, 5, and 10 years, respectively (p=0.006). At 40% reimbursement reduction, cumulative retirement rates are 20%, 29%, and 47% at 3, 5, and 10 years, respectively (p<0.001). Conclusion: Decreasing colonoscopy reimbursements may have a significant effect on the effective gastroenterology workforce through earlier retirement and decreased procedure volume. Tu1078 The Early Effect of Maryland's New Healthcare Delivery System Reform on Tertiary Hospital Transfers and GI Procedure Volume Raymond E. Kim, Iris Lee, Eric M. Goldberg, Lance T. Uradomo, Peter Darwin Background: In January, 2014, the Centers for Medicare and Medicaid Services (CMS) and the State of Maryland launched a model reforming Maryland's health care delivery system. Over the next 5 years, CMS will seek to shift hospital revenue away from fee-for-service models and into population-based payment models with a global budget. Specific Aim: To analyze the early effect of a new health care delivery system on GI procedures and inpatient transfers at the University of Maryland Medical Center (UMMC), a large tertiary referral center. Methods: A standardized electronic endoscopic reporting database (ProVation MD) was retrospectively reviewed. All ERCPs and EUSs performed at UMMC from May 1st through Oct 31st from 2011 to 2014 were included in the study. A May start date was chosen as this is when the hospital began adjusting its transfer practices. An inter-hospital transfer database was retrospectively reviewed. All patient transfers from outside hospitals to UMMC medicine service from May 1st to Oct 31st during 2011 to 2014 were included in the study. Data from May 1st to Oct 31st during 2011, 2012, and 2013 were averaged and compared to data from the same months in 2014. Results: (Table) Conclusion: The principles of the new Maryland healthcare delivery model and the process that led to its development may serve as a guide for future federal-state partnership efforts aiming to lower healthcare costs. Early data from May 1st to Oct 31st 2014 shows that the new Maryland health care delivery model with global budgets has decreased total inpatient transfers and shifted inpatient hospital procedures to outpatient procedures at UMMC. Further analysis of outcomes data will be important to determine the impact on quality of care. GI procedures and inpatient transfers at the University of Maryland Medical Center (UMMC)
Tu1075 The Impact of a Value-Based Health Program for Inflammatory Bowel Disease Management on Healthcare Utilization Welmoed K. van Deen, A Burak Ozbay, Martha Skup, Martijn G. van Oijen, Adriana Centeno, Bennett E. Roth, Natalie Duran, Precious Lacey, Darius Jatulis, Michael J. Belman, Eric Esrailian, Daniel W. Hommes Background Standardized care pathways, task differentiation, and knowledge of costs in clinical decision making are all likely to contribute to improved outcomes and cost-effective care delivery. The UCLA Center for Inflammatory Bowel Diseases (IBD) launched a valuebased health program for IBD management in February 2012 including all these aspects. The aim of this study was to compare utilization patterns observed at the UCLA Center for IBD to IBD care across California. Methods Administrative data were obtained from Anthem Blue Cross California. IBD patients and UCLA IBD Center providers were identified, as well as IBD non-program patients who were included as control group. Controls were matched 5:1 with the cases based on disease type, age, relapse rate, and Charlson Comorbidity Index in 2012. IBD-related office visits, laboratory tests, imaging studies, procedures, emergency department (ED) visits, hospitalizations, and pharmacy use in 2013 were compared. Results Forty-nine UCLA IBD Center patients were matched to 245 controls. Demographics were similar in groups with a mean age of 39 years (SD 12), 57% Crohn's disease and 43% ulcerative colitis, and 22% severe disease course in the year prior to analysis. We observed significantly less corticosteroid use in the UCLA IBD Center group (12% and 31%, respectively, p=0.03) and numerically more methotrexate (1% and 6%, p=0.11) and adalimumab (15% and 21%, p=0.43) use. Thiopurine (35% and 33%, p=1.00) and infliximab (14% and 15%, p=1.00) use were comparable in both groups. Patients in the UCLA IBD group had 25% fewer IBD-related office visits per year (1.7 and 2.2 visits per year, p=0.06), 12% to 100% fewer imaging studies (p=0.99), 10% less colonoscopies (p=0.91) and 1.3 to 3.4 times more biomarker testing (p<0.0002). Lastly, we observed 89% fewer hospitalizations (p= 0.06) in the UCLA IBD Center group and 75% fewer ED visits (p=0.52). Conclusion An administrative database was utilized to identify IBD patients treated at the UCLA Center for IBD and to compare those patients with a matched control population in California. We found a significant decrease in corticosteroid use and a trend towards more use of steroidsparing medications in the UCLA IBD group. Furthermore, UCLA IBD Center patients' disease activity was monitored more frequently using biomarkers, and fewer hospitalizations and ED visits were observed. This study indicates that a comprehensive, value-based care pathway is likely to improve outcomes and decrease unnecessary health care utilization. Future more powerful larger sample studies will be needed to confirm these positive findings.
Tu1079 ‘IBDpassport': Evaluating the Quality of an Internet-Based Travel Resource for Inflammatory Bowel Disease Kay Greveson, Mark I. Hamilton, Charles Murray Introduction:Travellers' with Inflammatory bowel disease (IBD) are at greater risk of travelrelated morbidity with European guidelines recommending expert consultation prior to travel, particularly for those on immunosuppression. Previous research into travel and IBD found travel consultations and patient travel preparation and knowledge to be deficient. As a result we developed a dedicated, evidence-based non-profit IBD travel advice website (www.ibdpassport.com) to enhance informed, safe travel. Here we present formal evaluation of this website. Methods: A link to the website, along with a structured web-based survey was sent to a sample of 15 UK IBD patients, IBD clinical nurse specialists and Gastroenterologists respectively. The survey contained demographic questions and asked respondents to rate the content, functionality and credibility of the website using a series of parameters including a 5-point Global Quality Score and Integrity Score. Readability statistics were graded on a 100 word sample of text from each page on the website using the Flesch Reading Ease and Flesch-Kincaid Grade level scores. Results: A total of 33 individuals responded (73% response rate; 11, 33% Patient; 10, 30% Nurse; 12, 36% Gastroenterologist (Table 1). The mean Global Quality score for all respondents was 4.5 out of a possible 5 (Range 3-5). The FleschKincaid Grade level score was US school grade 10.9 (range7.2 - 17.1) and median Flesch Reading Ease score 50.5 out of a possible 100 (Range 22.4- 65.1). The integrity score was 4.0 out of 6. The majority of respondents strongly agreed that the website was an accurate
Tu1076 The Effect of Colonoscopy Reimbursement Reductions on Gastroenterologist Practice Behavior Matthew B. McNeill, Shannon Chang, Farhad Sahebjam, Adam J. Goodman, Seth A. Gross, Samuel Sigal Introduction: In 2016, the Centers for Medicare and Medicaid Services may announce reductions in colonoscopy reimbursements. With new initiatives for increased colorectal cancer screening with colonoscopy, it is crucial to understand how reimbursement changes could affect these efforts. The purpose of this study is to assess the effect of decreased colonoscopy reimbursement on gastroenterologist practice behavior, including time to retirement and procedure volume. Methods: An online questionnaire was developed to investigate demographic information, practice characteristics, and potential effects of colonoscopy reimbursement on practice behavior of gastroenterologists. Participants were randomly selected from the American College of Gastroenterology membership database. Respondents were surveyed on incremental changes in practice behavior if colonoscopy reimbursements were to decrease by 10%, 20%, 30%, or 40%. Email responses were collected from July 2014 to October 2014. Data was analyzed using both Pearson Chi-Square and analysis of variance
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AGA Abstracts
AGA Abstracts
expected to endure through 2056. The most common co-morbidity among baby boomers is cardiovascular disease for which antiplatelets and anticoagulants are prescribed. Thus, baby boomers are at risk of gastrointestinal bleeding (GIB) related to both pharmacologic exposure and advancing age. In 2012, the cost of GIB care was estimated at >$2.5 billion; half of which was billed to Medicare. Quantifying health care utilization of current baby boomers with GI bleeding will assist policy makers to forecast impact of this generation on future health care resource needs. Methods: A retrospective cohort study using 5 years of the Nationwide Inpatient Sample (2007-2011) was conducted to identify temporal trends in non-variceal, upper- and lower-GIB to assess impact of age, co-morbidity, early vs. late endoscopy, transfer status, and disposition on the outcomes of hospital length of stay, 30day mortality and economic outcomes (charge). Temporal trends were evaluated using the Cochrane-Armitage test. The Chi-square test and multivariable linear regression models were used to quantify the impact of exposures of interest and potential effect modifiers on hospital length of stay and charge. Results: From 2007 to 2011 there were 1,322,122 hospital visits associated with GIB in 18,259,654 patients >50 years. Three-quarters of admissions were emergent, 19% occurred on the weekend and 51% were lower GIB. Overall prevalence was 7.2%, with an average length of stay (LOS) of 5.5 days (SD: 6.1) in 2007 that decreased to 5.1 days (SD: 5.7) by 2011 (p<0.001). A 1.4 day (95% CI: 1.31-1.44) increase in LOS was observed among patients ≥70 with a Charlson co-morbidity score ≥2. In-hospital mortality decreased over time from 2.5% to 2.0% (p<0.001). Total hospital charge increased over time from $29,602 (2007) to $38,549 (2011), p<0.001. Medicare or Medicaid was the primary payer in 39%. Primary drivers of the attributable charge (per admission) included age ≥70 years with a Charlson co-morbidity score ≥2 ($6,068; 95% CI: $5,796-$6,339); a transfer from another acute care facility ($15,429; 95% CI: $14,922-$15,937) and late endoscopy performed following a weekend admission ($5,784; 95% CI: $5,142-$6,425). Conclusions: The size, demographic composition and associated co-morbidities of this population have significant implications for health resource utilization, cost of care and third-party payers. Future study of alternative models of care and/or GIB reimbursement strategies is necessary to inform how to navigate the growing economic and health resource burden associated with this population.
Tu1075 The Impact of a Value-Based Health Program for Inflammatory Bowel Disease Management on Healthcare Utilization Welmoed K. van Deen, A Burak Ozbay, Martha Skup, Martijn G. van Oijen, Adriana Centeno, Bennett E. Roth, Natalie Duran, Precious Lacey, Darius Jatulis, Michael J. Belman, Eric Esrailian, Daniel W. Hommes Background Standardized care pathways, task differentiation, and knowledge of costs in clinical decision making are all likely to contribute to improved outcomes and cost-effective care delivery. The UCLA Center for Inflammatory Bowel Diseases (IBD) launched a valuebased health program for IBD management in February 2012 including all these aspects. The aim of this study was to compare utilization patterns observed at the UCLA Center for IBD to IBD care across California. Methods Administrative data were obtained from Anthem Blue Cross California. IBD patients and UCLA IBD Center providers were identified, as well as IBD non-program patients who were included as control group. Controls were matched 5:1 with the cases based on disease type, age, relapse rate, and Charlson Comorbidity Index in 2012. IBD-related office visits, laboratory tests, imaging studies, procedures, emergency department (ED) visits, hospitalizations, and pharmacy use in 2013 were compared. Results Forty-nine UCLA IBD Center patients were matched to 245 controls. Demographics were similar in groups with a mean age of 39 years (SD 12), 57% Crohn's disease and 43% ulcerative colitis, and 22% severe disease course in the year prior to analysis. We observed significantly less corticosteroid use in the UCLA IBD Center group (12% and 31%, respectively, p=0.03) and numerically more methotrexate (1% and 6%, p=0.11) and adalimumab (15% and 21%, p=0.43) use. Thiopurine (35% and 33%, p=1.00) and infliximab (14% and 15%, p=1.00) use were comparable in both groups. Patients in the UCLA IBD group had 25% fewer IBD-related office visits per year (1.7 and 2.2 visits per year, p=0.06), 12% to 100% fewer imaging studies (p=0.99), 10% less colonoscopies (p=0.91) and 1.3 to 3.4 times more biomarker testing (p<0.0002). Lastly, we observed 89% fewer hospitalizations (p= 0.06) in the UCLA IBD Center group and 75% fewer ED visits (p=0.52). Conclusion An administrative database was utilized to identify IBD patients treated at the UCLA Center for IBD and to compare those patients with a matched control population in California. We found a significant decrease in corticosteroid use and a trend towards more use of steroidsparing medications in the UCLA IBD group. Furthermore, UCLA IBD Center patients' disease activity was monitored more frequently using biomarkers, and fewer hospitalizations and ED visits were observed. This study indicates that a comprehensive, value-based care pathway is likely to improve outcomes and decrease unnecessary health care utilization. Future more powerful larger sample studies will be needed to confirm these positive findings.
Tu1079 ‘IBDpassport': Evaluating the Quality of an Internet-Based Travel Resource for Inflammatory Bowel Disease Kay Greveson, Mark I. Hamilton, Charles Murray Introduction:Travellers' with Inflammatory bowel disease (IBD) are at greater risk of travelrelated morbidity with European guidelines recommending expert consultation prior to travel, particularly for those on immunosuppression. Previous research into travel and IBD found travel consultations and patient travel preparation and knowledge to be deficient. As a result we developed a dedicated, evidence-based non-profit IBD travel advice website (www.ibdpassport.com) to enhance informed, safe travel. Here we present formal evaluation of this website. Methods: A link to the website, along with a structured web-based survey was sent to a sample of 15 UK IBD patients, IBD clinical nurse specialists and Gastroenterologists respectively. The survey contained demographic questions and asked respondents to rate the content, functionality and credibility of the website using a series of parameters including a 5-point Global Quality Score and Integrity Score. Readability statistics were graded on a 100 word sample of text from each page on the website using the Flesch Reading Ease and Flesch-Kincaid Grade level scores. Results: A total of 33 individuals responded (73% response rate; 11, 33% Patient; 10, 30% Nurse; 12, 36% Gastroenterologist (Table 1). The mean Global Quality score for all respondents was 4.5 out of a possible 5 (Range 3-5). The FleschKincaid Grade level score was US school grade 10.9 (range7.2 - 17.1) and median Flesch Reading Ease score 50.5 out of a possible 100 (Range 22.4- 65.1). The integrity score was 4.0 out of 6. The majority of respondents strongly agreed that the website was an accurate
Tu1076 The Effect of Colonoscopy Reimbursement Reductions on Gastroenterologist Practice Behavior Matthew B. McNeill, Shannon Chang, Farhad Sahebjam, Adam J. Goodman, Seth A. Gross, Samuel Sigal Introduction: In 2016, the Centers for Medicare and Medicaid Services may announce reductions in colonoscopy reimbursements. With new initiatives for increased colorectal cancer screening with colonoscopy, it is crucial to understand how reimbursement changes could affect these efforts. The purpose of this study is to assess the effect of decreased colonoscopy reimbursement on gastroenterologist practice behavior, including time to retirement and procedure volume. Methods: An online questionnaire was developed to investigate demographic information, practice characteristics, and potential effects of colonoscopy reimbursement on practice behavior of gastroenterologists. Participants were randomly selected from the American College of Gastroenterology membership database. Respondents were surveyed on incremental changes in practice behavior if colonoscopy reimbursements were to decrease by 10%, 20%, 30%, or 40%. Email responses were collected from July 2014 to October 2014. Data was analyzed using both Pearson Chi-Square and analysis of variance
S-781
AGA Abstracts
AGA Abstracts
expected to endure through 2056. The most common co-morbidity among baby boomers is cardiovascular disease for which antiplatelets and anticoagulants are prescribed. Thus, baby boomers are at risk of gastrointestinal bleeding (GIB) related to both pharmacologic exposure and advancing age. In 2012, the cost of GIB care was estimated at >$2.5 billion; half of which was billed to Medicare. Quantifying health care utilization of current baby boomers with GI bleeding will assist policy makers to forecast impact of this generation on future health care resource needs. Methods: A retrospective cohort study using 5 years of the Nationwide Inpatient Sample (2007-2011) was conducted to identify temporal trends in non-variceal, upper- and lower-GIB to assess impact of age, co-morbidity, early vs. late endoscopy, transfer status, and disposition on the outcomes of hospital length of stay, 30day mortality and economic outcomes (charge). Temporal trends were evaluated using the Cochrane-Armitage test. The Chi-square test and multivariable linear regression models were used to quantify the impact of exposures of interest and potential effect modifiers on hospital length of stay and charge. Results: From 2007 to 2011 there were 1,322,122 hospital visits associated with GIB in 18,259,654 patients >50 years. Three-quarters of admissions were emergent, 19% occurred on the weekend and 51% were lower GIB. Overall prevalence was 7.2%, with an average length of stay (LOS) of 5.5 days (SD: 6.1) in 2007 that decreased to 5.1 days (SD: 5.7) by 2011 (p<0.001). A 1.4 day (95% CI: 1.31-1.44) increase in LOS was observed among patients ≥70 with a Charlson co-morbidity score ≥2. In-hospital mortality decreased over time from 2.5% to 2.0% (p<0.001). Total hospital charge increased over time from $29,602 (2007) to $38,549 (2011), p<0.001. Medicare or Medicaid was the primary payer in 39%. Primary drivers of the attributable charge (per admission) included age ≥70 years with a Charlson co-morbidity score ≥2 ($6,068; 95% CI: $5,796-$6,339); a transfer from another acute care facility ($15,429; 95% CI: $14,922-$15,937) and late endoscopy performed following a weekend admission ($5,784; 95% CI: $5,142-$6,425). Conclusions: The size, demographic composition and associated co-morbidities of this population have significant implications for health resource utilization, cost of care and third-party payers. Future study of alternative models of care and/or GIB reimbursement strategies is necessary to inform how to navigate the growing economic and health resource burden associated with this population.