Table 1:

Screening/Surveillance Colonoscopy Cost Measure

Included patients	- Patients at average risk for colon cancer screening. - Patients must be enrolled in Medicare Parts A (inpatient) and B (outpatient) - Colonoscopies done for screening or surveillance at ambulatory surgical centers (ASC), hospital outpatient department (HOPD), ambulatory/office-based care, community hospital, hospital inpatient units, and acute care facilities. - Eligible cases are identified using CPT procedure codes and unique provider numbers on claims
Notable exclusion criteria	- Patients with inflammatory bowel disease (IBD) as they are not average risk - Colonoscopies in which endoscopic mucosal resection was performed - Cases in which esophagogastroduodenoscopy (EGD) is performed in the same session
Time frame that gastroenterologists are held responsible for associated patient costs	- For this cost measure, providers are not responsible for any events that occur prior to the colonoscopy - After the colonoscopy, providers are responsible for some costs that occur within 14 days of the procedure
Risk-adjustment	- CMS’ Hierarchical Condition Category (HCC), which includes medical conditions that are shown in a general population to impact cost of care such as diabetes, chronic obstructive pulmonary disease (COPD), and heart failure - Additional risk adjusters including outpatient use of anticoagulation prior to colonoscopy and history of anesthesia difficulties were also included
Cost measure calculation	- Medicare calculates and compares patients’ expected cost with the actual cost during the episode window in order to factor into bonus or penalty from MIPS