An Updated Approach to Colon Cancer Screening and Prevention

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1 An Updated Approach to Colon Cancer Screening and Prevention Kevin Liebovich, MD Director for Quality for Gastrointestinal diseases Advocate Condell Medical Center

2 Colon Cancer Screening and Prevention Review current use of colonoscopy Present updates for colon cancer screening

3 Colon Cancer Screening and Prevention American Cancer Society key statistics for 2016: 95,270 new cases of colon cancers and 39,220 new cases of rectal cancer are expected to occur in 2016 Colorectal cancer is the third most common cause of cancer death in the United States Colorectal cancer accounts for 49,190 deaths that are expected to occur in 2016 Currently, only about 65% aged 50 or older, for whom screening is recommended, report having received colorectal cancer testing consistent with current guidelines Lifetime risk of colon cancer for average risk patient is near 5%

4 Colon Cancer Screening and Prevention The Problem

5 Colon Cancer Screening and Prevention 1.0 to 2.4% decrease in both colorectal cancer incidence and deaths in Illinois.

6 When to be Screened Average Risk Patients Age 50 to 75 Colonoscopy every 10 years Stool testing every year High Risk Patients Personal History of colon polyps Family history of colon polyps or cancer Earlier age to initiate screening

7 Colonoscopy

8 Colonoscopy

9 Colon Polyps

10 Colonoscopy New England Journal of Medicine: National Polyp Study-53% Mortality reduction from colon cancer Annals of Internal Medicine: 77% Reduction in overall colorectal cancer risk

11 We need to do better According to the CDC, Illinois has a low prevalence of colorectal cancer screening

12

13 Changes in GI

14 Changes in our approach to get to 80% by 2018 and meet demands of Payers Emphasize quality Alternatives to colonoscopy Direct Access Screening Transparent costs

15 GI Lab Quality Indicators Average Risk Colonoscopy Without Polyp Recommended Follow-up Interval > 10 Years Colonoscopy Interval for Patients with History of Adenomatous Polyps > 3 Years Adenoma Detection Rate Colonoscopy Withdrawal Times (Excludes hx of resection)

16 Recommended Interval 10 years or Greater % Compliance Better % Average Risk Colonoscopy Without Polyp Recommended Follow-up Interval > 10 Years % 80.00% 70.00% 60.00% 50.00% % Compliance Goal

17 Recommended Interval 10 years or Greater % Compliance Better 100% Average Risk Colonoscopy Without Polyp Recommended Follow-up Interval > 10 Years % 80% 70% 60% 50% % Compliance Goal

18 Colonoscopy Interval for Patients with History of Adenomatous Polyps > 3 Years % 90% 80% 70% 60% 50% 40% 30% 20% B e t t e r 10% 0% 0% 0% May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 % Compliance Goal

19 Colonoscopy Interval for Patients with History of Adenomatous Polyps > 3 Years % 90% 80% 70% 60% 50% 40% 30% 20% B e t t e r 10% 0% May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 % Compliance Goal

20 # Female Colonoscopi es Adenoma Detection Rate 2015 # Female + Adenomas % Female Adenoma Detection Rate # Male Colonoscop ies # Male + Adenoma s % Male Adenoma Detection Rate YTD % % Jan % % Feb % % Mar % % Apr % % May % % June % % July % % Interpretation of quality metric will have limited value due to low volume utilization Benchmark 15% Females 25% Males

21 Percentage Adenoma Detection Rate % 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% B e t t e r 0.00% Jan-16 Feb-16 Mar-16 Apr-16 May-16 Female ADR Male ADR Female Benchmark Male Benchmark

22 % Colonoscopy Withdrawal Times > 6 Minutes GI Scope Withdrawal Time > 6 minutes is current standard of care 100% 90% 80% 70% 60% 93.40% 93% 97% 96% 93% 98% 90% 94% 97% 93% 97% 96% 97% 96.00% B e t t e r 50% Apr 2015 n 61 May 2015 n 70 June 2015 n 64 July 2015 n 68 Aug 2015 n 87 Sept 2015 n 77 Oct 2015 n 80 Nov 2015 n 93 Dec 2015 n 87 Jan 2016 n 125 Feb 2016 n 166 Mar 2016 n 203 Apr 2016 n 249 May 2016 n 212 Overall % Colonoscopy Withdrawal Times > 6 Minutes Benchmark

23 Benefits of measuring quality Demonstrate quality of care to payers Improved care for our patients

24 How can we get more patients screened? Stool FIT/Microscopic blood Stool DNA (Cologuard) Direct access screening colonoscopy

25 Potential Alternatives to Colonoscopy Stool FIT/Microscopic blood Stool DNA (Cologuard) Blood DNA

26 Cologuard vs FIT

27 Cologuard vs FIT Accuracy in identifying advanced polyps Cologuard 42% FIT 24%

28 Direct Access Screening Colonoscopy GI labs will market directly to patients GI labs will schedule procedures GI labs will provide prep instruction Coordination of care with GI physicians

29 Transparent Costs Bundled/Episode of care payments Shift risks to providers ASC vs HOPD

30 Colon Cancer Screening and Prevention Colonoscopy is effective at screening and preventing colon cancer Colon cancer incidence and mortality is declining More people need to be screened Improved access to colonoscopy Alternatives to colonoscopy Improved value

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