ACP Releases Position Paper on Colorectal Cancer Screening, Surveillance

The American College of Physicians (ACP) has released a position paper reviewing current performance measures for colorectal cancer screening and surveillance, ultimately supporting 1 of 5 reviewed measures.1

Published on October 21, 2025, in Annals of Internal Medicine, the paper seeks to inform physicians, payers, and policymakers in their selection and use of performance measures and make recommendations for measures that could be developed.1

In 2023, the ACP issued updated guidance for colorectal cancer screening for asymptomatic, average-risk adults that suggests starting screening at 50 years of age based on a critical review of existing clinical guidelines and evidence reviews and modeling studies used to develop those guidelines. In the latest position paper on screening and surveillance, while ACP supports performance measurement as a means to improve quality of care, the organization describes its belief that performance measures should only be considered for inclusion in reporting, accountability, or payment programs if they are methodologically sound and have undergone appropriate statistical analyses at the level of attribution for which they are used.1,2

“Several performance measures for screening and surveillance are currently used in pay-for-performance, public reporting, and/or accountability programs,” Amir Qaseem, MD, PhD, MHA, an adjunct Instructor at Thomas Jefferson University and Chief Science Officer and Senior Vice President, Clinical Policy, at the ACP, and colleagues wrote.1 “However, the validity, reliability, quality of evidence, attribution, and meaningfulness of performance measures have been questioned.”

To address this clinical uncertainty, the ACP Performance Measurement Committee (PMC) reviewed 5 measures identified using the following websites:

• National Quality Forum, the former consensus-based entity
• Partnership for Quality Measurement, the current consensus-based entity
• Centers for Medicare & Medicaid Services’ Measures Inventory Tool
• National Committee for Quality Assurance

For inclusion, performance measures were required to meet the following criteria: quality performance measures for colorectal cancer AND currently used in the United States in an accountability, public reporting, or payment program, such as the Centers for Medicare & Medicaid Services’ Merit-based Incentive Payment Program or National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set; AND relevant to internal medicine; AND/OR previously reviewed by the PMC; AND/OR endorsed by the consensus-based entity AND NOT solely included in Medicare Part C or Part D AND NOT cost measures.1

Investigators identified 5 measures meeting these criteria:

• Colorectal Cancer Screening: percentage of patients aged 45–75 years who had appropriate screening for colorectal cancer
• Age Appropriate Screening Colonoscopy: Percentage of screening colonoscopies performed in patients aged ≥86 years of age from January to December
• Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients: Percentage of patients aged 45 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of ≥10 years for repeated colonoscopy documented in their colonoscopy report
• Colonoscopy Interval for Patients with a History of Adenomatous Polyps–Avoidance of Inappropriate Use: Percentage of patients ≥18 years of age receiving a surveillance colonoscopy, with a history of prior adenomatous polyps in previous colonoscopy findings, which had an interval of ≥3 years since their last colonoscopy
• Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy: Rate of risk-standardized, all-cause, unplanned hospital visits within 7 days of an outpatient colonoscopy among Medicare fee-for-service patients ≥65 years of age

They sought to determine whether these measures are evidence-based, methodologically sound, and clinically meaningful within 5 domains: importance, appropriate care, clinical evidence base, measure specifications, and feasibility/applicability.1

Of the 5 performance measures assessed, the ACP PMC found only 1 performance measure, Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy, valid for use. The other 4 measures did not meet ACP’s standards for appropriate use, high-quality evidence, and scientific acceptability, with some measures not aligned with current evidence. The ACP also notes improvements needed for the performance measure specifications.1

“The ACP encourages measure developers to refine and test these performance measures that aim to improve health outcomes for patients,” investigators concluded.1

References

1. Qaseem A, Miller NL, Khetan RS, et al. Quality Indicators for Screening and Surveillance of Colorectal Cancer in Adults: A Review of Performance Measures by the American College of Physicians. Annals of Internal Medicine. https://doi.org/10.7326/ANNALS-25-01163

2. ACP. ACP issues updated guidance for colorectal cancer screening of asymptomatic adults. August 1, 2023. https://www.acponline.org/acp-newsroom/acp-issues-updated-guidance-for-colorectal-cancer-screening-of-asymptomatic-adults