Becker's ASC Review

24 GI & ENDOSCOPY SECTION: GI Payment Updates CMS Proposes Colonoscopy Payment Cuts for 2016: 4 Key Points By Carrie Pallardy C MS has released the 2016 Medicare Physician Fee Schedule pro- posed rule, which includes cuts for colonoscopy and other lower GI/endoscopy procedures, according to the American Gastroen- terological Association. Here are four key points on how the proposed rule would affect GI. 1. e reimbursement cuts for the colonoscopy family procedures could be up to 19 percent. 2. e AGA and its sister GI societies are unable to estimate the full impact of the cuts yet, due to errors in data files posted by CMS. 3. Proposed changes for 11 lower GI/endoscopy procedures, but RVU percent change, include: • Colonoscopy with biopsy (45380): -19 percent • Colonoscopy with snare polypectomy (45385): -12 percent • Colonoscopy (45378): -11 percent • Colorectal cancer screen, high risk (G0105): -2 percent • Colorectal cancer screen, low risk (G0121): -2 percent • Colonoscopy with hot biopsy (45384): -11 percent • Colonoscopy with submucosal injection (45381): -14 percent • Colonoscopy, flexible with ablation (45388): -15 percent • Flexible sigmoidoscopy with biopsy (45331): -7 percent • Flexible sigmoidoscopy (45330): -20 percent • Colonoscopy with control of bleeding (45382): -16 percent 4. e AGA, American College of Gastroenterology and American Society of Gastrointestinal Endoscopy are working to combat these proposed cuts. n per hour of office time. ere is no sufficient way, however, to still provide the same volume of high-quality colonoscopy and absorb these cuts without figuring on a substantial cut in take-home income. Q: What are the GI societies doing to work with CMS on com- bating these cuts? CK: e ACG in collaboration with ASGE and AGA have already met with CMS this summer on July 21 to discuss the impact of these proposed cuts and highlight some of the flaws in the agency's analysis. e meeting was an op- portunity to join together on behalf of all U.S. gastroenterologists to convey our mutual concerns regarding the significant impact these cuts will have on GI practices and Medicare patients. ACG and its sister GI societies will continue to engage in this dialogue with CMS. LK: e AGA will continue to work with ACG and ASGE to fight these cuts from a regulatory and legislative perspective. e three GI societies met with CMS to argue that the proposed colonoscopy reimbursement cuts were based on flawed data and should be revised. We're also working on Capitol Hill with lawmakers who champion colorectal cancer screening and rulemaking transparency to push CMS to reevaluate their methodology. GL: e societies have already had one face-to-face meeting with CMS to present them with the realities of how these cuts will undermine the efforts CMS wants to make to reduce rates of colon cancer by improved screening. We've demonstrated to them that the logic behind their rationale for cuts is seriously flawed and unprecedented. We showed them robust data that sup- ports our premise that the work of colonoscopy hasn't changed – it is no less and in some ways it is more than five years ago, when the last AMA RUC sur- vey was done. So how can cuts be justified? We're planning further meetings with CMS. Our health policy groups plan to firmly fight this issue, taking it to Congress, working with public interest groups, and using social media and our grassroots networks across the country to deliver the message that these cuts are dangerous to the public's health. n

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