Becker's ASC Review

26 GI & ENDOSCOPY SECTION: GI Payment Updates Payment Landscape Forecast: 3 Gastroenterologists Consider the Possibility of Colonoscopy Reimbursement Cuts By Carrie Pallardy C MS has released the 2016 Medicare Phy- sician Fee Schedule proposed rule, which could put into action payment cuts for colonoscopy and other lower GI/endoscopy pro- cedures of up to 19 percent. Colonoscopy is a mainstay procedure in GI and the gold standard for colorectal cancer screening. ree gastroenterologists look ahead and con- sider how these payment cuts would affect their specialty. Maxwell Chait, MD, FACP, FACG, FASGE, AGAF, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): During the MPFS Final Rule in 2012, CMS had identified colonoscopy, EGD and other GI endoscopy procedures as potential- ly misvalued through the Misvalued Code Ini- tiative. Over the last three years, representatives from the ACG, AGA and ASGE have success- fully delayed the revaluation of colonoscopy and other lower GI procedures. ey presented their proposal and recommendations, which were from survey data, regarding physician work and practice expenses related to colonoscopy to the American Medical Association's Relative Value Update Committee in February 2014. ey were able to convince CMS to hold off putting the rate cuts into effect for the 2015 calendar year because there was a lack of transparency in the data that prevented the medical societies from properly responding to the rate cuts. e next steps will involve thorough reviews of the pro- posed rules of MPFS and Hospital Outpatient Prospective System/Ambulatory Surgical Center Payment Systems. All comments are due Sept. 8, 2015. Rates will reportedly be finalized in No- vember, and the final action will take effect Jan. 1, 2016. These reductions are based on flawed meth- odology that did not use all the survey data that was provided. Rather, they used data from other specialties. The agency is relying on the same data sources as in the previous year. One might say that this follows the old adage "gar- bage in, garbage out," since they are using the same flawed logic. They contend that the RUC ultimately used data from another specialty to determine the value of colonoscopy services, resulting in the payment cut recommendations. The Government Accountability Office criti- cized the RUC, stating that members had con- flicts of interest that could affect how physician services are valued. What gastroenterologists are now getting paid from Medicare barely covers the costs of these procedures. At this time the anesthesiologists oen get more money per procedure than the endoscopists for routine colonoscopy, which seems preposterous. If these severe cuts are im- plemented, patient access could suffer. It could have the consequence of driving colonoscopy costs higher overall by gastroenterologists limit- ing their performance of this procedure within the Medicare population or possibly withdraw- ing from Medicare altogether. Colonoscopy has been shown to have a positive impact on the incidence of colon cancer. ese draconian cuts could possibly hinder public health efforts to reduce the incidence of colorectal cancer. Colo- noscopy in the outpatient setting is more cost- effective and presents a more patient-friendly environment. ese cuts could also lead to more procedures being done in the hospital outpatient setting, where Medicare pays more for the pro- cedure than in ambulatory surgical centers, driv- ing overall costs even higher. Elliot Ellis, MD, Team Lead, EMA Gastro- enterology, Modernizing Medicine: No one wants a reduction in salary, but most people can agree that healthcare costs in the United States can be better managed by ensuring that patients receive the right care at the right time – not too much and not too little. It's a compli- cated equation, but across the board payment cuts for colonoscopies and other lower GI/en- doscopy procedures won't solve the problem. Part of the responsibility rests with physicians to ensure any tests and procedures ordered are medically necessary, and one way that we as gastroenterologists can do this is through proper documentation of patient visits. An EHR system that captures all relevant patient information in a structured way can illustrate that a colonoscopy or another procedure is jus- tified. This approach may be more difficult, but by measuring quality and outcomes both physi- cian and patient – and the industry as a whole – win. William Katkov, MD, Providence Saint John's Health Center (Santa Monica, Calif.): Pro- posed cuts in Medicare reimbursement for colo- noscopy will have consequences not only for gastroenterologists, but for the aging population in the United States. A small decrease in Medi- care providers will amplify the physician short- age projected to become increasingly serious over the next 10 years. A strategy to attenuate the imminent shortage of physicians is needed in the short term, and it must include incentives for doctors to continue participating in Medi- care. Decreasing reimbursement for professional services will aggravate the situation, and impede access to effective colorectal cancer screening. In addition, the financial impact of reduced payment for colonoscopy will continue to drive gastroenterologists away from private practice and towards alignment with large hospitals and health systems. n THE LEADER IN ENTERAL FEEDING INTRODUCES THE NEW UPGRADED MIC * PEG KIT MIC * PEG STANDARD & SAFETY KITS for PUSH & PULL Method • New Kit & Components Streamline Procedure Placement 1 • Unique Bumper Design Helps Avoid Accidental Patient Dislodgements 2 www.halyardhealth.com/digestivehealth Visit us at ACG Booth #1116 *Registered Trademark or Trademark of Halyard Health, Inc. or its affiliates. © 2015 HYH. All rights reserved. DH70 A151089 1 Data on file. DVC-2013/-35 - Design Inputs. 2 Data on file. GL-DSR00143 / 1 - Retention Values for Competitor PEG Tubes Report.

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