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Once again, gastroenterologists are preparing to challenge the Centers for Medicare & Medicaid Services (CMS) on proposed cuts to reimbursement for colonoscopies.
Included in the recent proposed update to the physician fee schedule are various payment cuts, including a 19% reduction in payments for colonoscopy with biopsy, a 12% reduction for colonoscopy with snare polypectomy, and an 11% reduction for colonoscopy with no other ancillary services.
“These reductions are based on flawed methodology,” said Dr. Rajeev Jain, AGAF, chief of gastroenterology at Presbyterian Hospital of Dallas and a member of the American Gastroenterological Association (AGA) governing board. “They did not use all the survey data that was provided by gastroenterologists and surgeons. Rather, they recommended a value for colonoscopy based on a bronchoscopy code that they believed was similar in terms of physician work and time.”
Dr. Jain noted that in 2014, the AGA, along with the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE), were able to convince the CMS to hold off putting the rate cuts into effect for the 2015 calendar year because there was a lack of transparency in the system that prevented the medical societies from properly responding to the rate cuts.
But the agency is again relying on a misapplication of the American Medical Association/Specialty Society Relative Value Scale Update Committee’s (RUC)’s already flawed recommendation.
CMS in 2012 identified colonoscopy, among other procedures, as being potentially misvalued. The AGA, ACG, and ASGE provided survey data and recommendations to support proper reimbursement, but they contend that the RUC ultimately rejected the survey data and compared colonoscopy to another specialty to determine the value, resulting in the payment cut recommendations. The RUC recently was criticized in a GAO report for its members having conflicts of interest that could affect how physician services are valued.
The cuts could lead to gastroenterologists putting limits on this procedure within their Medicare population or withdrawing from Medicare altogether, Dr. Jain said. The cuts could also lead to more procedures being conducted in the hospital outpatient setting, where Medicare pays more for the procedure than in ambulatory surgical centers, which he said can be more cost effective and more patient friendly.
Comments on the proposal are due to CMS by Sept. 8.
Once again, gastroenterologists are preparing to challenge the Centers for Medicare & Medicaid Services (CMS) on proposed cuts to reimbursement for colonoscopies.
Included in the recent proposed update to the physician fee schedule are various payment cuts, including a 19% reduction in payments for colonoscopy with biopsy, a 12% reduction for colonoscopy with snare polypectomy, and an 11% reduction for colonoscopy with no other ancillary services.
“These reductions are based on flawed methodology,” said Dr. Rajeev Jain, AGAF, chief of gastroenterology at Presbyterian Hospital of Dallas and a member of the American Gastroenterological Association (AGA) governing board. “They did not use all the survey data that was provided by gastroenterologists and surgeons. Rather, they recommended a value for colonoscopy based on a bronchoscopy code that they believed was similar in terms of physician work and time.”
Dr. Jain noted that in 2014, the AGA, along with the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE), were able to convince the CMS to hold off putting the rate cuts into effect for the 2015 calendar year because there was a lack of transparency in the system that prevented the medical societies from properly responding to the rate cuts.
But the agency is again relying on a misapplication of the American Medical Association/Specialty Society Relative Value Scale Update Committee’s (RUC)’s already flawed recommendation.
CMS in 2012 identified colonoscopy, among other procedures, as being potentially misvalued. The AGA, ACG, and ASGE provided survey data and recommendations to support proper reimbursement, but they contend that the RUC ultimately rejected the survey data and compared colonoscopy to another specialty to determine the value, resulting in the payment cut recommendations. The RUC recently was criticized in a GAO report for its members having conflicts of interest that could affect how physician services are valued.
The cuts could lead to gastroenterologists putting limits on this procedure within their Medicare population or withdrawing from Medicare altogether, Dr. Jain said. The cuts could also lead to more procedures being conducted in the hospital outpatient setting, where Medicare pays more for the procedure than in ambulatory surgical centers, which he said can be more cost effective and more patient friendly.
Comments on the proposal are due to CMS by Sept. 8.
Once again, gastroenterologists are preparing to challenge the Centers for Medicare & Medicaid Services (CMS) on proposed cuts to reimbursement for colonoscopies.
Included in the recent proposed update to the physician fee schedule are various payment cuts, including a 19% reduction in payments for colonoscopy with biopsy, a 12% reduction for colonoscopy with snare polypectomy, and an 11% reduction for colonoscopy with no other ancillary services.
“These reductions are based on flawed methodology,” said Dr. Rajeev Jain, AGAF, chief of gastroenterology at Presbyterian Hospital of Dallas and a member of the American Gastroenterological Association (AGA) governing board. “They did not use all the survey data that was provided by gastroenterologists and surgeons. Rather, they recommended a value for colonoscopy based on a bronchoscopy code that they believed was similar in terms of physician work and time.”
Dr. Jain noted that in 2014, the AGA, along with the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE), were able to convince the CMS to hold off putting the rate cuts into effect for the 2015 calendar year because there was a lack of transparency in the system that prevented the medical societies from properly responding to the rate cuts.
But the agency is again relying on a misapplication of the American Medical Association/Specialty Society Relative Value Scale Update Committee’s (RUC)’s already flawed recommendation.
CMS in 2012 identified colonoscopy, among other procedures, as being potentially misvalued. The AGA, ACG, and ASGE provided survey data and recommendations to support proper reimbursement, but they contend that the RUC ultimately rejected the survey data and compared colonoscopy to another specialty to determine the value, resulting in the payment cut recommendations. The RUC recently was criticized in a GAO report for its members having conflicts of interest that could affect how physician services are valued.
The cuts could lead to gastroenterologists putting limits on this procedure within their Medicare population or withdrawing from Medicare altogether, Dr. Jain said. The cuts could also lead to more procedures being conducted in the hospital outpatient setting, where Medicare pays more for the procedure than in ambulatory surgical centers, which he said can be more cost effective and more patient friendly.
Comments on the proposal are due to CMS by Sept. 8.
