Once again, gastroenterologists are preparing to challenge the Centers for Medicare & Medicaid Services (CMS) on proposed cuts to reimbursement for colonoscopies and related services.
The payment update is included in the recent proposed update to the physician fee schedule and will involve 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.
Dr. Rajeev Jain
“These reductions are based on flawed methodology,” said Dr. Rajeev Jain, 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. Rather, they used data from other specialties.”
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 data that prevented the medical societies from properly responding to the rate cuts.
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But the agency is relying on the same data sources as in the previous year, and “to use the same flawed logic doesn’t make any sense,” Dr. Jain said.
The 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 American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) ultimately used data from another specialty to determine the value of colonoscopy services, resulting in the payment cut recommendations. The RUC recently was criticized in a Government Accountability Office report for its members having conflicts of interest that could affect how physician services are valued.
Dr. Jain said that what gastroenterologists are getting paid right now from Medicare “barely covers the costs of that care,” and he suggested that if these “draconian” cuts are implemented, patient access could suffer, and it could have an unintended consequence of driving colonoscopy costs higher overall.
The cuts could lead to gastroenterologists limiting their performing of this procedure within their Medicare population or withdrawing from Medicare altogether, he 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 are a more patient-friendly environment.
Comments on the proposal are due to the CMS by Sept. 8.