This Week – February 17, 2012

This Week in Washington DC:

  • Congress Passes Medicare Reimbursement Freeze Until 2013: What’s Your Reimbursement for Certain GI Procedures and Services? 
  • ACG Provides Comment to Physician “Sunshine Payment” Rule  

Legislation Delays Looming Medicare Provider Cuts
On Friday, February 17th, both the U.S. House of Representatives and U.S. Senate passed legislation that freezes Medicare reimbursement rates until January 2013. Absent this legislation, Medicare providers were facing a 27% reimbursement cut beginning next month pursuant to the sustainable growth rate (SGR) formula. This moratorium on reimbursement cuts is part of a larger bill extending unemployment benefits and payroll tax cuts through 2012. The Medicare reimbursement component of the bill costs $18 billion over 10 years. President Obama is expected to sign the bill into law.

The offsets used to pay for the SGR patch include:

  • $5 billion from the “Prevention Fund” included in health reform law, the Patient Protection and Affordable Care Act (ACA);
  • $2.4 billion from reducing the Medicaid matching rate for the state of Louisiana beginning in 2014;
  • $4.1 billion from reducing payments to hospitals treating a disproportionate share of low-income patients (Medicaid DSH payments);
  • $6.9 billion from reducing compensation to hospitals for uncollectable Medicare beneficiary bills (Medicare “bad debt” payments);
  • $2.7 billion from payment cuts to clinical laboratories.

ACG anticipated this reprieve in reimbursement cuts through the end of this year and appreciates Congress adding this provision into the larger payroll tax and unemployment benefits “extenders” package. However, ACG maintains its belief that Congress missed an ideal opportunity to resolve this Medicare reimbursement crisis during the health reform debate. The result in neglecting to address the SGR formula is a more expensive tab to pay for full SGR repeal as well as the opportunity-cost in time spent passing these temporary fixes each year instead of addressing other important legislative issues.

What are your reimbursement rates for 2012? Please click the link below for ACG’s “2012 GI Payment Grid” for selected GI procedures. This includes the 2012 Medicare fee schedule payment as well as the 2012 in-office, ambulatory surgical center, and hospital outpatient department facility fees.

2012 ACG Payment Grid

ACG Provides Comment to  Proposed “Sunshine Payments” Regulation
On Friday, February 17th ACG submitted comment to a proposed regulation regarding drug and device manufacturers’ payments to physicians and teaching hospitals. This regulation was mandated by Congress when it passed the ACA in March 2010 and includes monetary penalties to manufacturers for failing to disclose payments to physicians, including physicians serving as consultants, as well as failing to disclose physician ownership interests in the companies (this does not include ownership of publicly traded stocks).

Among ACG’s concerns with the rule as written is whether a company is required to trace, identify, and report grants for sponsoring continuing education courses that ultimately help to pay speakers’ honoraria or travel expenses. ACG believes this was not the intent of the statute and is very concerned that public reporting of these payments creates an inferred financial relationship between GI clinicians and industry. Once an inferred relationship is out in the public domain, it is near impossible to recant public perception. ACG requests the Centers for Medicare and Medicaid Services (CMS) to specifically exclude from reporting requirements grants that sponsor continuing medical education courses and other educational events.

CMS proposes that manufacturers submit a partial year report by March 31, 2013. Once the data has been submitted, CMS will aggregate manufacturer submissions at the individual physician and teaching hospital level, provide physicians with a 45-day period to confidentially review and, if necessary, correct the data, and then make the data publicly available by September 30, 2013.

ACG will continue to work with CMS on the reach of this regulation and protect the integrity of clinical GI . 

Please click the following link to read ACG’s comment letter.

Please click the following link to view the proposed rule:
“Sunshine Payment” Proposed Regulation

Please stay tuned for further updates. Please also share and discuss your thoughts with fellow ACG members on the ACG GI Circle. To login and share your comments, go to and sign in as a member. Once you have done so, click here and then click the orange "Visit ACG GI Circle" button to be taken to the GI Circle site. If you have not yet activated your ACG GI Circle account, please email us at

Contact Brad Conway, VP Public Policy, with any questions or for more information.

Brad Conway