This Week – January 18, 2014

This Week in Washington DC:

  1. GI Societies to Meet with CMS and Discuss Cuts to Upper GI Endoscopy
  2. HHS to Release Medicare Physician Reimbursement Data

ACG and GI societies to discuss significant cuts to upper GI reimbursement
In December, the Presidents of ACG, AGA, and ASGE came together and sent a joint-society message conveying our commitment to helping ensure our members receive fair and accurate reimbursement. Our societies remain extremely disappointed in the Centers for Medicare and Medicaid Services’ (CMS) decision to significantly cut reimbursement rates for upper GI endoscopy services in the 2014 Medicare Physician Fee Schedule final rule.

On January 21st, ACG, AGA, and ASGE will meet in-person with CMS to gain a better understanding of the methodologies CMS used to determine reimbursement rates for these GI codes in the 2014 final rule, as the meeting may also provide some insight into the process CMS may use when determining reimbursement for lower GI endoscopy codes in the near future.

We are hopeful that this meeting will provide us with an opportunity to better understand CMS’ rationale which will help to shape our advocacy efforts moving forward on these very important issues. The GI societies are also currently working together to provide formal comments to CMS by January 27th on these reimbursement provisions in the final rule. In the coming days, and once we have an opportunity to first learn more from CMS, ACG, AGA, and ASGE will be calling on our members to lend their voices to this effort.

Please know that our societies continue to explore all options to mitigate these cuts to endoscopy services.

ACG members should also know that potential cuts to colonoscopy may be on the horizon. This is one reason why ACG continues to urge Congress to pass the SCREEN Act (S. 608 / H.R. 1320) despite the divisive political environment on Capitol Hill. This bill improves quality of care in our specialty, lowers patient barriers to life-saving colorectal cancer screening, and also strives to ensure Medicare reimbursement for colonoscopy is fair. This is a very crucial time for clinical gastroenterology and our patients. Please urge your leaders to support the SCREEN Act:

ACG will continue to fight Medicare reimbursement cuts that threaten clinical GI and the patients we serve.

HHS to release provider-level Medicare claims data upon request
On Tuesday, the Department of Health and Human Services (HHS) announced that it would begin responding to public requests for Medicare provider payment data under the Freedom of Information Act. HHS noted every request may not be accommodated, but instead, HHS would begin using a “balancing test” to determine which information should be released. HHS also noted that no disclosure would reveal the identities of individual patients.

ACG joined other medical societies in submitting comments prior to this final determination. The College and others urged caution when releasing these data, as provider privacy must be balanced against public interest as well. The societies also urged HHS to implement safeguards and qualifying statements to avoid any misinterpretation of the data. Please click here to read the letter to HHS.

Public access to Medicare physician-payment data was previously banned because it was deemed an invasion of physician privacy. Last year, however, a federal court in Florida ruled that doctors’ privacy concerns did not trump the public interest in disclosing the information.

According to legal experts, the Freedom of Information Act’s privacy exemption may still shield some information from public view if the damage to physician privacy is judged greater than the public interest in the information. 

ACG will continue to engage HHS on this issue in order to protect the privacy interests of our membership.

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