This Week – July 20, 2013

This Week in Washington DC:

  1. SGR Reform Legislation Released in U.S. House of Representatives
  2. ACG Assisting FDA in Developing Policies on FMT
  3. ACG Responds to Recent GAO Report on Anatomic Pathology

House Energy & Commerce Committee to address bipartisan SGR reform bill next week
On Thursday, July 18th, the U.S. House of Representatives Committee of Energy & Commerce released draft legislation to repeal the sustainable growth rate (SGR) formula and reform Medicare provider reimbursement. The Committee announced that it will hold a hearing and finalize the draft on Tuesday, July 23rd. If the Committee finalizes and approves the draft, the next step would be for the bill to move to the House of Representatives floor for a final vote.

The draft has support from both Republican and Democrat leaders on the Energy & Commerce Committee. While there are many details that still need to be addressed (such as how Congress will pay for the bill), the draft released on Thursday includes:

  • A .5% Medicare physician reimbursement update for 2014-2018. During this time, programs such as PQRS and “Meaningful Use” will continue.
  • Physicians will have the option to participate in alternative payment models (APMs) beginning 2015.
  • Beginning 2019, physicians will receive annual updates of .5% but physicians continuing to practice in the Medicare fee for service model will be under a new Update Incentive Program (UIP). This program will compare physician performance based on quality metrics developed by societies and other stakeholders. Physicians will select a “peer cohort,” or a group of providers practicing in a similar area of medicine. The reimbursement rate will be based on the physician’s UIP performance in their respective peer cohort. Physicians deemed “high performers” have the opportunity to receive a 1% increase in payment while “low performers” will experience a 1% reduction.
  • Providers not participating will receive a 3% reduction as well as other reductions under current law (PQRS, Meaningful Use).

While ACG is encouraged that the Committee is serious about SGR reform, ACG continues to work with Congress to ensure these reforms are not additional quality reporting burdens for ACG members and that ACG members have a seat at the table when defining “high quality of care.” ACG has met with staff and offered comments throughout this process as well as in response to the Committee’s requests for assistance:

April 20, 2013 “This Week”
February 23, 2013 “This Week”

ACG will continue to represent the GI clinician throughout this debate and will continue to keep membership updated on the latest developments.

FDA Seeks ACG Assistance in Developing FMT Policies
On Monday, July 15th, ACG joined a group of like-minded specialty societies in responding to a U.S. Food and Drug Administration (FDA) request for assistance in developing donor screening and stool testing recommendations for treating patients with recurrent Clostridium difficile infection (C. diff.) with fecal microbiota transplantation (FMT). ACG continues to work with the FDA on this issue to ensure ACG members and our patients have access to safe and effective treatment options.

ACG staff would like to thank the workgroup of ACG members who volunteered to develop these recommendations.

Multi-Society Letter to the FDA on Donor Screening and Stool Testing

In June, the FDA released a statement on requirements for FMT. Specifically, the FDA announced that it would use discretion in enforcing investigational new drug (IND) requirements for treating of refractory Clostridium difficile infection by FMT. Please click here to learn more.

In addition to partnering with other societies, ACG continues to work closely with the FDA in various capacities, including the unique ACG-FDA Liaison Council, which regularly meets with the FDA’s Center for Drug Evaluation and Research. ACG was also invited to join the “Network of Experts” Program to assist the FDA’s Center for Devices and Radiological Health in approving and monitoring medical devices.

GAO Releases Report Critical of Self-Referrals in Pathology
A Government Accountability Office (GAO) report released this week found physician referrals for anatomic pathology services paid for by Medicare doubled from 2004 to 2010 when physicians had a financial stake in the service, compared with a 38% increase among physicians who did not.

ACG believes the negative implications for GI raised by this GAO study are unwarranted. GAO found that the average number of biopsies for various GI procedures was 2.2 in the self-referral setting versus 1.9 in other settings. This difference is negligible. The report fails to understand that standard practice is to clear the colon of polyps and send them for evaluation by a pathologist because often it is not possible to tell if a polyp is precancerous merely by looking at it.

Please click here to read the GAO report.

ACG will work to educate the GAO and congressional offices to understand why the conclusions of this study are not supported by the data and do not acknowledge the realities of clinical practice.

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