This Week – July 27, 2012

This Week in Washington DC:

  1. ACG Invited to Submit Comments for the Legislative Record to Recent House of Representatives Ways & Means Committee Hearing on Medicare Reimbursement
  2. Congressional Budget Office Lowers Spending Projections for Health Reform Law

ACG Advocates for Adequate Reimbursement, Improved Outcomes, and Patient Responsibility
On Thursday, ACG submitted comments for the legislative record of the House Ways & Means Health Subcommittee hearing entitled “Physician Organization Efforts to Promote High Quality Care and Implications for Medicare Physician Payment Reform.” The hearing was held on Tuesday, July 22nd and ACG’s comments were placed into the final hearing record, which the Committee will use when drafting Medicare reimbursement reform legislation.

Committee members on both sides of the political aisle expressed the desire to replace the current Medicare reimbursement system and sustainable growth rate (SGR) formula.  However, there is no consensus on how to pay for the $300 billion cost in repealing SGR, or how Medicare can better pay providers for performing high quality of care. While Congress may look to the Independent Payment Advisory Board (IPAB) or care-coordination models as ways to lower health care costs and improve patient care, ACG cautioned the Committee that the Medicare fee-for-service reimbursement system cannot be replaced with a punitive reimbursement model or a model that does not reward physicians for providing high quality of care nor encourages patient responsibility. Also, in order to improve patient care, Congress must work with physician specialty societies to help develop meaningful quality metrics should reimbursement be further tied to quality reporting. This can be achieved, ACG urged, with the promotion of clinical registries such as the GI Quality Improvement Consortium or “GIQuIC.” These meaningful and relevant quality measures already exist and can help reward providers for performing high quality of care while lowering programmatic costs through more preventative services. In fact, ACG’s signature legislation, the SCREEN Act (HR 3198), helps move the Medicare reimbursement system further towards this goal.

ACG also stressed in its comments that it is important for Congress to not lose sight of the looming near-term crisis when deliberating over a long-term solution:

ACG would like to stress to the Committee that the SGR formula is based on a flawed presumption that Medicare providers actually have substantial influence over the various components in the formula itself, including: the estimated changes in reimbursement for physician services (determined by Medicare or other payers of health care services), the estimated change in beneficiaries enrolled in the Medicare FFS program, the estimated per capita growth in the U.S. gross domestic product (GDP), and the estimated change in expenditures due to any revision in federal law or regulation. Yet, physicians are scheduled to receive devastating cuts in Medicare reimbursement rates as a result of the SGR formula—a 27% reduction for services provided after January 1, 2013.

Please click here to read ACG’s letter to the House Ways & Means Committee.

ACG will continue to advocate for adequate Medicare reimbursement and promote the high quality of care ACG members are providing patients.

Recent Supreme Court’s Decision Reduces Health Reform Law Spending by $84 Billion
Also on Tuesday, July 22nd, the Congressional Budget Office (CBO) released its revised cost estimates of the Patient Protection and Affordable Care Act (now known as the “ACA”), which the U.S. Supreme Court largely upheld in June. The ACA spending provisions are now estimated at $1.17 trillion over 10 years compared to the $1.25 trillion over the same 10 year period released in March 2012. The revised cost-estimates reflect the lower than expected enrollment in Medicaid due to the Court’s ruling that Congress may not withhold Medicaid funding to states unwilling to expand Medicaid eligibility requirements.

The CBO also said repealing the ACA would actually add to the national deficit as repealing the law would also eliminate certain taxes, Medicare provider cuts, and other revenue raisers passed to pay for the Medicaid expansion and other provisions. Repealing these revenue raisers would add to the national deficit by $109 billion over 10 years.

ACG will continue to support those provisions in the ACA that benefit gastroenterology and our patients. However, CBO estimates notwithstanding, ACG will continue to fight proposals that place the burden of federal deficit reduction squarely on the backs of Medicare providers.

Click here to read the revised CBO estimates:

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