This Week – July 9, 2016

This Week in Washington, D.C.

  • CMS Releases Rules with Proposed 2017 Medicare Facility Fee Rates and Physician Fee Schedule Proposed Rates
  • CMS Moderate Sedation Plans Will Tighten the Pressure on Medicare Reimbursement

From ACG National Affairs Committee Chair, Whitfield L. Knapple, MD, FACG

CMS Releases Rules with Proposed 2017 Medicare Facility Fee Rates and Physician Fee Schedule Proposed Rates

On Wednesday, CMS released the 2017 proposed rule that includes policy and payment changes for the Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Centers (ASC).

On Thursday, CMS released the 2017 proposed rule that includes policy and payment changes for the Medicare physician fee schedule (MPFS).

ACG is reviewing both of the regulations and will update our membership on the potential impact to clinical GI.  In the meantime, here are some highlights:

 

For a comprehensive review of these important changes, please read the full blog here.


From ACG’s Advisor to the AMA RVS Update Committee (RUC), R. Bruce Cameron, MD, FACG

CMS Moderate Sedation Plans Will Tighten the Pressure on Medicare Reimbursement

GI has been feeling the squeeze on Medicare reimbursement for several years, and it just got somewhat tighter.

On July 7th, a proposed rule from CMS for the Medicare 2017 Physician Fee Schedule decouples moderate sedation from the payment for more than 100 GI endoscopic procedures.  This move effectively reduces the physician work value by .10 RVUs and lowers your overall reimbursement (if you are not administering anesthesia yourself) – creating further downward pressure on your bottom line.

Up until now, CMS has never placed a value on moderate sedation work.  The genesis of the proposed rule is a 2014 announcement by CMS that the Agency would look to separate moderate sedation services from procedural codes in all specialties where the underlying procedure is performed with moderate sedation.

Reimbursement for GI endoscopic procedures will be reduced if the endoscopist doesn’t administer moderate sedation.

Under the proposed rule announced July 7th, there will be no financial impact for gastroenterologists who perform their own moderate sedation.  You will just report two codes instead of one beginning January 2017 — the procedure code and the new moderate sedation code.

However, gastroenterologists who use anesthesia professionals will see the value of the majority of GI endoscopy procedures reduced by 0.10 RVUs.

GI has already sustained drastic cuts over the past four years.

ACG recognizes your frustration and appreciates the real world implications you have provided for your practice and your patients.  We have shared your anger that GI procedures have been targeted by CMS for slashed reimbursement over the years, simply because of their high volume and to meet Medicare cost control mandates from CMS and Congress.

This latest move by CMS to create separate codes for moderate sedation means further erosion in Medicare payments for endoscopic procedures. GI procedures fared better than other specialties whose procedures face a .25 RVU valuation for moderate sedation.  It’s noteworthy that CMS listened to the GI societies as opposed to the AMA RVS Update Committee’s (RUC) recommendations, which were higher.  Nonetheless, it is perhaps a small consolation that things could have been worse, when overall, the rule would cut reimbursement for GI endoscopic procedures between 2 and 3 percent if you don’t administer your own moderate sedation.

CMS Considered Data from ACG, AGA, and ASGE

In March, as ACG’s physician representative to the RUC, I joined with AGA and ASGE to meet with regulators at CMS.  We made a case to the Agency about the appropriate value of moderate sedation.  The data we presented were based on the survey responses provided by members of the three GI societies.

In the proposed rule, CMS acknowledged the work of the GI societies as follows: read the full blog here.