This Week – March 23, 2013

This Week in Washington DC:

  1. The SCREEN Act Introduced in Both the House and Senate
  2. ACG Endorses Legislation Reducing “Meaningful Use” Reporting Burdens

SCREEN Act: Lowering Barriers and Raising Quality
This week Senator Ben Cardin (D-MD) and Representative Richard Neal (D-MA) introduced the “Supporting ColoRectal Examination and Education Now” (SCREEN) Act (S. 603/HR 1320).

ACG commends Sen. Cardin and Rep. Neal for their longstanding support to reduce barriers to colorectal cancer screening. ACG members have also been advocating for lowering burdens for colorectal cancer screening for over a decade, beginning in 1998 when helping to convince Medicare to provide coverage for a screening. This benefit, however, remains woefully underutilized due to financial burdens as well as fear of the procedure itself. Unfortunately, Medicare reimbursement for colorectal cancer screening is also consistently threatened each year even as studies demonstrate that colorectal cancer deaths can be reduced by over 50% due to removing polyps during screening colonoscopy, one of the few preventive services actually demonstrated to save the Medicare Program money in the long-term.

The SCREEN Act is a comprehensive package addressing each of these issues impacting the GI clinician and our patients.

The bill waives all Medicare beneficiary cost-sharing for screening colonoscopies turning into therapeutic procedures. Under current law, only exams coded as “screenings” result in no patient cost-sharing. This is due to an unintended quirk in the Patient Protection and Affordable Care Act, the health reform law passed in March 2010.

The SCREEN Act also provides Medicare coverage for a pre-screening or pre-operative office visit before the date of the exam. Medicare does not provide coverage for the beneficiary to review the procedure or preparation with the physician. Yet colorectal cancer screening is unique in that the patient’s participation is crucial to the accuracy and quality of the exam. This benefit is good medicine and good for the Medicare program. It may also help avoid unnecessary repeat procedures due to inadequate preparation or other issues discovered on the day of the exam. The NIH and other organizations have concluded that the fear of the procedure itself is a barrier to screening utilization rates as well.  

Lastly, the legislation helps reform the Medicare reimbursement system by ensuring providers are paid for the quality of the services as opposed to the quantity of the services. The SCREEN Act provides for a 10% Medicare reimbursement incentive conditional upon voluntary participation in a nationally recognized quality improvement registry, such as GIQuIC, that compares the physician to outcome-based metrics accepted in the medical literature. Congress is requiring Medicare to move towards this type of “value-based purchasing” reimbursement model yet is looking for additional guidance when implementing these reforms. The SCREEN Act provides such an example. Congress and Medicare should harness the power of participating in quality improvement registries, something that thousands of gastroenterologists in the U.S. are currently doing anyway, when moving forward with Medicare reimbursement reform. It is crucial for clinical GI to have a seat at the table when defining “quality of care,” especially as Medicare reimbursement is tied to quality reporting.

The SCREEN Act is also budget-neutral and was drafted so that the costs add nothing to the national deficit.

ACG will continue to promote the SCREEN Act as well as other legislation on Capitol Hill that increases colorectal cancer screening utilization rates and reduces patient barriers to screening.

ACG Endorses Legislation Promoting Clinical Registries and Reduces “Meaningful Use” Reporting Requirements
ACG and other medical organizations endorsed the “Electronic Health Records Improvement” Act (HR 1331) introduced by Representative Diane Black (R-TN) this week. This bill allows for participation in quality improvement registries, such as GIQuIC, to help satisfy Medicare’s Electronic Health Records Incentive Program. The bill also provides a temporary exemption for services performed in the ambulatory surgical center (ASC). This is important as eligible “meaningful use” services are used to determine whether the provider is ultimately eligible for Medicare reimbursement cuts from failing to use HHS-certified EHRs in 50% of the provider’s total services. Lastly, the bill provides a temporary exemption from “meaningful use” for those physicians at or near retirement age.

Please find the multi-society letter here.

ACG appreciates Rep. Black’s leadership in helping to reduce onerous Medicare quality reporting requirements, and instead, introducing legislation to promote meaningful quality initiatives such as society-developed quality improvement registries.

ACG will continue to work with Rep. Black’s office in promoting the Electronic Health Records Improvement Act and be the voice for clinical gastroenterology on Capitol Hill.

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