This Week – May 7, 2016

This Week in Washington, D.C.

  • “Sunshine” Payments: Review and Dispute Periods End May 15th
  • ACG and Coalition of Specialties Oppose Rep. Jackie Speier (D-CA) Legislation
  • RVUs Undervalue the Cognitive Physician Visit: A Focus on IBD Cognitive Services
  • ACG Guidance: Making $ense of MACRA

Important Date for ACG Members: May 15th

“Sunshine” Payments: Review and Dispute Periods End May 15th

CMS announced the beginning of the 45 day Open Payments (“sunshine payments”) review and dispute period.  This period ends May 15, 2016.  CMS will publish the 2015 payment data on June 30, 2016, which includes updates to the 2013 and 2014 data.

The Affordable Care Act requires manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals.  CMS has been charged with implementing the Sunshine Act and has called it the Open Payments Program.

Why is it important to review Open Payments data?

Source: cms.gov

Source: cms.gov


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

ACG and Coalition of Specialties Oppose Rep. Jackie Speier (D-CA) Legislation

This week, ACG called upon leaders in the U.S. House of Representatives’ committees with health care jurisdiction to oppose H.R. 5088, the “Promoting Integrity in Medicare Act.” This legislation would eliminate the in-office ancillary exception.

ACG has been actively engaged on this issue for years, including educating Congress to refute a 2013 GAO report on anatomic pathology.  The bill’s supporters also say that H.R. 5088 “will ensure that incentives driving medical decisions are solely in the patients’ best interests, thereby reducing unnecessary and inappropriate services and costs to the Medicare program.”  Really?  These folks fail to understand that it is often not possible to diagnosis a patient or tell if a polyp is precancerous merely by looking at it.  That’s the whole point of taking a biopsy.

ACG will continue to lead on policy issues solely impacting clinical GI.   When policy issues impact other specialties in addition to GI, however, ACG will work both independently as well as part of larger coalitions to help further our membership’s priorities.

Read the full blog here.


KatzMelmedRVUs Undervalue the Cognitive Physician Visit

A Focus on IBD

In the April issue of Gastroenterology & Hepatology, Seymour Katz, MD, MACG and Gil Y. Melmed, MD call into question the Resource-Based Relative Value Scale (RBRVS) physician compensation model for cognitive services.  “The present RVU metric for compensating physicians is flawed,” write the authors.

For many, institutions and practices significantly undervalue these services, especially because cognitive visits are usually the gateway for higher RVU endoscopy procedures attributed to someone else.  For example, the inflammatory bowel disease (IBD) office visit creates an “unfortunate paradigm.”  The growing complexity of diagnosis and management of IBD patients is an area of medicine where gastroenterologists must grapple with extraordinary complicating disease features of fistula, abscess, obstruction, postoperative sequelae, biologic therapies and changing paradigms of therapy.

CMS has recently sought stakeholder opinion in previous regulations, highlighting this same conundrum of the value of cognitive evaluation and management services on improving the quality of patient care versus the value of cognitive evaluation and management services viewed through the RVU compensation-based model.

Read the blogpost here.

ACG continues work with CMS to improve the value of Medicare reimbursement for cognitive services.

Read the article by Dr. Katz and Dr. Melmed in Gastroenterology & Hepatology.


From ACG Staff:  Making $ense of MACRA

CMS….SGR… MACRA… MIPS… APMs… QCDRs… ACOs… Why does Washington D.C. love acronyms and complicated payment systems?  What the heck is going on here?

ACG Hopes to Keep This Simple

ACG has reviewed the law and continues to review the recently proposed regulation that implements MACRA.  We compiled a detailed overview for you that seeks to make some sense out of this alphabet soup – but hopefully in a simplified fashion and in plain English.  In the upcoming days, ACG will focus on certain segments of this newly proposed payment system, delving more into the specifics but in piecemeal and in brief summaries.  This way, we hope the busy GI clinician is not overloaded with lengthy explanations, complicated charts, and more acronyms all at the same time.

Read the ACG summary here.