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

 ACG President Ken DeVault recently articulated a “credo” which has guided the College in its advocacy to preserve appropriate reimbursement for colonoscopy under Medicare: “ACG believes U.S. gastroenterologists seek to be paid fairly and accurately for a highly skilled intervention which prevents cancer, reduces suffering, saves lives and saves money.”

The College is incredibly frustrated by the news that for 2016 CMS will deeply cut the colonoscopy family of codes under Medicare’s Physician Fee Schedule Final Rule, slashing payment for some colonoscopy procedures by more than 17 percent.  In making these cuts, CMS relied on the recommendations the RUC and has effectively rubberstamped a fundamentally flawed and unfair process and disregarded the public health priority of increasing colorectal cancer screening for Medicare.

Fundamentally Unfair and Flawed Process at the RUC

In dealings with the RUC and CMS, ACG sought fair reimbursement based on data-driven appraisal of the effort involved in providing colonoscopy, a lifesaving procedure which detects and removes precancerous lesions and prevents colorectal cancer.  Colonoscopy is the cornerstone of widely heralded national goal to screen 80% of eligible U.S. adults for colorectal cancer by 2018 which ultimately aims to prevent morbidity and mortality.

ACG is outraged that these devastating cuts are based on an arbitrary and ill-conceived RUC process which blatantly disregarded the substantive clinical recommendations of the three GI societies.  The RUC ignored the survey data gathered painstakingly by the three GI societies’ members using a survey instrument approved by the RUC itself – effectively RUC disregarded its own process!  Along with the ASGE and AGA, the College played by the RUC’s rules, but based on the final rule, it is clear now GI never stood a chance.  

CMS Rubberstamped the RUC Recommendations

As the federal health agency charged with determining the Medicare fee schedule, CMS has the authority to make its own determination.  Throughout 2014 and 2015  ACG leaders and staff went to CMS to fight on behalf of clinical GI physicians and the Medicare patients they treat to share the GI societies’ survey data with CMS policy specialists.  Rather than serving as an expediter and arbiter of fact, CMS failed in their responsibilities and caved to the RUC’s goal of self-preservation instead of  objectively evaluating the physician work value for colonoscopy.

CMS failed in its responsibilities, but the real victim is national public health efforts on colorectal cancer prevention. Cuts to Medicare colonoscopy undermine one of the major public health success stories of recent memory – colorectal cancer prevention.  Moreover, these cuts also undermine a major priority of several policymakers to reduce deaths from one of the most common cancers.  At a time when the federal government and numerous non-profit health organizations are rallying behind the 80% by 2018 goal, CMS has pulled the rug out from under one of the key constituencies for this national prevention strategy: Medicare patients.

Where Can ACG Members Go from Here? The SCREEN Act

ACG is committed to GI physicians being paid appropriately by Medicare for colonoscopy.  In advocating for colonoscopy reimbursement on behalf of our members, the College had no faith in the RUC and little faith in CMS.  This is precisely why the College has long championed the SCREEN Act as a cornerstone of our strategy.

ACG saw the need for a legislative option in the face of the potential failure of the regulatory process and have long embraces the SCREEN Act as ACG’s number one legislative priority.  This bill not only improves patient access to colorectal cancer screening services, but also stands as the only bill currently before the U.S. Congress that implements fair Medicare reimbursement for providers participating in a colon cancer screening quality improvement initiative.

While the College continues to rally and educate the public on this ill-conceived policy in both the short-term and long-term, ACG will focus on rallying around the SCREEN Act as we head towards 2016 and into an election year.   We need your help to do this.

Reverse Medicare Colonoscopy Cuts – Take Action

  1. Sign ACG’s petition and urge your colleagues and patients to sign it as well. ACG’s Medicare Colonoscopy Petition
  2. Call all your Members of Congress and urge them to pass the SCREEN Act (S.1079/H.R.2035) this year. Connect to your Member of Congress via the U.S. Capitol Switchboard by calling 202-224-3121.

Thanks for your support, Whit

Whitfield L. Knapple, MD, FACG

Chair, ACG National Affairs Committee

Learn more about the SCREEN Act