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

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.

The Stark law generally prohibits physicians from making designated health service referrals for other services with which the physicians also have a financial relationship, unless an exception under the law applies.  Of these exceptions, the in-office ancillary services exception allows physicians in medical practices to make referrals within same the medical practice.

The Medicare Access and CHIP Reauthorization Act (MACRA) seeks to transform the delivery of health care by rewarding providers for delivering high quality and cost-efficient care.  The recently released proposed regulation, implementing MACRA (see below) includes metrics specifically measuring a provider’s individual quality of services as well as resource-use (or cost-impact to the Medicare program)— this includes quality and cost metrics for both gastroenterology and pathology.  ACG believes MACRA can be significantly improved.  However, H.R. 5088 is introduced on the inaccurate premise of saving the Medicare system money; not on the goals of both improving Medicare costs as well as the quality of care to Medicare beneficiaries as shared by Congress when passing MACRA.

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.


Whitfield L. Knapple, MD, FACG

Chair, ACG National Affairs Committee