ACG Active on ASC Reimbursement: Policymakers Need to Know that ASCs are Cost-Effective

From Chair and Vice Chair of the ACG Board of Governors, Neil H. Stollman, MD, FACG and Patrick E. Young, MD, FACG

ACG Board of Governors Chair Neil Stollman, MD, FACG

ACG Board of Governors Vice Chair Patrick Young, MD, FACG

Recently, CMS released the proposed CY 2020 Medicare facility fees for ambulatory surgical centers (ASCs) and hospital outpatient departments. While ASC are projected to get a small increase, annual updates continue to be higher for outpatient hospitals departments. This is in part because ASCs have traditionally been unwilling to submit cost-data to CMS, as hospitals provide.

However, ACG and like-minded organizations continue to remind Congress, CMS, and state legislators that ASCs are safe and cost-effective. Yet, state legislators continue to look at taxing ASC revenue just to help with state-budget shortfalls. This is counter to policymakers' goals of increasing cost-effective access to care. Just look at the data from Medicare:

In April, ACG Governors met with Congress to discuss these issues and data. ACG Governors are also very active on this issue at the state and local level. We must continue to demonstrate to policymakers the value that ASCs provide to our patients.

Remember to contact your ACG Governor on important state and local issues impacting you and your practice.

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 77 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.

Thank You ACG Members: Nearing a Milestone for H.R. 1570 and We Need Your Help!

From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple, MD, FACG

ACG urges you to contact your members of Congress and request that they cosponsor the Removing Barriers to Colorectal Screening Act of 2019, (H.R. 1570 and S. 668). We are close to an important milestone for this bill—290 House cosponsors is crucial. Thank you for lending your voice to support this bill.

Legislative Status: Over 285 House members support H.R. 1570, and over 50 Senators have cosponsored S. 668 as well! ACG, national and state GI societies, as well as patient advocacy groups have all been advocating for this important bill that will protect Medicare beneficiaries from surprise medical bills, help to increase CRC screening rates, and reduce Medicare costs due to lower CRC incidence.

Why Your Help Matters Now:
An important threshold in the House of Representatives is 290 cosponsors. H.R. 1570 currently has over 285 cosponsors at the time of this writing. According to the U.S. House of Representatives Rules Committee, Speaker Pelosi and the U.S. House must consider one bill (at a minimum) from the “Consensus Calendar” each session week. For a bill to be eligible for the Consensus Calendar, a measure must accumulate 290 cosponsors for at least 25 legislative days. While a vote is not guaranteed just for meeting the criteria, not many bills will meet this threshold, thus improving the likelihood of consideration.

A Recent Review of Medicare Fee-for-Service Claims Emphasizes the Need for Congress to Pass H.R. 1570 and S. 668.
ACG and the Moran Company recently reviewed Medicare claims data from 2011 to 2017 and found that the incidence of polypectomy during screening colonoscopy is increasing dramatically. This is good news. For each percent increase in pre-cancerous polyp detection, there is a 3 percent reduction in CRC incidence and a 4 percent reduction in CRC death.

Thanks to the improved quality of CRC screening procedures, gastroenterologists have improved adenoma detection rates. At the same time, CRC incidence rates in the Medicare-age population have been declining as well.

Quality is Improving!

... But Medicare Beneficiary Liability is Increasing with the “Post-Polypectomy Surprise”
Due to a quirk in federal law, Medicare will cover the full cost of a "screening" colonoscopy. However, when a polyp is detected and removed, this "therapeutic" procedure is no longer considered a "screening" for coding and reimbursement purposes. Thus:

  • Medicare beneficiaries incur surprise out-of-pocket medical costs.
  • This is counter to the U.S. public healthcare goal of removing barriers to increasing CRC screening rates.

In April 2019, 100 ACG Governors and member of the ACG Leadership advocated for the Removing Barriers bill and other important issues impacting your GI practice and patients.

CMS Releases 2020 Medicare Reimbursement Rules: What is the Impact to GI Practices?

On Monday, July 29, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2020 proposed rules for the Physician Fee Schedule (PFS), Outpatient Prospective Payment System (OPPS) and Quality Payment Program, which include several significant policy and payment changes impacting gastroenterologists.

ACG, AGA, and ASGE provided a topline summary of the most important proposed changes to the payment rates and policies for services paid under Medicare. Click here to read this summary.

Click here for the CY 2020 Medicare fee for services RVU chart for selected GI services

Click here for the CY 2020 proposed Medicare E/M RVUs chart

Click here for the proposed CY 2020 HOPD Medicare facility fees for selected GI services

Click here for the proposed CY 2020 HOPD Medicare facility fees for the top 10 GI base and biopsy codes

Click here for the proposed CY 2020 ASC Medicare facility fees for selected GI services

Click here for the proposed CY 2020 ASC Medicare facility fees for the top 10 GI base and biopsy codes

ACG, AGA and ASGE are currently reviewing the details of the proposed rules and will be providing joint comments. CMS will accept comments until September 27, 2019. We expect the final rule to be issued around November 2019. We will keep you updated as we learn more.

What is the Practice Management toolbox?

Gastroenterologists in private practice find themselves working in a time of unprecedented transformation. Pressures are high as they make important management decisions that profoundly affect their business future, their private lives, and their ability to provide care to patients. The ACG Practice Management Committee has a mission to bring practicing colleagues together to explore solutions to overcome management challenges, to improve operations, enhance productivity, and support physician leadership. It was in this spirit that the Practice Management Toolbox was created.

The Toolbox is a series of short articles, written by practicing gastroenterologists, that provide members with easily accessible information to improve their practices. Each article covers an issue important to private practice gastroenterologists and physician-lead clinical practices. They include a brief introduction, a topic overview, specific suggestions, helpful examples and a list of resources or references. Each month a new edition of the Toolbox will be released and will then remain available here along with all previous editions. The Practice Management Committee is confident this series will a provide valuable resource for members striving to optimize their practices.