ACG and 100+ Medical Societies Urge Congress for Medicare Reimbursement Reform

From the Chair of ACG Legislative and Public Policy Council, Louis J. Wilson, MD, FACG

ACG joined a coalition of medical associations in April as well as this week in letters to Congress, urging policymakers to pass H.R. 2474. The bill provides an annual update to the Medicare physician fee schedule, tied to inflation and as measured by the Medicare Economic Index (MEI). There is currently no inflationary update in the Medicare physician fee schedule. Congress needs to address this problem as soon as possible. Independent and physician-led GI practices nationwide continue to experience a perfect storm of lower reimbursement rates, higher costs, and higher administration burdens. Click here to read my recent blogpost on the background of the Medicare reimbursement statute and why reform is necessary. ACG leaders advocated for this bill during the 2023 ACG Advocacy Day.

ACG President Dan Pambianco MD, FACG, and I also had the good fortune of being invited to the House Doctors Caucus Meeting on April 19th, where we thanked our physician colleagues in Congress for introducing this important bill. I also continue to meet with the committees of jurisdiction, educating leaders and staff on the importance of passing reimbursement reform. Congress must act now!

Other Important Updates for GI Practices and Patients

ACG Urges Congress to pass legislation on USPSTF Ruling: ACG also called upon Congress this week to take action in light of a recent Texas court holding that the United States Preventive Services Task Force (USPSTF) is a "policy-making body," thus subject to the Appointments Clause of the U.S. Constitution. In Braidwood v. Becerra, the court reviewed whether insurers under the Affordable Care Act (ACA) must cover pre-exposure prophylaxis (PrEP) drugs for individuals at high-risk of HIV, as recommended by the USPSTF. The court said that since the USPSTF essentially "makes policy" under the ACA, the Task Force violates the Appointments Clause of the U.S. Constitution, requiring nomination by the President and confirmation by the U.S. Senate. This case has significant implications for GI because the ACA and state colorectal cancer screening coverage laws follow USPSTF guidance. While the Administration is appealing this decision, ACG is calling upon Congress to pass legislation to avoid major disruptions in preventive services across the country.

COVID-19 PHR Ends May 11: The Centers for Medicare and Medicaid Services (CMS) recently issued an updated Frequently Asked Questions (FAQs) on preparing for the end of the COVID-19 public health emergency (PHE). The COVID-19 PHE will end May 11, 2023. The FAQs covers cost and reimbursement for vaccines, testing, and treatment, as well as telehealth. CMS also maintains and updates the COVID resource page, which includes fact sheets on various issues related to the end of the PHE.

Gift Cards for CRC Screening? The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued Advisory Opinion (AO) 23-03, analyzing a proposed arrangement in which a company would provide gift cards to certain patients as an incentive to complete the sample collection process.

The HHS OIG reviews fact patterns and scenarios submitted by organizations (the "Requestors") and will publish guidance on whether the fact-pattern runs afoul of Medicare laws, Stark, Anti-Kickback statutes, etc. The requestor in this case is a company that produces the screening kit and has a wholly owned laboratory, with the test billable to Medicare at around $500 per test, covered once every three years for eligible beneficiaries.

The requestor noted that it maintains contact with patients throughout the process of shipping and collecting the sample, including phone calls, text messages, emails, and other contact methods, to remind the patient to complete and return the sample. Despite these efforts, approximately 30% of patients do not return their samples to the laboratory. The OIG evaluated a proposal where the patient would be eligible for a prepaid gift card (e.g., Visa or Mastercard) with a value of up to $75 if, after 2 weeks and 2 more attempts for outreach, they return the stool sample by a specified deadline. The HHS OIG reached a favorable conclusion here, finding that the proposed arrangement could satisfy certain exceptions in federal law and is unlikely to trigger the Federal Anti-Kickback Statute.

Stay tuned for more important updates from ACG.