ACG Advocating Congress to Prevent Medicare Cuts

From ACG Legislative and Public Policy Council Chair, James C. Hobley, MD, MSc, FACG

Medicare physician payments are scheduled to be cut across most specialties in CY 2021 when increases to evaluation and management (E/M) services are implemented. GI procedures are scheduled to be cut roughly 10%.

Good news: There is a new bill in Congress that prevents these cuts for 2 years. The “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020” (HR 8702) was introduced by Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN). While this only a temporary solution, ACG joined a coalition of medical societies in endorsing this legislation. ACG is supporting this bill despite various primary and internal medicine societies’ opposition to the bill. The rationale for the opposition is that the bill specifically excludes certain E/M services in this 2 year safe-harbor. However, these services are already slated for an increase in reimbursement. ACG continues to urge Congress to step in and prevent these cuts, whether by waiving budget-neutrality rules altogether, or under this more targeted approach of preventing cuts for those GI services slated for reimbursement cuts.

ACG Urging Congress to Forgo Medicare Sequestration Cuts
This week, ACG joined a coalition of societies urging Congress to extend a moratorium on Medicare reimbursement cuts for as long as the COVID-19 public health emergency continues, warning that the pandemic is already straining providers’ finances. Congress, in its first coronavirus aid package, suspended a planned 2% Medicare pay cut through the end of the year. However, that reduction is set to take effect in January 2021 unless lawmakers opt to extend the moratorium.

Gastroenterology practices are slowly re-opening and treating more patients after many states and Medicare placed a moratorium on elective endoscopy procedures earlier this year. GI practices were forced to shut down, leading to delays in needed care, including serious delays in colon cancer detection. A recent study found that a drop in cancer diagnoses was attributed to COVID-19 and the delay in screening, including colorectal cancer screening. Another study found that screenings for breast, cervical, and colon cancer dropped by an estimated 90% after the declaration of the COVID-19 national emergency. While the number of cancer screenings has recently begun to rise, a follow-up study demonstrates that the expected levels of screenings are still down by a third.

ACA Back in the Supreme Court
On Tuesday, the U.S. Supreme Court heard oral arguments for the latest case to strike down the Patient Protection and Affordable Care Act (now known as the Affordable Care Act or “ACA”). The Court upheld the law in part both in 2012 and 2015.

How did we get here?
The lawsuit was brought by 18 Republican-led states, alleging that Congress' decision to zero-out (but not repeal) the “individual mandate” penalty in 2017 rendered the entire ACA unconstitutional. This argument stems from the U.S. Supreme Court’s decision in 2012 to uphold the ACA as a valid exercise of Congress’ taxing power, but also that this individual mandate intrinsically links the other parts of the ACA.

Gets more complicated
When Congress passed the Tax Cuts and Jobs Act of 2017, there was a provision in the bill that zeroed out the individual mandate penalty, beginning in 2019. At issue is whether the 2017 law actually repealed this provision, or just changed the penalty amount. The Justice Department (DOJ) in June 2018 chose not to defend the ACA in this case. This Justice Department letter also noted that it agrees with the Justice Department under President Obama, concluding the individual mandate is inseverable with important provisions in the ACA.

When will the Supreme Court announce its decision?
A decision is expected as soon as March 2021, although the ruling could come at the end of the term in June or July. During the oral arguments this week, various justices did note that there is a strong presumption in favor of severability, perhaps showing that the Court is leaning towards upholding the ACA for the third time.

ACG will continue to fight for important patient protections
The court’s ruling may have a significant impact on important ACG policy priorities, such as coverage protections for pre-existing conditions and eliminating cost-sharing for preventive care.

ACG Urging CMS and Insurers to Cover CPT Code 99072

From ACG Practice Management Committee Chair Stephen T. Amann, MD, FACG

This week, ACG joined the coalition of medical societies led by the American Medical Association (AMA) in urging CMS and commercial insurers to provide payment for CPT code 99072, used to report the additional supplies, materials, and clinical staff time over and above the practice expense(s) included in an office visit or other non-facility service(s) when performed during a public health emergency. To help address the significant fiscal pressures placed on ACG members by the COVID-19 pandemic, the letters were sent to CMS, America’s Health Insurance Plans (AHIP), Blue Cross Blue Shield Association (BCBSA), and major commercial health plans (i.e., Anthem, Aetna, Cigna, Health Care Service Corporation, Humana and UnitedHealthcare) urging these organizations to immediately implement and pay for CPT code 99072.

New ACG Practice Management Toolbox Article

What is the Practice Management Toolbox?

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.