Important Policy Updates for ACG Members

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

USPSTF Recommends Screening at Age 45:
On Tuesday, the United States Preventive Services Task Force (USPSTF) published a draft plan recommending colorectal cancer screening at age 45. ACG is in the process of updating and finalizing the College's colorectal cancer screening guidelines from 2008. The College is reviewing the USPSTF’s recommendations, as well as the underlying data. The USPSTF recommendations are very important and used to help determine patient coverage requirements for some states, insurance plans regulated by the Affordable Care Act, as well as federal health programs. Generally, enhanced screening is a good thing. The College continues to review all data and recommendations to help ensure our guidelines continue to be driven by the science and improve patient care.

HHS Delays Data Blocking Rules: On Thursday, the Office of the National Coordinator for Health IT (ONC) announced it is extending compliance deadlines for certain information blocking and health IT certification requirements. Originally, physicians and hospitals had to be compliant with information blocking requirements by November 2, 2020. ONC’s interim final rule now pushes the information blocking compliance date to April 5, 2021. ACG's advocacy is paying off. This is good news as ACG has been advocating for a delay in these rules significantly impacting patient care and physician notes.

New Price Transparency Rules for Insurers: On Thursday, the Centers for Medicare & Medicaid Services (CMS) along with the Departments of Labor and the Department of the Treasury issued a final rule on price transparency for insurers. CMS has already finalized requirements for hospitals to disclose their standard charges, including negotiated rates with third-party payers.

For enrollees and beneficiaries: Insurers are required to disclose an initial list of 500 services by January 1, 2023. Of note to GI, in addition to E/M services, consultations, telehealth services, insurers must also provide pricing information for colonoscopy and EGD. The remainder of all items and services will be required for these self-service tools for plan years that begin on January 1, 2024.

For the public: Insurers must disclose the negotiated rates for all covered items and services between the plan or issuer and in-network providers. Insurers must also disclose both the historical payments to, and billed charges from, out-of-network providers. In addition, insurers must detail the in-network negotiated rates and historical net prices for all covered prescription drugs at the pharmacy level. These files are required to be made public for plan years that begin on January 1, 2022.

Medicare Reimbursement Cuts: ACG Advocating for Clinical GI

GI procedures and various Medicare physician payments are scheduled to be cut across most specialties in 2021 in part due to increases to evaluation and management (E/M) services. More than just E/M changes are impacting cuts to procedural services: According to the American Medical Association, the increases to E/M services make up roughly one-half of these projected cuts to other services due to budget-neutrality rules. ACG supports changes to E/M services but continues to stress the importance of preventing these cuts to other GI services and endoscopy. CMS and Congress must consider waiving budget-neutrality rules in order to maintain access to important GI procedures and services. Medicare reimbursement for GI procedures are scheduled to be cut by an estimated 10%.

ACG on Capitol Hill again this week educating lawmakers and staff. A new October 2020 update on health care services demonstrates that while some specialties are close to returning to pre-pandemic levels, gastroenterology is still down by an estimated -5%. This is concerning, as studies continue to mount on COVID-19’s impact to patient care, colorectal cancer screening, and missed diagnoses. 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, however, a follow-up study concluded that the expected levels of screenings are still down by one-third. Earlier this year, GI practices were forced to shut down, furlough staff, and delay necessary care. At a time when GI practices are trying to treat patients and bracing for a potential second wave of shutdowns, proposed cuts to these very services only exasperates the problem.

New ACG Practice Management Committee Toolbox

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

The ACG Practice Management 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.