AGA Washington Insider

A policy blog for GIs

AGA Storms the Hill

capitol-snowmanLast week, a snow storm hit Washington, DC, closing the federal government and cancelling a meeting that AGA and the other GI societies had scheduled with officials from CMS to discuss the Medicare Physician Fee Schedule Final Rule and the cuts to upper endoscopy services. However, once the streets were clear, we were up to Capitol Hill with our allies from the Alliance of Specialty Medicine to discuss the Medicare Patient Access and Quality Improvement Act, legislation that repeals the sustainable growth rate formula (SGR) and transitions physicians to a more value-based payment system. Our timing was perfect given that we have heard the committees are close to a final deal.

How do the bills compare?
All three committees with jurisdiction over Medicare physician payment have announced their version of this legislation and committee staff are trying to reconcile some of the differences among their bills. Luckily, all three versions are similar. The Congressional Budget Office (CBO) recently scored the costs of each one over the next ten years: Ways and Means at $121 billion; Energy and Commerce at $146 billion; and Senate Finance at $148.6 billion. The two big differences — the Energy and Commerce Committee bill provides physicians with a five year period of payment stability at .5 percent and the Ways and Means Committee bill provides a .5 percent update for three years to give physicians time to prepare for a value-based payment system.

How did the meetings go?
The AGA and the alliance were very busy, conducting 29 meetings in three days with members of the authorizing committees to express our concerns over the packages.

We did, first, thank members for soliciting the input of physician organizations and giving us the opportunity to help shape the legislation. AGA and the alliance have sent numerous letters to the committees in which we shared our concerns and offered suggestions as to what quality initiatives have worked and how they can be improved to make them more meaningful to physicians and their patients.

However, the AGA and the alliance remain concerned over the freeze in updates and the budget neutral quality initiatives that pit physicians against one another and discourage the sharing of best practices. The committee members we met with stated that they understood our concerns and were trying to reconcile them. Yet, the committees are the closest they have ever been to finalizing a permanent fix to the SGR. If Congress fails to pass a bill in the next few months, it will continue to become more difficult, given the challenges of trying to enact such a large bill in an election year.

AGA’s concerns
AGA is certainly appreciative of all of the efforts and hard work that the committees have expended on this process, but we remain concerned with the freeze in updates given the cuts that gastroenterologists are facing in upper endoscopy services and potential cuts to colonoscopy in the future. We continue to develop quality measures and tools to help gastroenterologists be prepared to survive and thrive in the new value-based world, but we also continue to advocate that physicians be reimbursed fairly for their services to Medicare beneficiaries.

Physician allies
The AGA, the alliance and all of organized medicine have some influential advocates on Capitol Hill — the physician members of Congress who are making their voices heard during these SGR negotiations. Reps. Tom Price, R-GA; Michael Burgess, R-TX; Bill Cassidy, R-LA; and Charles Boustany, R-LA, have been advocating on our behalf to improve the SGR package and make it more palatable for the physician community. In fact, the alliance recently held a teleconference during which Rep. Burgess stated that he is fighting for positive updates for physicians that will represent an inflationary update, which physicians have not been given over the past decade. He stressed the importance of allowing some physicians to be given a viable option to remain in fee-for-service, if that best suits their specialty and patient mix.

AGA will continue to storm Capitol Hill on your behalf while keeping you updated on the ongoing negotiations to replace the broken Medicare physician reimbursement formula once and for all.

1 Comment

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