AGA Washington Insider

A policy blog for GIs

Push for More Transparency Gaining Traction

Last November when CMS published the Medicare Physician Fee Schedule (PFS) final rule, it contained deep cuts to many upper endoscopy procedures. Certain procedures, like EUS, were cut by as much as 36 percent. These cuts came as a surprise to the AGA and the other GI societies — none of these changes were included in the proposed Medicare Physician Fee Schedule rule that typically comes out in July and includes a 90-day comment period. The comment period provides time for our societies to analyze CMS proposals and rates and determine the impact on GI practices. This period also gives us the opportunity to potentially dispute what CMS has proposed and make our own recommendations.

However, in the 2014 proposed rule, CMS chose to not give the GI community the opportunity to comment on the upper endoscopy codes. Instead, it announced changes in reimbursement in the final rule, which made those rates interim final, meaning the new rates went into effect on Jan. 1, 2015.

Transparency Campaign
The AGA and the other GI societies opposed this method and took our fight to Capitol Hill to protest the process by which CMS chose to implement changes to physician reimbursement for upper endoscopy procedures. Given that the colonoscopy codes were next up for review, the stakes were high. We believe that physicians and their patients are entitled to a more fair and transparent process and should be given the opportunity to fairly and meaningfully participate in the regulatory process.

We found a sympathetic ear on Capitol Hill and with many of our physician specialty colleagues. The AGA, ACG and the ASGE worked closely with Rep. Bill Cassidy, R-LA, who organized a “dear colleague” letter in the House to CMS asking for more transparency when CMS is proposing changes in physician values; Sen. Kelly Ayotte, R-NH, organized a similar letter in the Senate. Together, 59 members of Congress weighed in with CMS on this issue and we believe it has made a difference. We also secured the support of 32 physician specialty organizations in urging CMS to provide more transparency in their process.

Medicare Physician Fee Scheduled Proposed Rule for 2015
In July, CMS released its Medicare Physician Fee Schedule Proposed Rule in which they outlined their proposal for a new timeline to allow for more transparency when making changes to physician values. Specifically, CMS states, “we are proposing to modify our process to make all changes in the work and MP RVUs [Medicare physician relative value units] and the direct PE [practice expense] inputs for new, revised and potentially misvalued services under the PFS by proposing the changes in the proposed rule, beginning with the PFS proposed rule for CY 2016.”

Although this proposal does not address our specific issue with the colonoscopy codes since CMS did not include any proposed changes in the proposed rule, we are encouraged that CMS is considering a more transparent process and clearly listened to concerns that were expressed by legislators and physician specialty societies. Although we would like for proposed changes in colonoscopy to benefit from this new process, we believe this proposal is a step in the right direction and will ultimately benefit providers and patients.

Since CMS did not include changes to colonoscopy in the proposed rule, Rep. Cassidy again organized a letter to CMS urging the agency to implement its new proposed transparency timeline immediately, instead of in it’s the CY 2016 fee schedule.

AGA, ACG and ASGE are currently working on our joint comment letter to CMS and are calling on the agency to apply this new process to colonoscopy. AGA and the GI societies need the opportunity to review and comment on any changes before new rates are implemented and they go through the rulemaking process.

One thing is clear, these proposed changes to CMS’s process never would have occurred had the agency not felt the message sent by Congress, the physician community and our members who reached out to their legislators on this important issue.

We will continue to beat the drum that physician practices and their patients need an opportunity to review and comment on changes that could impact their practices and the care they provide. And the beat goes on . . .


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