A few of the ways that ACA affects AGA members include:

• The law requires coverage of preventative care without cost sharing. Beginning in 2011, Medicare will have no cost sharing for colorectal cancer screenings even if a polyp or lesion is found. For commercial insurers, cost-sharing is eliminated for preventive screenings such as colorectal cancer, unless a polyp or lesion is found.  This provision begins for plan years beginning on or after Sept. 23, 2010. So, if your health plan is renewed in January 2011, these benefits would not be implemented until then. AGA is working with other GI societies and patient organizations to ensure that the co-pay for colorectal cancer screening is waived after a polyp is found for patients with commercial insurance.
• Coverage of preventative care is limited to services that have an “A” or “B” rating from the U.S. Preventative Task Force. “A” recommendations for colon cancer screening include fecal occult blood testing (FOBT), sigmoidoscopy and colonoscopy. AGA is working to make sure that plans will not “steer” patients to FOBT because it is less costly and ensure that patients have an array of screening options.  The CDC published a study this year that showed 75 percent of FOBT is not done appropriately — providing false reassurance to patients and providers.
• The independent payment advisory board (IPAB) has been created to reduce the per capita rate of growth in Medicare spending. The majority of appointments are required to be non-providers and physician members cannot be gainfully employed outside of IPAB. The IPAB approach will further ratchet down provider reimbursement without adequate oversight or accountability. AGA is continuing to work with the Alliance of Specialty Medicine to oppose this inappropriate delegation of Congress’s oversight responsibilities to an arbitrary, unelected board.
• Shared responsibility for business with more than 50 employees. If health insurance is not offered, there will be a fee of $2,000 per full time employee (FTE) for every employee who uses a premium credit through the exchange. For those that offer insurance, they would pay the lesser fee of either $3,000 for each employee who receives a premium credit through the exchange or $2,000 for each employee for businesses with 30 or more employees.
• We are required to complete a 1099 for services or merchandise in excess of $600. This sounds complicated and messy as we would be required to get the social security number at the time of bill payment for all kinds of services, including the plumber. The provision becomes effective Jan. 1, 2012 — providing ample time for repeal.
• W2 reporting must include aggregated cost of employer-sponsored health benefits starting Jan. 1, 2011. The focus is on clear reporting of premiums. It seems that the goal is to make employer contributions to health-care coverage more transparent and employees more aware of health-care costs. Hopefully, this won’t open doors for future taxation.
• Unearned income will have a Medicare contribution. A tax of 3.8 percent goes into effect in 2013 for joint filers with an income greater than $250,000 and single filers greater than $200,000. This provision could motivate some to sell their home before 2013 if a house sale is being considered since the sale of the house would include this new tax.
• The Physician Quality Reporting Initiative (PQRI) is extended through 2014 and the incentive payment is increased by 0.5 percent for 2011 to 2014. The program has been improved with the addition of an appeals process and more timely feedback. In addition, maintenance of certification program participation was added as a participation option, including an additional 0.5 percent incentive payment. Beginning in 2015, physicians who are not successful participants in PQRI will receive penalties. The penalty for 2015 is 1.5 percent and for 2016 is 2 percent. PQRI has considerable administrative issues and kinks that have prohibited physicians from successfully participating.

These are just a sampling of the issues related to health-care reform implementation. There are many other glaringly important policy issues that also need continued, focused attention given the way they effect the GI community, including the Medicare physician payment formula, meaningful use regulations regarding health information technology, pay for performance,  administration of sedation, and colonoscopy screening for African Americans at age 45.

My eyes are wide open about the potential future of gastroenterology and I am motivated to participate in the process. My response to this weekend was multifold. The first thing that I did when I returned home was send in a financial donation to the AGA PAC (well, actually I sent this electronically using the AGA Web site). I truly hope more AGA members will do the same, because unfortunately, the way to get things done in Washington requires deep pockets. As the health-care reform bill continues to be implemented, we need to have the AGA PAC playing a key role in helping to ensure AGA’s message is heard.

I also am going to start following the AGA Washington Insider blog. I’ve even signed up for e-mail notification of new postings so that I won’t miss a beat. On my flight home I felt motivated enough to write this summary. I am thankful that the AGA has provided me with several ways to easily engage in the process.

I will look to the AGA to continue to educate and support all of us on the ramifications of health-care reform implementation. There will be a session at DDW regarding these issues — I definitely won’t miss that one.

If you are interested in learning about how to get more involved, visit the AGA Web site or contact Lauren DePutter at the AGA at ldeputter@gastro.org.