7 Medicare 2015 Proposed Payment Changes Affecting GI
1. The proposed changes do not include payment updates for lower endoscopy, including colonoscopy, despite rigorous advocacy efforts by the AGA and its sister societies: the American College of Gastroenterology and American Society for Gastrointestinal Endoscopy. The three societies released a joint statement urging CMS to allow for a more transparent rulemaking process and improved colonoscopy reimbursement.
2. The exclusion of payment values for colonoscopy from the proposed rule leaves the GI societies little time to comment on new values before they go into effect on Jan. 1, 2015. The AGA, ACG and ASGE are working to improve accuracy in GI endoscopic procedure valuation through CMS and the AMA Relative Value Update Committee.
3. The proposed rule also includes an increase in Physician Quality Reporting System requirements. In 2014, physicians were only required to report three PQRS quality measures to avoid a 2 percent payment reduction in 2016. But, the proposed rule would require eligible professionals to report nine quality measures across three domains for at least 50 percent of Medicare Part B fee-for-service patients.
4. The proposed rule also includes an expansion of the physician Value-Based Payment Modifier program. The VBPM will continue to be linked to eligible physicians' participation in PQRS. Failure to satisfactorily participate in PQRS could lead to a payment reduction of 6 percent.
5. The proposed rule would raise payments to ASCs by 1.2 percent. The ACG, AGA and ASGE have argued the Consumer Price Index for All Urban Consumers is not an appropriate tool for making ASC payment updates. Instead, the societies advocate for ASC payments to be updated using the hospital market base index, the same inflation factor used to update HOPD payments. The proposed rule would update HOPD payments by 2.1 percent in 2015.
6. The rule would also add a new colonoscopy measure to the ASC Quality Reporting Program. The new measure, Facility Seven-Day Risk Standardized Hospital Visit Rate After Outpatient Colonoscopy, will be used for the CY2017 payment determination, based on claims from July 1, 2014 to June 30, 2015.
7. The proposed rule would redefine colorectal cancer screening colonoscopy to include anesthesia. As a result, Medicare Part B deductible and coinsurance will be waived for anesthesia services charged separately. The GI societies appreciate this move towards eliminating barriers to colorectal cancer screening, but they express disappointment that CMS has not made the same move to eliminate coinsurance for colonoscopy including polyp removal.
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