Reimbursement, Thriving in the Age of Accountable Care & More: Q&A With AGA Institute President Dr. John Allen
Dr. Allen is also a professor of medicine and clinical chief of the section of digestive diseases at Yale University School of Medicine in New Haven, Conn. Dr. Allen answers questions about his goals as the new AGA Institute president and the best opportunities for practicing GI physician success.
Question: What do you hope to achieve during your term as AGA Institute president?
Dr. John Allen: The AGA has a tripartite mission of clinical practice, education and research. These three pillars will guide my work as president over the coming year. The AGA will continue to expand its portfolio under the "Roadmap to the Future of GI" to equip members with resources to deliver high-quality care, demonstrate quality and maximize revenue.
AGA education will transform into new, exciting modalities that speak to both beginning and advanced-career gastroenterologists. We will work to keep DDW as the premier educational venue for clinicians and research scientists that work in gastroenterology and hepatology.
I plan to reinforce AGA's commitment to raising funds to support young investigators in research through the AGA Research Foundation. AGA will also continue to advocate for increased federal funding of research. All of this work will be supported by robust advocacy and networking with national organizations that create healthcare law, regulations and policies.
Q: What are a few of AGA's top priorities this year?
JA: One of AGA's primary goals, in terms of practicing gastroenterologists, is to help them thrive in a world of accountable care. The goal for success is to focus on improving quality and value in patient care. AGA has developed a number of practical tools and products to help gastroenterologists with patient care and the practice of medicine.
The AGA clinical service lines support practices in delivering high-quality, cost-efficient care for the management and treatment of patients with inflammatory bowel disease, hepatitis C and colorectal cancer.
Practices face shifting reimbursement structures, so the AGA is educating gastroenterologists about alternative payment models. We are preparing GIs for success in possible new reimbursement environments, including the development of a bundled payment framework for colonoscopy performed for colorectal cancer screening or surveillance. We intend to continue to expand on these and other offerings as the year progresses.
Medicare reimbursement for GI procedures is also a major issue. In the 2014 Medicare Physician Payment Final Rule, gastroenterology was blindsided by significant cuts to the reimbursement rates for upper GI endoscopy services. AGA is working with the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy to dispute the validity of the cuts, which CMS announced last year, just weeks before they went into effect without the opportunity for public comment.
The GI societies have enlisted the help of Congress to avoid future eleventh-hour changes to our reimbursement. It is critical that we improve the transparency of this process, which impacts millions of Medicare beneficiaries and practices across the country. Colonoscopy codes are currently under review for the 2015 Medicare physician fee schedule, so the stakes are high. The GI societies have collaborated on a campaign, The Value of Colonoscopy, to highlight the value of colonoscopy in detecting and preventing colorectal cancer and the gastroenterologists who perform this life-saving procedure. The goal of the initiative is to ensure access to life-saving colorectal cancer screening procedures while working together to improve the quality and affordability of healthcare for all Americans.
Q: Why do you think participation in societies, such as the AGA, is important for gastroenterologists?
JA: Between healthcare reform and advances in science and practice, there is an overwhelming amount of information for busy clinicians to keep up with. Membership in AGA gives clinicians information and, more importantly, guidance to help with patient care and the business of running a practice. We also provide you a voice on our lawmakers and regulators — an incredibly important audience in this critical time in the profession of gastroenterology.
On a personal level, membership in AGA has allowed me to network with colleagues from around the world in ways that I never thought possible. I've developed relationships, both personally and professionally, that have enabled me to further my career and continually better myself as a practicing gastroenterologist, an educator, a researcher and a person.
Q: What do you think are a few of the most exciting opportunities for gastroenterologist success in 2014?
JA: AGA sees five concepts that are both our greatest challenges and opportunities — performance measures, population management, aggregation, cost and accountability. Virtually all healthcare professionals must now report publically on their use of clinical outcomes measures, which will soon be linked to reimbursement. Soon, we will all feel increased pressure to reduce costs and increase clinical coordination with our colleagues, especially in primary care.
Since 2002, AGA has been creating guidelines and measures to support quality guidelines. We also have developed an infrastructure to help practices demonstrate quality and value. Through the AGA Digestive Health Recognition Program™ (DHRP™), we provide a platform for clinicians to demonstrate and be recognized for superior quality of care in the treatment of inflammatory bowel diseases, hepatitis C and colorectal cancer screening and surveillance. DHRP is a CMS Qualified Clinical Data Registry, which is a new reporting mechanism available for the Physician Quality Reporting System. As a QCDR, the DHRP will help clinicians complete the collection and submission of PQRS quality measures data.
These programs, coupled with AGA's clinical decision support tools, clinical care guidelines and an increasing focus on fellowship and practitioner education, will help gastroenterologists continue to thrive and succeed in an accountable care world.
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