6 Ways Healthcare Reform and ARRA Will Impact Gastroenterology

The realm of healthcare has changed dramatically in recent years with the signing of the new healthcare reform law and American Recovery and Reinvestment Act of 2009, and more drastic changes are forecasted to change the nature of healthcare. Brian Jacobson, MD, MPH, FASGE, who is a GI physician at Boston (Mass.) Medical Center, associate professor of medicine at Boston (Mass.) University's School of Medicine, and chair of the American Society for Gastrointestinal Endoscopy’s Health and Public Policy Committee, shares six ways recent and forthcoming changes to healthcare will impact gastroenterology.

1. Increased number of patients and screening colonoscopies. GI specialists can expect to see a tremendous increase in the number of patients visiting their offices as a result of the new healthcare reform, which will expand healthcare coverage to millions to Americans, and the passage of a provision under the Affordable Care Act that became effective in September which expands coverage of screening colonoscopies for colorectal cancer.

"Healthcare reform is going to be providing health coverage for more individuals, so I think all practicing physicians will have potential for larger number of patients and the  reform law also eliminates most cost sharing for preventive services, such as screening colonoscopy. As a result, we'll see greater compliance with screening guidelines," Dr. Jacobson says.

2. Increased use of health information technology. Under the ARRA, healthcare providers are able to qualify for incentive payments upon adopting and demonstrating meaningful use of healthcare information technology, particularly electronic health records. Dr. Jacobson says although the concept of the EHR has been around for some time, the market for EHR products is just now booming as a result of ARRA, which leads to more opportunities for GI specialists to implement health IT in their ASCs.

"There's an obvious push for improved health information technology through the use of EHRs, but there's going to be a lot of growing pains that we're all going to experience with this new push for expanded health IT," he says. "Once these systems are more universal and the glitches are worked out, healthcare providers will find care coordination to be easier because it takes the guesswork out of caring for patients. Health IT eventually will help us take better care of patients by avoiding duplicative testing, or surveillance procedures at inappropriate intervals."

3. Reduced salaries for GI specialists. Dr. Jacobson says the healthcare industry as whole, including GI specialists, will see salary reductions, which aren't tied directly to the reform law but speak to the spirit of healthcare reform as federal regulators and governing bodies attempt to rein in and reduce healthcare costs.

"We've already seen a loss of consultation codes for the GI specialty and payments associated with that, and we're starting to see other private insurers in different locations following suit and dropping consultation codes, too," he says. "We used to get additional reimbursement for the time spent with consultation, which involved going through patients' prior records, preparing final reports back to referring physician and so forth. What I think we all have to acknowledge is that this is the government's desperate attempt to change a healthcare system we're used to, which is unsustainable."

4. Entities with new centralized powers. Secretary of Health & Human Services Kathleen Sebelius has the power to revalue any medical service, including endoscopy services provided by GI physicians; the new Independent Payment Advisory Board will have the ability to do so in 2015. Dr. Jacobson says the two entities have the power to decide that a particular procedure might be overvalued and revalue that procedure. As a result, reimbursement can be devalued simply because either entity thinks it's overvalued, he says.

"IPAB is tasked with looking for ways to save money in the Medicare system, and essentially their recommendations will become policy," he says. "The best we can hope for is that they maintain the current value for GI procedures and provide positive yearly updates for reimbursement to account for increased operating costs. They could very easily decide that if physicians are providing more of a service over time, it suggests there may be either waste or abuse. In the future, there may be more colonoscopies because of an aging population and more people accepting colonoscopies as colorectal cancer prevention. This could trigger a closer look at the value of a colonoscopy, and the IPAB may decide that they're reimbursing too much for the procedure."

5. Increased emphasis on value-based purchasing. Healthcare reform will also push for value-based purchasing, which will require GI physicians to report measures of quality as well costs incurred. With this, physicians will be receiving report cards essentially showing their resource utilization for patient care and how compliant they are with quality measures. These reports to the federal government will then made available to insurance companies who decide if a physician seems to be spending too much for patients without necessarily improving quality.

"Ultimately, patients and private insurers will be able to look up this quality information on individual physicians," Dr. Jacobson says. "The concern is how do you accurately and reliable attribute care to any one physician since patients see multiple physicians for multiple reasons. Furthermore, the quality measures they're using may or may not be valid. It is still very much a big unknown, and we should be monitoring this very closely to protect against unintended consequences for the physicians, such as risk of being misrepresented."

6. New novel payment systems. New payment models, such as bundled payments and accountable care organizations, will impact the practice of GI physicians in the ASC setting, but it is yet to be seen whether this impact will be a positive or negative one. Dr. Jacobson says these payment structures — where physicians will most likely work with a hospital and receive capitated payments to provide care for a large census of patients — can have outcomes on polar ends of a spectrum.

"We don't know yet with these new payment models if there will be cost-savings or if they will ensure the best care for our patients," he says. "For instance, we don't know if this will mean more office visits for GI specialists as primary care physicians rely on us more for quality care or if it's going to mean less work for GI specialists because the primary care physicians don't want to incur more expenses in caring for their patients."

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