The payment landscape for physicians is dramatically changing. Here are eight updates on compensation and reimbursement in the gastroenterology field.
1. In 2014, gastroenterologists earned an average salary of $370,000, up seven percent from the previous year, according to the Medscape Gastroenterologist Compensation Report 2015. Self-employed male gastroenterologists earned an average salary of $419,000 in 2014, while self-employed female gastroenterologists earned an average of $434,000. Employed male gastroenterologists earned $321,000, while female gastroenterologists in the employed setting earned $292,000.
2. Gastroenterologists are testing out various payment models, according to the Medscape survey, including:
• Accountable care organizations: 31 percent
• Planning to join an ACO within a year: 8 percent
• Concierge practice: 3 percent
• Cash-only practice: 1 percent
3. Though gastroenterologist salary remains steady, 2016 holds the potential for severe reimbursement cuts to one of the most common GI procedures. CMS announced proposed colonoscopy reimbursement cuts with the release of the 2016 Medicare Physician Fee Schedule proposed rule. The reimbursement cuts for the colonoscopy family procedures could be up to 19 percent.
Proposed changes for 11 lower GI/endoscopy procedures, by RVU percent change, include:
• Colonoscopy with biopsy (45380): -19 percent
• Colonoscopy with snare polypectomy (45385): -12 percent
• Colonoscopy (45378): -11 percent
• Colorectal cancer screen, high risk (G0105): -2 percent
• Colorectal cancer screen, low risk (G0121): -2 percen
• Colonoscopy with hot biopsy (45384): -11 percent
• Colonoscopy with submucosal injection (45381): -14 percent
• Colonoscopy, flexible with ablation (45388): -15 percent
• Flexible sigmoidoscopy with biopsy (45331): -7 percent
• Flexible sigmoidoscopy (45330): -20 percent
• Colonoscopy with control of bleeding (45382): -16 percent
4. The proposed colonoscopy cuts would have a significant impact on GI reimbursement. If CMS' proposal were to go into effect, 55 percent of gastroenterologists would limit procedures for Medicare patients, 43 percent of gastroenterologists would refer patients to the hospital for colonoscopy and 15 percent would consider opting out of Medicare entirely, according to a American Gastroenterological Association survey.
5. In response to the proposed reimbursement cuts, the AGA, American College of Gastroenterology and American Society for Gastrointestinal Endoscopy are combining their efforts to work against these payment reductions. The AGA took the results of it survey to CMS. The ACG also offers a playbook, which outlines recommendations for GI physicians interested in advocating a change in the proposed payment rule.
6. In addition to updates to physician reimbursement, CMS also released its proposed policy and payment changes rule for the CY 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. SC payments are updated on an annual basis based on the Consumer Price Index for all urban consumers. For CY 2016, CMS proposes a 1.7 percent CPI-U update. With a multi-factor productivity adjustment of 0.6 percent, the update is expected to be 1.1 percent.
7. On the private payer side, UnitedHealthcare recently announced changes to how GI procedures would be reimbursed. Starting Nov. 15, UnitedHealthcare will use CMS special multiple endoscopic resection rules on specific commercial claims. The payer will allow the full allowable amount for the highest valued endoscopy code in the family when multiple procedures from the same family are reported on the same day, according to the report.
UnitedHealthcare's multiple surgery reduction rule will continue to apply to endoscopy codes in different families. In this case, the primary procedure will be reimbursed at 100 percent. A 50 percent reduction is applied to the second procedure, and a 25 percent reduction is applied to all subsequent procedures, according to the report
8. CVS Caremark and Express Scripts released lists of medications that will be excluded from insurance coverage next year, according to an AGA report.
• Excludes Viekira Pak, prefers Harvoni and doesn't mention Sovaldi: HCV treatments
• Amitiza: IBS agent
• Relistor: Opioid-induced constipation agent
• Prevacid and Protoni: Proton pump inhibitors
• Vimozo and Duexis: Anti-inflammatory/anti-ulcer agents
• Asacol HD, Delzicol and Dipentum: Inflammatory bowel agents
• Pancreaze, Pertzye and Ultresa: Pancreatic enzymes
• Harvoni, Olysio and Sovaldi: HCV treatments