AGA Statement of Principles

Reforming the Health-Care System

The Obama Administration and Congressional leaders intend to advance proposals on comprehensive health-care reform this year. While the Obama Administration expects Congress to take the lead on offering specific proposals on comprehensive healthcare reform, the administration will be involved in the debate. The AGA is also actively involved in the debate, vigorously advocating for gastroenterology.

 

Health Care for the Uninsured

AGA believes we must ensure that all Americans have access to affordable health-care coverage.

  • AGA supports expanding health-care coverage to the 46 million uninsured Americans.
  • Health insurance must be affordable, ensure choice of provider and guarantee access to specialty care.
  • All Americans should have coverage for colorectal cancer screening.
  • Improving the quality and the value of health care must be part of comprehensive health-care reform.

Medicare Physician Reimbursement

AGA sees reforming the Medicare payment system as a fundamental part of health-care reform.

  • Medicare’s sustainable growth rate (SGR) formula must be replaced with a stable and equitable payment system that reflects the costs of caring for Medicare beneficiaries and ensures access to high quality care.
  • AGA supports retroactively removing Part B drugs from the SGR formula since physicians have no control over the costs of these drugs. Doing so would significantly lower the cost of a permanent payment fix.
  • AGA advocates for eliminating the debt accumulated from the SGR system (also known as rebasing), which will help transition to a more viable payment system.
  • Medicare should reimburse separately for care coordination services such as phone calls and electronic communications.
  • Reimbursement should be provided for physician counseling related to Medicare covered preventive services including a patient’s consultation with a gastroenterologist prior to colonoscopy. No other screening service carries the potential risks and professional liability as seen with colonoscopy. The current Medicare policy of not reimbursing physicians for precolonoscopy visits for assessment and education does not support coordinated care.
  • The current Medicare deductible waiver policy for colorectal cancer screening should be corrected to allow for the waiver regardless of whether a polyp or lesion is found when undergoing a colonoscopy. This policy is confusing to Medicare beneficiaries and only adds additional barriers to livesaving screenings.

Health Information Technology

AGA is working to ease GI practices’ adaptation to government mandated health information technologies (HIT).

  • AGA supports the development of an electronic health information network that is reliable, interoperable, secure and protects patient privacy.
  • Congress should provide financial incentives to cover HIT startup costs, training and maintenance. Incentives should be structured as bonuses, not penalties.
  • The federal government should facilitate the development, harmonization and adoption of interoperability standards among HIT systems and pilot test them before adoption.
  • The AGA has identified the clinical and functional criteria necessary for electronic medical record (EMR) systems for gastroenterology practices. AGA is publishing the EMR Field Guide for Gastroenterology based on those criteria to help GI practices navigate the selection and implementation of an EMR system.

Physician Quality Reporting

AGA actively supports quality improvement, but recommends CMS enhance the Physician Quality Reporting System (PQRS).

  • The PQRS must provide physicians with access to data in a timely manner and it must have a reasonable appeals process.
  • CMS should not make quality data publicly available until its validity has been verified.
  • If reporting is made mandatory, Congress should provide physicians with funding to offset the expensive systems needed to facilitate reporting.

Crisis in Primary Care

While recognizing the need to strengthen primary care, AGA will not support proposals that provide additional payments to primary care physicians (PCPs) at the expense of specialists.

  • The Patient Centered Medical Home concept should not develop into a gatekeeper model, limiting beneficiary access to gastroenterologists. Gastroenterologists, as internal medicine subspecialists, should be able to serve as a medical home for patients with chronic conditions who need coordinated care.
  • Increasing Medicare beneficiaries’ access to PCPs will necessitate increased payments. This could be accomplished by reducing payments to Medicare Advantage plans and by supporting efforts to allow funds to be transferred from Part A to Part B — not by reducing payments to physicians. The AGA supports the concept of shared savings across practice settings and breaking down the current silos that exist in the Medicare program. Physicians should benefit from savings that are generated in Part B from improved quality and efficiency. These savings could help finance enhanced payments to PCPs as well as to those physicians who demonstrate quality and efficiency.
  • Proposals to expand Medicare’s role in the medical home should be thoroughly tested before implementation.

Comparative Effectiveness Research (CER)

The economic stimulus package included $1B in funding for CER — research to determine which treatments work best for which patients. While CER can provide sound evidence for clinical decision making, AGA recommends the following guiding principles to NIH to ensure that CER doesn’t limit patient access to optimal care or discourage medical advances.

  • CER should not be a vehicle for making centralized coverage and payment decisions.
  • Public comments should be sought regarding the CER entity’s research priorities, agenda, peer review process, dissemination protocols and research design. A formal comment period should also apply to research findings.
  • Permanent and ad hoc advisory panels appointed by the CER entity should include members who are board certified specialist and subspecialist clinicians who are involved in treating the disorder under consideration.
  • Health-care providers should be afforded medical liability protections when they follow practice guidelines recommended by the CER entity.

 

Updated Dec. 2010