2015-02-12 20:21:33 UTC

Cuts to Lower Endoscopy Codes Delayed; AGA PAC Plays Key Role

Feb. 16, 2015

The news arrived on Oct. 31, 2014: CMS decided to delay valuation of lower endoscopy codes, averting a potentially deep reduction to those GI services. A ballpark estimate of the impact of the delay indicates that GIs saved approximately $220 million in reimbursement cuts from Medicare and commercial payors. While this was welcome news to the GI community, the effort expended to achieve this result was more than a year-long process.
AGA and our sister societies knew that we had to develop a strategy to provide gastroenterology more opportunity to express meaningful concerns on the valuation of codes under CMS’s process. Heretofore, CMS would publish new values in its physician fee schedule “final rule” in late October/early November, leaving societies little time to argue against fee reductions before they took effect in January. AGA and its allies argued that CMS’s process must be made more transparent by publishing its intentions in the “proposed rule” in early July, thereby giving societies several months to present data to CMS challenging its findings before they become final.
“We took our message to Congress and other policymakers,” notes AGA PAC Board of Advisors chair, Donald R. Campbell, MD, AGAF. “We found champions in Rep. Bill Cassidy, R-LA, a hepatologist, and Sen. Kelly Ayotte, R-NH, who organized congressional ‘Dear Colleague’ letters to CMS pressing for more transparency. After a collaborative effort and many visits to other congressional offices, 47 House members signed onto the Cassidy letter and 12 senators signed onto the Ayotte letter.”
The transparency campaign included a number of other components, such as a meeting between the GI society presidents and CMS administrator Marilyn Tavenner asking for a delay in valuing the lower endoscopy codes. GIs were asked to contact CMS expressing their concerns with the process and more than 450 members responded by sending letters to the agency. GI society representatives who are experts in the Medicare rate setting processes spent countless hours developing arguments for the delay and transparency strategy.
In the end, CMS agreed with our arguments and the agency is implementing a more transparent process for valuing codes in 2015. Valuation of the lower endoscopy codes was delayed a year so that they will be considered under this new transparent process.
“The key take away from this effort is ‘leave no stone unturned’,” said Dr. Campbell. Many people committed considerable time to this effort and we identified a large group of legislators who were willing to go to bat for us. AGA PAC, and its role in helping to develop congressional champions, played a key role in this effort.”
Work on this issue is not finished, however. The lower endoscopy codes face a new valuation process this year and we will certainly confront new challenges. We will need existing champions in Congress, and new ones, to help us fight these battles. You can play a vital role in these efforts by contributing to AGA PAC today!
Contribute to AGA PAC. Get involved by contact Navneet Buttar at 240-482-3221 or NButtar@gastro.org

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