2015-07-30 12:01:55 UTC

GI Societies Fight CMS on Colonoscopy Pay Cuts

July 30, 2015

AGA, along with our sister societies, is committed to fighting CMS-proposed cuts to colonoscopy for 2016.

During a July 21 meeting with officials at CMS, leaders from AGA, ACG and ASGE argued that proposed colonoscopy reimbursement cuts were made on flawed data. The agency showed interest in taking another look at the data, and we are pushing for a meeting in late August. 

In the meantime, we’re working to rally lawmakers who champion colorectal cancer screening and rulemaking transparency to push CMS to reevaluate their methodology. When the time is right, we’ll ask you to support this effort. Watch your email for more information.

The stakes are high. The proposed cuts threaten public health gains made thanks largely to effective use of screening colonoscopy. 

Background: CMS announced the proposed cuts in the 2016 proposed Medicare Physician Fee Schedule on July 8. If finalized, cuts will take effect Jan. 1, 2016. More info.

The evidence we presented to CMS

The physician work values for colonoscopy recommended by the AMA’s Relative Value Update Committee (“The RUC”) were not based on the robust and representative data presented by the GI and surgical societies during the last survey of colonoscopy. We pointed out that CMS’ reliance on the flawed RUC recommendations as the basis for its physician work value determination for colonoscopy only exacerbates the valuation errors made by the RUC.

Society presidents weigh in:

  • “The proposed payment cuts to colonoscopy are a direct contradiction to the goal supported by the U.S. Department of Health and Human Services to increase rates of colorectal cancer screening in the U.S. to 80 percent by 2018,” said Michael Camilleri, MD, AGAF, AGA Institute president. “CMS’ proposed cuts will turn back the clock on the progress we have made in reducing deaths and suffering from colorectal cancer.” 
  • “Cuts to colonoscopy under Medicare, if allowed to become final, threaten that success and could stymie Medicare’s progress against this deadly cancer and make things worse for Medicare patients,” explained ACG President Stephen B. Hanauer, MD, FACG. “More, not less, needs to be done to increase the use of colorectal cancer screening tests by Medicare beneficiaries. It is counter-intuitive and short-sighted to cut Medicare reimbursement for colonoscopy just at the point when our nation needs all the help it can get to continue the real progress we are making in reducing the number of new cases of colorectal cancer and the number of colorectal cancer deaths.”  
  • “The GI societies are pursuing every possible avenue in our fight to halt implementation of drastic cuts to colonoscopy,” said ASGE President Douglas Faigel, MD, FASGE. “CMS’ acceptance of a flawed methodology for revaluing colonoscopy that does not reflect data presented by the GI societies is unacceptable.”

Next steps 

As the three GI societies continue their discussions with CMS officials, we also are turning to Congress for help. We will be asking the support of our colorectal cancer champions in Congress — those who have supported removing barriers to screening colonoscopy — to voice their opposition to CMS’ proposed cuts.  

CMS’ proposed colonoscopy cuts represent the biggest threat to the practice of gastroenterology over the past decade. Our societies have the data and expert knowledge to fight these cuts, but we can’t do it without the support and active involvement of every member of our societies. In the weeks ahead our societies will issue “calls to action” urging letters, emails and phone calls to CMS and congressional lawmakers. Our societies are counting on you to respond. 

Together, we can make a difference.  

More on Colonoscopy

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AGA leader Dr. Christina Ha performed Jimmy Kimmel’s first colonoscopy. Here’s the clip.