AGA President provides perspective on the Medicare Final Rule

CMS recently announced that they are delaying alteration of colonoscopy relative value units (RVUs) as part of the Medicare Physician Fee Schedule Final Rule for 2015, which is welcome news. More information on this decision is available in the December issue of GI & Hepatology News.

AGA believes that CMS acted in response to an intensive educational effort coordinated among multiple medical and surgical societies. Six societies involved in colonoscopy all worked together to educate CMS about the importance of maintaining fair reimbursement for a cancer prevention procedure that has helped lower the annual incidence of colon cancer by 30% over the last decade. This effort was launched last year after the announcement of the reduction in value for upper endoscopy codes in the 2014 final rule. We all understood that the entire family of endoscopy codes was to be reviewed by the AMA’s Relative Value Update Committee (RUC), with recommendations submitted to CMS for a final decision.

Through intensive work with CMS and the RUC, GI RUC/CPT representatives convinced the RUC to first focus on upper endoscopy, and then lower endoscopy codes. When the upper endoscopy codes were submitted by the RUC, we were disappointed in the interim final values, but then were further astounded by the fact that CMS rejected 78% of the RUC recommendations and further reduced upper GI endoscopy RVU levels. This was historically unprecedented. To put it in perspective, CMS accepted the RUC recommendations for nearly 90% of all other codes reviewed by the RUC for the 2014 MPFS fee schedule. It was a clear wake-up call for us to mobilize an educational campaign. We also were dismayed that the upper endoscopy codes were not published until the final rule, which was delayed in 2014 due to the government shutdown. This only allowed a month for GIs to prepare their practices for the reduced codes.

We approached several congressmen, urging them to reach out and encourage CMS to adopt a more transparent process when re-valuing significant codes such as this. This effort, which was led by Rep. Bill Cassidy (R-La.), and Sen. Kelly Ayotte (R-N.H.), garnered the support of 46 representatives in the House and 11 senators. AGA, ACG, and ASGE also arranged several meetings with CMS, including a joint meeting between our presidents (and senior staff) and Marilynn Tavenner, CMS administrator, on May 22. Ms. Tavenner was very polite and open to our urging to delay implementation of the colonoscopy code changes. The three societies also worked together to launch an intense campaign (http://www.valueofcolonoscopy.org) to educate legislators, patients, and other key stakeholders about the importance of following a fair and transparent valuation process and maintaining fair reimbursement for this life-saving procedure.

I personally am proud to have partnered with Dr. Harry Sarles, ACG president, and Dr. Colleen Schmitt, ASGE president, in jointly working on these communications. This effort was a clear demonstration of the importance of our society leadership and advocacy efforts and the power of partnership.

CMS recently announced that they are delaying alteration of colonoscopy relative value units (RVUs) as part of the Medicare Physician Fee Schedule Final Rule for 2015, which is welcome news. More information on this decision is available in the December issue of GI & Hepatology News.

AGA believes that CMS acted in response to an intensive educational effort coordinated among multiple medical and surgical societies. Six societies involved in colonoscopy all worked together to educate CMS about the importance of maintaining fair reimbursement for a cancer prevention procedure that has helped lower the annual incidence of colon cancer by 30% over the last decade. This effort was launched last year after the announcement of the reduction in value for upper endoscopy codes in the 2014 final rule. We all understood that the entire family of endoscopy codes was to be reviewed by the AMA’s Relative Value Update Committee (RUC), with recommendations submitted to CMS for a final decision.

Through intensive work with CMS and the RUC, GI RUC/CPT representatives convinced the RUC to first focus on upper endoscopy, and then lower endoscopy codes. When the upper endoscopy codes were submitted by the RUC, we were disappointed in the interim final values, but then were further astounded by the fact that CMS rejected 78% of the RUC recommendations and further reduced upper GI endoscopy RVU levels. This was historically unprecedented. To put it in perspective, CMS accepted the RUC recommendations for nearly 90% of all other codes reviewed by the RUC for the 2014 MPFS fee schedule. It was a clear wake-up call for us to mobilize an educational campaign. We also were dismayed that the upper endoscopy codes were not published until the final rule, which was delayed in 2014 due to the government shutdown. This only allowed a month for GIs to prepare their practices for the reduced codes.

We approached several congressmen, urging them to reach out and encourage CMS to adopt a more transparent process when re-valuing significant codes such as this. This effort, which was led by Rep. Bill Cassidy (R-La.), and Sen. Kelly Ayotte (R-N.H.), garnered the support of 46 representatives in the House and 11 senators. AGA, ACG, and ASGE also arranged several meetings with CMS, including a joint meeting between our presidents (and senior staff) and Marilynn Tavenner, CMS administrator, on May 22. Ms. Tavenner was very polite and open to our urging to delay implementation of the colonoscopy code changes. The three societies also worked together to launch an intense campaign (http://www.valueofcolonoscopy.org) to educate legislators, patients, and other key stakeholders about the importance of following a fair and transparent valuation process and maintaining fair reimbursement for this life-saving procedure.

I personally am proud to have partnered with Dr. Harry Sarles, ACG president, and Dr. Colleen Schmitt, ASGE president, in jointly working on these communications. This effort was a clear demonstration of the importance of our society leadership and advocacy efforts and the power of partnership.

CMS recently announced that they are delaying alteration of colonoscopy relative value units (RVUs) as part of the Medicare Physician Fee Schedule Final Rule for 2015, which is welcome news. More information on this decision is available in the December issue of GI & Hepatology News.

AGA believes that CMS acted in response to an intensive educational effort coordinated among multiple medical and surgical societies. Six societies involved in colonoscopy all worked together to educate CMS about the importance of maintaining fair reimbursement for a cancer prevention procedure that has helped lower the annual incidence of colon cancer by 30% over the last decade. This effort was launched last year after the announcement of the reduction in value for upper endoscopy codes in the 2014 final rule. We all understood that the entire family of endoscopy codes was to be reviewed by the AMA’s Relative Value Update Committee (RUC), with recommendations submitted to CMS for a final decision.

Through intensive work with CMS and the RUC, GI RUC/CPT representatives convinced the RUC to first focus on upper endoscopy, and then lower endoscopy codes. When the upper endoscopy codes were submitted by the RUC, we were disappointed in the interim final values, but then were further astounded by the fact that CMS rejected 78% of the RUC recommendations and further reduced upper GI endoscopy RVU levels. This was historically unprecedented. To put it in perspective, CMS accepted the RUC recommendations for nearly 90% of all other codes reviewed by the RUC for the 2014 MPFS fee schedule. It was a clear wake-up call for us to mobilize an educational campaign. We also were dismayed that the upper endoscopy codes were not published until the final rule, which was delayed in 2014 due to the government shutdown. This only allowed a month for GIs to prepare their practices for the reduced codes.

We approached several congressmen, urging them to reach out and encourage CMS to adopt a more transparent process when re-valuing significant codes such as this. This effort, which was led by Rep. Bill Cassidy (R-La.), and Sen. Kelly Ayotte (R-N.H.), garnered the support of 46 representatives in the House and 11 senators. AGA, ACG, and ASGE also arranged several meetings with CMS, including a joint meeting between our presidents (and senior staff) and Marilynn Tavenner, CMS administrator, on May 22. Ms. Tavenner was very polite and open to our urging to delay implementation of the colonoscopy code changes. The three societies also worked together to launch an intense campaign (http://www.valueofcolonoscopy.org) to educate legislators, patients, and other key stakeholders about the importance of following a fair and transparent valuation process and maintaining fair reimbursement for this life-saving procedure.

I personally am proud to have partnered with Dr. Harry Sarles, ACG president, and Dr. Colleen Schmitt, ASGE president, in jointly working on these communications. This effort was a clear demonstration of the importance of our society leadership and advocacy efforts and the power of partnership.