Providers say the CMS cut colonoscopy Medicare reimbursement without taking into account their data-driven evidence of patient impact.
In the finalized CY 2016 Physician Fee Schedule rule, released Friday, the CMS cut reimbursement for several colonoscopy codes, some by as much as 17%. Gastroenterologists are outraged, despite the cuts being less than the 20% proposed by the agency.
The CMS originally proposed a 20% cut to the procedures, which the federal agency argued should be paid at a lower rate similar to less time-intensive tests.
During the comment period on the proposed rule, several GI societies presented data that showed the impact of lower Medicare reimbursement for a disease that greatly affects the elderly. The average age of diagnosis for colorectal cancer is 72, according to Fight Colorectal Cancer.
The time it takes a physician to perform a colonoscopy has been under intense scrutiny since a 2013 Washington Post investigation challenged American Medical Association-panel provided estimates of 75 minutes. The CMS has since accepted that the total time for a colonoscopy procedure is 67 minutes.
The American Gastroenterological Association has argued that the physician work of colonoscopy has not decreased since the last time it was reviewed. Changes in technology and screening guidelines have increased the time and intensity of the work, according to the association. Technological advancements have kept costs the same or even increased them and other GI societies say that as a result of the Medicare payment cuts, providers will be forced to stop performing the test or get out of practice all together.
“We have heard from our members that many would be forced to limit the number of Medicare patients to whom they can provide screening colonoscopy,” said Dr. Douglas Faigel, president of the American Society for Gastrointestinal Endoscopy. “As much as doctors want to provide the best possible care, it would be difficult to sustain these cuts to reimbursement for this service.”
GI societies plan to appeal the cuts to the CMS and are asking members to reach out to legislators.
The CMS' decision to lower the code reimbursement follows a recommendation by the Relative Value Scale Update Committee, a committee involving the American Medical Association and national medical specialty societies, that stated that the level, time and intensity of physician work of performing a colonoscopy is similar to that of a bronchoscopy and hysteroscopy.
The CMS also noted it disagreed that patient access to care would suffer as a result of it siding with RUC.
“We believe that establishing (reimbursement) that most accurately reflect the relative resource costs involved in furnishing services paid under the physician fee schedule is not only required by the statute, but also important to preserve and promote beneficiary access to all physician fee schedule services,” the agency said in the final rule.
Advocates worry providers will stop taking Medicare patients.
“We should not add yet another barrier to screening within the healthcare community and disincentivize physician care for the elderly in our country," said Anjee Davis, president of Fight Colorectal Cancer.
Others agreed. “We are hopeful concerns around Medicare reimbursement will be resolved in a way that preserves beneficiary access,” said Kirsten Sloan, senior policy director for the American Cancer Society Cancer Action Network.
A CMS spokesman did not return a request for comment.
