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Proposed Medicare Payment Changes May Affect Colon Cancer Screening


Last week, the Centers for Medicare and Medicaid Services (CMS) released two proposals that could affect the gastroenterologists who perform colonoscopies.

The CY 2015 Hospital Outpatient Prospective Payments System and Ambulatory Surgery Center Proposed Rule, and the CY 2015 Phyisican Fee Schedule Proposed Rule outline changes to the rules that govern reimbursement for both physicians and hospital outpatient departments.

The Medicare payment changes do not include payment updates for lower endoscopy procedures, including colonoscopy, despite efforts from the American Gastroenterological Association, American College of Gastroenterology, and the American Society for Gastroenterological Endoscopy to improve colonoscopy reimbursement.

CMS proposes a 24% decrease in Medicare phsyician reimbursement rates, along with significant modifications to quality improvement programs, the addition of polyp detection rate to the Physician Quality Reporting System requirements, and raising ACS and HOPD payment rates by several percentage points.

The AGA, ACG and ASGE have expressed concern over these changes and issued a joint statement urging CMS for improved colonoscopy reimbursement and a more transparent rulemaking process.

However, CMS did propose a notable positive change to the current rule for colonoscopies. The proposal reworks colon cancer screening colonoscopy to include anesthesia. This means the Medicare deductible and co-pay would be waived for anesthesia services charged separately from the cost of the procedure itself.

This change represents a move toward removing insurance barriers to colon cancer screening, but the GI societies remain intent on furthering this movement to include eliminating the cost of colonoscopies that include removing polyps.

Other News From Around the Web

  • A Forbes article gives the scoop on how often aging boomers should go in for cancer screenings.
  • This new study links heavy antibiotic use to increased risk of colon cancer.
  • A $3.75 million grant was given to the University of Kentucky Rural Cancer Prevention Center to promote colon cancer screening in central Appalachia.
  • This study shows that more polyps detected means lower cancer risk.

Image Source: Alex E. Proimos via photopin cc

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