Just prior to the Thanksgiving holiday, CMS released the Medicare pay rates for 2014. As reported by the AGA, ACG, and ASGE, these contain significant cuts for gastroenterology. AGA will fight these cuts, which the GI community cannot accept for a number of reasons. It’s important that patients maintain access to critical procedures.
The issues are clear. The CMS misvalued code initiative mandates review of procedure codes. Through the AMA Relative Value Update Committee (RUC), and in compliance with the CMS mandate for the GI codes, the GI societies are surveying codes to determine the current time and effort spent on a procedure. AMA, through the RUC, makes recommendations to CMS, which then determines the reimbursement rates. As you likely know, this process is being criticized by the media and Capitol Hill.
For the proposed 2014 reimbursement rates, CMS made cuts beyond the AMA RUC-recommended changes. These will be felt primarily in the endoscopy family of codes.
AGA members and leadership are questioning the rationale for the cuts as the methodology is unclear. The rule is open for public comment until Jan. 27, 2014. We are exploring all options to appeal and mitigate these reductions. Our initiative needs your support. Capitol Hill and CMS need to hear from gastroenterologists in the trenches that the cuts are untenable and may reduce access to care. We are evaluating the optimal timing for our campaign to have success. Stay tuned for more information.
Please direct questions to Elizabeth Wolf, director of regulatory affairs, at 240-482-3223 or ewolf@gastro.org.
