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November 7, 2018

Spotlight on Washington: CMS boosts payments to ASCs

AGA tracks regulation and legislation important to the GI field. Here are quick updates on issues that are moving this week.

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Ask your senator to sign the Brown letter to CMS to fix the colonoscopy loophole. Sen. Sherrod Brown, D-OH, is sending a letter to CMS urging the agency to fix the screening colonoscopy coinsurance problem. Forty-eight senators have signed the letter but we need your help to get more and put pressure on CMS to fix this problem for seniors.


GI codes recommended for revaluation, E/M payment changes delayed in Medicare Physician Fee Schedule (PFS) final rule. In the final rule, CMS agreed with Anthem that two endoscopy services – (1) colonoscopy with lesion removal by snare (43239) and (2) EGD biopsy single/multiple (45385) – could be “misvalued.” These services have been referred to the AMA Relative-value Update Committee (RUC) for review. Review will impact payments no earlier than 2021. In the final rule, CMS also withdrew or delayed several proposals related to evaluation and management (E/M) services. Implementation of changes to E/M services for new and established patient office visits is delayed until 2021 and CMS’ proposal to apply a multiple-procedure payment reduction for E/M services furnished on the same day as certain procedures was not finalized. As a result, for calendar year (CY) 2019, physician payment rates for E/M services and for endoscopy services remain stable.


Good news! CMS boosts payments to ambulatory surgical centers (ASCs) in Medicare Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System final rule. In the CY 2019 Medicare OPPS and ASC Payment System final rule released on Nov. 2, CMS finalized several proposed changes that boost payments to ASCs, including a new (albeit temporary) annual update factor and modified criteria for identifying device dependent procedures. In the final rule, CMS also finalized its proposal to lower payment rates for clinic visits, the most common service billed by hospital outpatient departments, provided at all off-campus provider-based departments (PBDs).  The policy reduces the CY 2019 OPPS payment rate for clinic visits to $81. Payment rates for endoscopy services performed in the hospital outpatient setting remain stable.


Field testing of new Merit-based Incentive Payment System (MIPS) cost measures ends. AGA, together with ACG and ASGE, weigh in on measure specifications. On Nov. 5, the ACG, AGA and ASGE submitted a joint letter to CMS on three cost measures – (1) Lower Gastrointestinal (GI) Hemorrhage, (2) Total Per Capita Cost (TPCC) and (3) Medicare Spending Per Beneficiary (MSPB) – being developed or revised for use in MIPS. The letter provides detailed recommendations for modifying measure specifications for each measure based on input from AGA, ACG and ASGE members.


AGA comments on FDA draft guidance addressing use of colony forming units (CFUs) on supplement labels. Under current regulations, FDA does not have the authority to mandate reporting of CFUs for supplements that contain live microbials, such as probiotics. Additionally, there are no conditions or standards that must be met by manufacturers who choose to include CFUs on their supplement labels. The draft guidance, issued by FDA in September, announces FDA’s intent to use enforcement discretion for manufacturers that choose to declare CFUs on product labels and seeks feedback on draft CFU reporting requirements. In a comment letter to FDA, AGA commends the agency’s efforts and encourages FDA to expand what information manufacturers are required to report to include recommended storage conditions as well as an expiration or “use by” date.


Take a brief survey to help us advocate on prior authorization. Prior authorization is burdensome to physicians and delays patient care. To help AGA’s advocacy efforts to change prior authorization, we need data. You can help. Please take a moment to take this brief survey that AGA and the Alliance of Specialty Medicine are conducting to bolster our advocacy efforts in the new congress to ensure patients have access to medically necessary care.


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