Here are five major moves that disrupted gastroenterology in 2024:
1. Dallas-based GI Alliance entered a definitive agreement with Dublin, Ohio-based pharmaceutical distributor and healthcare services company Cardinal Health in which Cardinal will acquire a majority stake in GI Alliance.
2. CMS finalized a 2.83% physician pay cut in its 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System released on Nov. 1. The physician fee schedule conversion factor for 2025 is $32.35, down from $33.29 in 2024.
The Digestive Health Physicians Association released a statement July 16, when the rule was proposed, opposing the cut, saying it "follows years of negligible increases, freezes and a payment cut in 2024."
3. There are also loopholes to colonoscopy reimbursements standing in the way of physicians and patients. According to a recent study, only 17% of patients pay nothing for their bowel preparation for screening colonoscopy and that almost half of patients are directed toward using non-FDA-approved, over-the-counter regimens.
Study leader Eric Shah, MD, a gastroenterologist at Ann Arbor-based University of Michigan, told Becker's the research identified a loophole where prescription drugs are tied to screening costs, and Medicare patients end up paying more.
4. Some gastroenterologists expressed concern over a lack of clarity in eligibility requirements in UnitedHealthcare's new gold card program. The program was introduced on Sept. 1, and went into effect on Oct. 1. The program aims to reward eligible provider groups who follow certain procedure guidelines and allow qualifying practices to bypass typical prior authorization processes.
No endoscopy services have thus far been included on UHC's list of gold card-eligible services, leading some gastroenterologists to question the decision-making process behind the program's eligibility criteria.
5. In July, the FDA approved a new screening test for colorectal cancer that only requires a sample of blood. While many applaud the test for its convenience and potential for increasing screening accessibility, others are raising concerns about its accuracy.
The new Shield test detected 83% of colorectal cancers in studies but identified only 13% of high-risk polyps, compared to colonoscopies, which find roughly 95% of these dangerous polyps. Specialists from The Oregon Clinic in Portland argue that the Shield test is ineffective in reducing or preventing colon cancer, as it primarily detects late-stage cancer. At that stage, patients often face more invasive treatments, such as chemotherapy or surgery, and the disease may be incurable.