Reimbursement pressure hovers near the top of the list of physicians' concerns for the future of medical practice. Here are six updates for gastroenterologists to know about the Medicare sustainable growth rate, physician attitude towards the shifting healthcare landscape and gastroenterologist compensation.
1. Payment cuts
The Centers for Medicare and Medicaid Services recently announced cuts to 2014 Medicare reimbursement for upper GI/endoscopy services. The American Gastroenterological Association, American College of Gastroenterology and American Society for Gastrointestinal Endoscopy announced a joint commitment to work with policymakers to address concern over the payment cuts and to make headway in mitigating the cuts. The three GI societies created a payment analysis of common GI codes under the Medicare physician fee schedule to demonstrate the affects of the payment cuts.
2. Activity at Capitol Hill
This month, the AGA, in conjunction with the other GI societies and the Alliance of Specialty Medicine, journeyed to Capitol Hill to discuss SGR repeal and the goal of shifting physicians to a value-based payment system. In late 2013, the Senate Finance and House Ways and Means committees passed separate but similar bills for the replacement of the SGR. The House Energy and Commerce Committee passed a similar proposal earlier in the year. Though similar, each committee's plan varies in cost. The Congressional Budget Office scored the costs at:
• Ways and Means: $121 billion
• Energy and Commerce: $146 billion
• Senate Finance: $148.6 billion
The legislation is called the Medicare Patient Access and Quality Improvement Act. The three committees are currently working to resolve the differences between their versions of the bill.
3. Medicare/Medicaid beneficiaries
Despite the cuts and uncertainty surrounding Medicare payments, 58 percent of gastroenterologists plan to see both current and new Medicare and Medicaid patients, according to Medscape's Gastroenterologist Compensation Report: 2013. Only 12 percent of gastroenterologists intend to drop or stop taking on new Medicare and Medicaid patients, while 30 percent remain undecided.
4. Gastroenterologist compensation
While reimbursement pressure is a reality, overall gastroenterologist compensation remains steady. From 2011 to 2012, 72 percent of gastroenterologists' received the same level of compensation or higher, according to Medscape's report. Compensation varied by gender, geographic location and practice setting. Men earned more than women. GI physicians in the northwestern U.S. earned the most and those in the Mid-Atlantic region earned the least. Partners in a practice earned the most, while employed gastroenterologists earned the least.
5. ASCs and endoscopy centers
For two years in a row, the Medicare Payment Advisory Commission has recommended that Congress give ambulatory surgery centers a 0 percent pay increase. On the other hand, MedPAC recommended a 3.25 to 5.25 percent increase for hospital outpatient departments in 2015, depending on whether or not sequestration continues. ASC reimbursement as a percentage of HOPD reimbursement has been steadily declining since 2003. Gastroenterologists that perform procedure in ASCs or endoscopy centers will continue to be affected by flat reimbursement.
6. Payment methodology shift
The shift away from fee-for-service reimbursement to value-based payment is a hot topic, but actually adopting this new methodology is easier said than done. Caroll Koscheski, MD, FACG, Chairman of the National Affairs Committee for the American College of Gastroenterology and ACG Governor for North Carolina discussed where value-based care stands in the GI field and the work that needs to be done to realize a widespread pay-for-performance model in a recent Becker's ASC Review report.
A change in payment methodology, whether rapid or taken on in small steps, seems inevitable. Physicians remain unsure of what this means for practice. Nearly a third of physicians, 26.6 percent, feel that a shift in payment methodology will be bad for their practice, according to a Physicians Practice survey. Only 16.2 percent report thinking a new payment methodology will be a positive change. The majority of physicians, 57.1 percent, gave a neutral response or remain unsure of how practice will be impacted.
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1. Payment cuts
The Centers for Medicare and Medicaid Services recently announced cuts to 2014 Medicare reimbursement for upper GI/endoscopy services. The American Gastroenterological Association, American College of Gastroenterology and American Society for Gastrointestinal Endoscopy announced a joint commitment to work with policymakers to address concern over the payment cuts and to make headway in mitigating the cuts. The three GI societies created a payment analysis of common GI codes under the Medicare physician fee schedule to demonstrate the affects of the payment cuts.
2. Activity at Capitol Hill This month, the AGA, in conjunction with the other GI societies and the Alliance of Specialty Medicine, journeyed to Capitol Hill to discuss SGR repeal and the goal of shifting physicians to a value-based payment system. In late 2013, the Senate Finance and House Ways and Means committees passed separate but similar bills for the replacement of the SGR. The House Energy and Commerce Committee passed a similar proposal earlier in the year. Though similar, each committee's plan varies in cost. The Congressional Budget Office scored the costs at:
• Ways and Means: $121 billion
• Energy and Commerce: $146 billion
• Senate Finance: $148.6 billion
The legislation is called the Medicare Patient Access and Quality Improvement Act. The three committees are currently working to resolve the differences between their versions of the bill.
3. Medicare/Medicaid beneficiaries
Despite the cuts and uncertainty surrounding Medicare payments, 58 percent of gastroenterologists plan to see both current and new Medicare and Medicaid patients, according to Medscape's Gastroenterologist Compensation Report: 2013. Only 12 percent of gastroenterologists intend to drop or stop taking on new Medicare and Medicaid patients, while 30 percent remain undecided.
4. Gastroenterologist compensation
While reimbursement pressure is a reality, overall gastroenterologist compensation remains steady. From 2011 to 2012, 72 percent of gastroenterologists' received the same level of compensation or higher, according to Medscape's report. Compensation varied by gender, geographic location and practice setting. Men earned more than women. GI physicians in the northwestern U.S. earned the most and those in the Mid-Atlantic region earned the least. Partners in a practice earned the most, while employed gastroenterologists earned the least.
5. ASCs and endoscopy centers
For two years in a row, the Medicare Payment Advisory Commission has recommended that Congress give ambulatory surgery centers a 0 percent pay increase. On the other hand, MedPAC recommended a 3.25 to 5.25 percent increase for hospital outpatient departments in 2015, depending on whether or not sequestration continues. ASC reimbursement as a percentage of HOPD reimbursement has been steadily declining since 2003. Gastroenterologists that perform procedure in ASCs or endoscopy centers will continue to be affected by flat reimbursement.
6. Payment methodology shift
The shift away from fee-for-service reimbursement to value-based payment is a hot topic, but actually adopting this new methodology is easier said than done. Caroll Koscheski, MD, FACG, Chairman of the National Affairs Committee for the American College of Gastroenterology and ACG Governor for North Carolina discussed where value-based care stands in the GI field and the work that needs to be done to realize a widespread pay-for-performance model in a recent Becker's ASC Review report.
A change in payment methodology, whether rapid or taken on in small steps, seems inevitable. Physicians remain unsure of what this means for practice. Nearly a third of physicians, 26.6 percent, feel that a shift in payment methodology will be bad for their practice, according to a Physicians Practice survey. Only 16.2 percent report thinking a new payment methodology will be a positive change. The majority of physicians, 57.1 percent, gave a neutral response or remain unsure of how practice will be impacted.
More Articles on Gastroenterology:
Looking Beyond the Scope: Integrated Care & Women's Health in Gastroenterology
19 Statistics on Gastroenterologist Lifestyle
High-Volume Hospitals May Offer Better Colorectal Surgery Recovery Rates