Three years ago, a group of physicians representing independent gastroenterology practices met in a Starbucks on Capitol Hill to discuss pending legislation threatening independent practices.
The proposed legislation would have limited the use of integrated pathology in the independent practice setting, alleging that independent physicians overutilize pathology services because of an economic incentive to do so.
A lawyer present at the Starbucks meeting, experienced in working with specialty associations suggested the physicians organize and "get your viewpoints out there." A few months later, the Digestive Health Physicians Association was launched, beginning with 11 practices representing 400 physicians. Fred Rosenberg, MD, of Illinois Gastroenterology Group in Gurnee, Illinois and the current president of DHPA, says that legislation "was viewed as an existential threat to independent practice."
In one of its first actions, DHPA commissioned a Medicare approved actuarial firm to review CMS' data on anatomical pathology utilization by independent and hospital-employed physicians. That analysis found the rate of increase was significantly higher by hospital-based physicians as compared to independent physicians. DHPA submitted the study findings to Congress, and the pending legislation failed.
"We were able to provide data that their premise was flawed," Dr. Rosenberg says. "This demonstrated to us that with a strong organization, numbers and an effective voice, we could successfully advocate for accessible, high quality and cost-efficient care in the independent GI medical practice setting.”
Three years later, DHPA has grown to 76 Member practices in 36 states with more 1,800 physicians representing, as Dr. Rosenberg estimates, about one-third of all independent gastroenterologists in the U.S.
Dr. Rosenberg says that while DHPA specifically represents independent GI practices, the organization works collegially with other professional societies representing gastroenterologists. He says DHPA and the Tri-societies are like-minded in their goals of improving quality of care and patient outcomes. To this point, DHPA recently held a joint “Partners in Value” conference with the American Gastroenterological Association, where experts discussed how gastroenterologists can better prepare for the transition to value-based care.
Addressing the payment disparity
The widening gap in inpatient and outpatient reimbursement for GI procedures is endangering the viability of independent practices nationwide. Rosenberg said that while there are some GI procedures which are more appropriately performed in a hospital, for a vast majority of patients, there's no rationale that the cost should be 50 percent higher for no reason other than it's done in a hospital.
“It’s the same procedure done by a physician with the same qualifications, with the same equipment and same outcome,” said Dr. Rosenberg. “Those extra dollars could be better spent on other critical healthcare needs."
Key issues
DHPA is currently focusing on two issues important to gastroenterology:
- Stark Law Modernization.
The current form of the Stark Law inhibits independent groups from participating in payment models incentivized by the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015. DHPA is working with a group of 25 organizations representing more than 500,000 physicians that are supporting this legislation to update the Stark Law to "fit into today's healthcare arena."
The Medicare Care Coordination Improvement Act of 2017 (H.R. 4206, S. 2051), seeks to eliminate barriers created by the Stark Law, which currently inhibit physician practices that are developing advanced payment models from rewarding or penalizing physicians for complying with clinical guidelines and treatment pathways designed to improve patient outcomes and/or lower costs with revenue from designated health services.
- Removing Barriers to Colorectal Cancer Screening
DHPA is educating legislators about the necessity of eliminating a loophole inadvertently created in the Affordable Care Act concerning screening colonoscopies where Medicare patients are left responsible for a portion of the costs if a polyp is discovered.
Dr. Rosenberg says, "When some Medicare patients awake following their procedure, they discover that they are responsible for costly co-insurance payments because the procedure transitioned into a therapeutic exam."
DHPA has supported the efforts of the bipartisan Congressional sponsors of a bill to correct this financial burden for patients. Dr. Rosenberg believes the funding necessary to fix the loophole could be generated from savings from value-based care, particularly from site of service differential related to colonoscopy services.
For more information on DHPA, click here.