Gastroenterologists across the U.S.are voicing concerns about three key policies affecting patient care, screening accuracy and physician reimbursements.
Here are three policies gastroenterologists are criticizing:
1. CRC blood test
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.
Both The Oregon Clinic and the American Cancer Society continue to uphold the colonoscopy as the "gold standard" for CRC screening and prevention. Amol Akhade, MD, a medical oncologist, expressed similar concerns in an Aug. 27 piece for Oncology News Central, where he highlighted the limitations of blood-based tests in detecting precancerous lesions and early-stage cancer. While non-invasive testing may increase overall screening rates, many experts remain skeptical about its ability to catch aggressive, early-stage cancers.
"Finding a blood-based test to screen for cancer is a dream for every oncology researcher. Imagine a simple blood test that can detect precancerous lesions or stage 1 cancer in asymptomatic individuals," Dr. Akhade wrote.
While the noninvasive nature of these tests might mean that more people receive CRC screenings overall, Dr. Akhade questioned the tests' accuracy and ability to detect aggressive, precancerous lesions.
UnitedHealthcare's gold card prior authorization program
The American Gastroenterological Association issued a statement expressing concerns over UnitedHealthcare's new "gold card" prior authorization program, which went into effect on Oct. 1. This program rewards provider groups that "consistently adhere to evidence-based care guidelines" by allowing certain physicians to bypass the prior authorization process for select procedures.
While some see this as a way to streamline care, many gastroenterologists fear it's another strategy by UnitedHealthcare to restrict access to essential procedures like colonoscopies and endoscopies.
"This program, which comes with few details to date, is concerning to many gastroenterologists who see this as a familiar strategy by UHC to implement prior authorization for various procedures, including life-saving colonoscopies and endoscopies for the millions of patients who need them," AGA President Maria Abreu, MD, wrote in an Aug. 7 news release from the organization.
The American College of Gastroenterology’s prior-authorization task force echoed this criticism, raising concerns that the program may create new barriers for necessary GI treatments.
CMS pay cuts
Two major gastroenterology organizations have criticized CMS' proposal to cut physician pay by 2.8% in its physician fee schedule for 2025. The Digestive Health Physicians Association released a statement July 16 opposing the proposal, saying it "follows years of negligible increases, freezes and a payment cut in 2024."
"This is unsustainable for our nation’s medical groups, physicians and other health care providers," the statement said. "The effects of these cuts will be exacerbated in rural and underserved areas, which continue to face significant healthcare access challenges."
The group added that if the proposal is adopted, Medicare payments will have been slashed by more than 7% over the past four years. Additionally, when adjusted for inflation, Medicare payments have declined by 30% in the last 20 years.
The American Society for Gastrointestinal Endoscopy echoed these concerns, calling on Congress to reverse the proposed cuts in a July 12 statement.