Upper GI/endoscopy procedure codes have already undergone reduction in reimbursement. This year, lower GI/endoscopy codes, including colonoscopy, were up for CMS review. The potential for cuts was one of the foremost concerns for gastroenterologists in 2014. That review has since been postponed until 2016, and the possibility of reduced reimbursement lurks in the not-so-distant future.
Two American Gastroenterological Association leaders and practicing gastroenterologists offer three vital ways in which to prepare for those hypothetical cuts and mitigate any effect they may have.
1. Improve practice efficiency. The marriage of efficiency and quality is king in healthcare. "Whether in an office or ASC, we have had to over the course of the past few years streamline and improve all efficiencies," says Shivan Mehta, MD, MBA, assistant professor of medicine at the Perelman School of Medicine, University of Pennsylvania in Philadelphia. But, the job is never done. Dawn L. Francis, MD, AGA RUC Advisor and associate chair of the quality department at Mayo Clinic in Jacksonville, Fla., recommends:
• Honing in on revenue cycle management functions
• Doubling down on payer contract negotiations
• Revisiting and optimizing supplier contracts
• Maintaining and growing your referral base
• Reviewing all service lines and understanding how payment is received
All of these courses of action, though labor intensive, are expedient steps to insulating a practice from a sudden, significant drop in revenue.
2. Demonstrate value to payers. GI is one specialty amongst many, all clamoring for a piece of the precious, and finite, healthcare dollar. Payers, just like providers, are under pressure to allocate those dollars in the most efficient manner; cuts are inevitable, though where and to what degree are uncertain. "We must show the value of what we are providing," says Dr. Mehta. "Think about patient outcomes and experience. Find ways to demonstrate this to your payers."
Colonoscopy has undeniably been asserted as a life-saving tool in the battle against colorectal cancer. "Now is not the time to panic, Medicare does see that colonoscopy has value for its beneficiaries," says Dr. Francis. But, gastroenterologists can continue to improve on the quality of colonoscopies delivered by consistently meeting and exceeding established benchmarks. Patients and payers will respond to a proven track record of quality, and therefore valuable, care.
3. Look to society support. The review of lower GI/endoscopy was delayed in large part by efforts spearheaded by the sister GI societies. "The AGA and other GI societies are involved in helping practices maximize their value and answering questions about how to maintain viability," says Dr. Francis. Turn to the resources these groups offer and use this support to best prepare your practice for the uncertain future.