The National Colorectal Cancer Roundtable set a goal to screen 80% of eligible patients by 2018. To accomplish this goal, the Centers for Medicare & Medicaid Services (CMS) decided to waive copayments and deductibles for screening colonoscopies. Section 4104 of the “Patient Protection and Affordable Care Act” waives the beneficiary coinsurance for covered preventative service that have a grade of “A” or “B” from the U.S. Preventative Services Task Force (USPSTF). Colorectal screening has an A grading.
While this may be good to increase access to colorectal cancer screening, CMS followed this change with endoscopy related payment cuts in 2016. Those cuts effectively decrease payment to gastroenterologists by 9%, facilities by 9.5% and offices by 2.3%. So drastic were those cuts, that a recent survey of 327 gastroenterologists conducted by Dr. Matthew McNeill, MD found that the surveyed gastroenterologists may cut procedure volume by about half.
If this survey result comes to fruition, a collision course is on its way that spells trouble for most gastroenterologists and anesthesia providers. More patients seeking screening colonoscopies but dwindling payments for those procedures. If this reality wasn’t bad enough, private insurers have paired specialists against each other in an effort to further reduce payments.