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.
In the summer of 2015, Dr. Robert Shaffer, the president of the Alabama Gastroenterological Society, sent a letter to members to inform them that Blue Cross Blue Shields of Alabama was “considering a 25% cut in all of our endoscopy codes in exchange for releasing the use of propofol for any patient we want to use it for.” In other words, use propofol (anesthesia services) and we will cut your payments by 25%. Eventually, BCBS of Alabama decided instead to cut anesthesia payments in 2016. Gastroenterology groups that employ their anesthesia providers took a large cut!
At AnesthesiaStat, we have monitored these trends for several years and have advised our clients and colleagues to be well ahead of the market. A new cut is coming in 2017. However, there continues to be a small window of opportunity to capitalize on this trend, transfer the risks and take several steps to protect your valuable practice from these threats. While groups are unique in their structure and challenges, we encourage you to read the articles on our site that give you the tools to shield your compensation. As always, you may contact us at firstname.lastname@example.org or 410-385-3336 for further discussion.