Gastroenterologists brace for potential 20% rate cut
Report offers ideas for surviving changes
According to a newly released report, reimbursement for gastroenterology procedures provided in surgery centers will decrease by as much as 20% in coming years, which will require a significant restructuring of many practices.1
In the proposed 2008 Medicare reimbursement system for ambulatory surgery centers, gastroenterology has been "singled out" for substantial deductions, says Robert S. Sandler, MD, MPH, vice president of the American Gastroenterological Association (AGA) Institute and chief of the Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill.
Lobbyists are working to achieve a more generous final payment plan. However, many gastroenterologists have taken on significant debt to build their own centers, according to the report from the AGA Institute. The final result for them may be financial hardship, he says. "People need to be alert to that possibility," he says.
There may be options that can lessen the potential financial losses, according to the AGA report, which says that recertifying an ASC as an independent diagnostic testing facility (IDTF) may allow physicians heavily invested in ASCs to purse other developing diagnostic technologies and to buffer themselves from changes in reimbursement. The IDTF certification allows providers to perform radiological procedures, Sandler says. Providers need to perform six CT scans daily to make such an investment feasible, the report says. Additionally, some large gastroenterologists may find that an IDTF designation allows them to perform their own pathology work and capture those fees, Sandler says.
Gastroenterologists have been concerned that CT colonoscopy might become popular and replace screening colonoscopies. "If we were doing a lot of CT colonographies for screening, it could be done in an IDTF and kept within the GI [gastrointestinal] practice." Sandler says.
The report recommended that the AGA Institute provide detailed information and workshops that teach computed tomographic colonography (CTC) and how it may be incorporated into GI practice, including the potential transition from a designated ASC to IDTF. However, keep the "ifs" in mind when considering designation as an IDTF, Sandler advises. For example, a big "if" is whether CTC actually becomes popular and widely embraced, he says. "Now, it's thought to be experimental by some people," he says.
In fact, the report points to a "range of issues" with CTC, including its relative sensitivity, technological challenges, costs, and reimbursement issues. Currently CTC is not covered by Medicare. "However, local coverage decisions by specific third-party payers in 46 states allow for CTC for patients in specific clinical situations, such as incomplete colonoscopy for any reason," the report says.1
Another "if" is whether gastroenterologists are able and willing to read those examinations, Sandler says. "Most of people I talk to say gastroenterologists would be better to read the colon than the radiologists, so we're fully capable or reading the colon part of those examinations," he says.
Reference
- AGA Institute. Will screening colonoscopy disappear and transform gastroenterology practice? Threats to clinical practice and recommendations to reduce their impact: Report of a consensus conference conducted by the AGA Institute Future Trends Committee. Gastroenterology 2006; 131:1,287-1,312.
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