A Bundled Payment Framework for Colonoscopy Performed for Colorectal Cancer Screening or Surveillance

With the release of the 2014 Physician Fee Schedule by the Centers for Medicare & Medicaid Services (CMS), it is clear that the substantial reductions in reimbursement for endoscopic procedures will have a profound impact on the practice of community and academic gastroenterology. In the Final Rule, CMS rejected the recommendations of the American Medical Association/Specialty Society Relative Value Update Committee, establishing significant reductions in physician payment for esophagoscopy, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography services by reducing the physician work component of the relative value units for many of the listed services. For some procedures, there was a reduction in relative value units of more than 30%. Future reductions in actual payment to physician practices may occur if the conversion factor (dollars paid per relative value units) is adjusted further. Implementation of these changes by Medicare could potentially result in an $80 million reduction in 2014 payments for endoscopic services based on 2011 Medicare claims paid for these procedures, which does not take into account the impact on commercial payers who base their fee schedules on a percentage of Medicare. Further revisions by CMS to payment for colonoscopy, enteroscopy, and flexible sigmoidoscopy procedures are poised to occur in 2015.

Source: Gastroenterology - January 30, 2014 Category: Gastroenterology Authors: Joel V. Brill, Rajeev Jain, Peter S. Margolis, Lawrence R. Kosinski, Worthe S. Holt, Scott R. Ketover, Lawrence S. Kim, Laura E. Clote, John I. Allen Tags: AGA Section Source Type: research