Policy Statement on Physician Payment and Delivery Reform

The American Society for Gastrointestinal Endoscopy (ASGE) affirms the value endoscopic services provide in diagnosing and treating a wide spectrum of digestive disorders and its public health role in colorectal cancer prevention.

Our society recognizes health care costs under the current health care system are unsustainable.  Overly-burdensome regulations and lack of electronic health record interoperability are among the contributors to health care cost, but payment inadequacy can drive behaviors that are misaligned with efforts to encourage wise use of health care resources and value-based care.

The Medicare Quality Payment Program provides two reimbursement pathways for physicians – the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). While both pathways are intended to incentivize the delivery of high-value care, there are limitations that undermine their potential.  MIPS involves a complex scoring system and participation requirements that necessitate tremendous practice investment with diminished upside potential. Ultimately, more opportunities are needed for physicians to achieve successful transition to APM participation, which should be addressed by creating and certifying new physician-focused payment models and by reducing thresholds that currently limit the number of qualifying APM participants. Modernizing the Stark Law is required to further facilitate APM development.

While recent proposals to reduce administrative burden associated with documentation requirements for Evaluation and Management (E/M) codes are supported, reimbursement for E/M codes that fails to adequately recognize the complexity of certain patients is not. In addition, proposals to bundle multiple outpatient service payments for patients that may need to seek specialized centers of care will inadvertently disadvantage complex patients and those physicians who care for them. ASGE supports policies that alleviate administrative burden while adequately valuing the care provided for all patients.

Endoscopy services were re-evaluated in 2014 for upper GI endoscopy and in 2016 for colonoscopy. Both went through a rigorous revaluation process and payments were ultimately reduced. Proposals to re-evaluate these codes are motivated by the targeting of high-volume procedures and will be vigorously opposed by ASGE.

Approved by the ASGE Governing Board November 2018