August 05, 2025
5 min learn
Key takeaways:
- CMS’ proposed “effectivity adjustment” of –2.5% — made each 3 years — can be utilized to work RVUs for GI procedures.
- ACG believes this sends a “combined message” centered extra on velocity than high quality.
ACG has voiced issues about CMS’ proposed cost charges for doctor providers in 2026, which incorporates an “effectivity adjustment” of –2.5% utilized to funds for gastrointestinal procedures resembling colonoscopies.
These cuts can be made each 3 years, in response to ACG.
Moreover, CMS has proposed adjustments to the best way doctor apply bills are calculated for office-based vs. hospital settings, probably resulting in decreased funds for these working primarily in hospitals.
Based on ACG President Amy Oxentenko, MD, FACP, FACG, AGAF, professor of drugs and vice dean of apply at Mayo Clinic, the effectivity changes are notably regarding and can imply decreased compensation for proceduralists, together with these in gastroenterology.
“We really feel it’s sending a combined message,” Oxentenko advised Healio. “We’ve been so centered on value-based care lately, and now it’s pivoting towards velocity and amount. We imagine it sends the flawed message in well being care, the place high quality is so vital, particularly in a procedural specialty like screening colonoscopy.”
Healio spoke with Oxentenko concerning the proposed payment schedule’s potential affect and mentioned how gastroenterologists — and sufferers — can take motion to make sure process high quality requirements are maintained.
Healio: What are your ideas on CMS’ doctor cost proposal?
Oxentenko: Relying on an individual’s sort of apply, this proposal would possibly really feel impartial and even appear useful for some suppliers. The one factor that’s most regarding for us is that this effectivity piece. That is an space that gastroenterologists, but in addition any procedural or surgical practitioners, needs to be attentive to. It proposes slicing most doctor work funds by 2.5% each 3 years.
I believe that when this idea was put into place, the group who conceived it was assuming that as you do any technical talent or procedural exercise, you develop into extra environment friendly in it. With repetition, all of us achieve experience and effectivity in these hands-on duties.
Healio: Why is that this logic doubtlessly defective?
Oxentenko: Within the first few years of somebody’s profession, they’re up-skilling and studying be extra environment friendly of their apply, so there may be some linearity to that improved effectivity. Nevertheless, that can plateau.
Think about getting this message about an effectivity tax each 3 years over the course of a 30-year profession. Based mostly on this proposal, this implies you’re going to be paid much less each 3 years due to that effectivity.
There’s solely a lot quicker and extra environment friendly we are able to get. At a sure level, high quality will begin to endure. Early on in your profession, you might get extra savvy at inserting the scope extra rapidly. Nevertheless, our tips suggest a minimal withdrawal time of at the very least 6 minutes, ideally 9 minutes, as a high quality metric in colonoscopy, given we all know there’s improved adenoma detection.
Which means we must always not have a objective to get quicker on the best way out, as we all know that it’ll come at the price of performing a high-quality examination.
Healio: What are the potential harms of prioritizing effectivity on this means?
Oxentenko: The half we have to shed a lightweight on is that we don’t wish to encourage effectivity on the best way out. We maintain gastroenterologists to a high quality customary about minimal withdrawal occasions. If CMS tells individuals they’re going to be reimbursed much less as a result of they’re extra environment friendly, is the company incentivizing them to do quicker procedures as a result of they’re being reimbursed much less per process? If that’s the case, would possibly high quality endure? Will gastroenterologists be rushed, see fewer adenomas and take much less time to scrub, wash and actually examine?
One other concern is that we’ve been growing plenty of nice AI instruments to assist with procedures, as they’ll present an extra set of “eyes” to permit us to see extra polyps we could have in any other case missed. I fear that there might be misinformation round the concept the usage of AI is making us extra environment friendly and faster with our procedures.
AI might be including time to our procedures as a result of it’s drawing our eyes to extra areas we’d have missed and revealing extra polyps, which should then be eliminated. These instruments are making the standard of what we’re doing even higher. Nevertheless, that extra high quality means extra time.
Healio: What is ACG’s stance on this?
Oxentenko: We’ve tried to be vocal about it, and to say, “Let’s forged a lightweight on this and ensure CMS understands what they’re implying and what stands out as the unintended penalties.” GI practices should add extra procedures, as a result of they’re getting paid much less because of the “effectivity adjustment,” most impacting these practices with essentially the most skilled endoscopists.
We additionally need the company to grasp our issues that by lowering reimbursement based mostly on effectivity, they could be incentivizing velocity over high quality. We’re involved this can trigger proceduralists to go towards our said tips due to a perverse disincentive that isn’t evidence-based or quality-based.
That’s the message that must be emphasised in a means that can hopefully attain the administration. We wish to remind them that they wouldn’t wish to have their colonoscopies achieved by somebody who’s extra nervous about how briskly they’re going fairly than doing an intensive, high quality examination.
Healio: What can our readers do to strengthen ACG’s place?
Oxentenko: We should always make sufferers conscious that we do have high quality indices in colonoscopy, by way of adenoma detection charge and minimal scope withdrawal time.
We wish to ensure sufferers are conscious that these are vital. We wish to bear in mind the voice of the affected person in all this and encourage them to boost their voices to Medicare and say, “Wait a minute. I don’t wish to go to somebody simply because they’re quick. That’s not vital to me. I would like somebody who is sweet and can present a high-quality examination.”
Healio: Is there anything you’d like to emphasise?
Oxentenko: We now have centered a lot on high quality lately, and we don’t wish to simply begin specializing in numbers and velocity. That’s not how we’ve been skilled in well being care. This isn’t a manufacturing unit the place we’re not involved about high quality output.
That is the place we have to lean in. We’d like physicians to work with coverage makers and provides examples of the unfavorable affect this might have on our sufferers. ACG, AGA and ASGE not too long ago known as on members in an motion alert to contact CMS on to voice their issues. We actually have to dial that up and lift our voices, as a result of it’s onerous to disregard the voice of purpose in offering high quality well being care.
Reference:
For extra info:
Amy S. Oxentenko, MD, FACP, FACG, AGAF, may be reached at oxentenko.amy@mayo.edu.
