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Change Coming to GI Centers' Payment Models

AGA President: Now's the time to get a jump on bundled colonoscopy payments.

Published: August 26, 2014

Bundled payments are the future for GI centers, and it could be for the best, some say.

John Allen, MD, MBA, president of the American Gastroenterological Association (AGA), says in a recent article in Gastroenterology & Endoscopy News that falling fee-for-service reimbursement rates for colonoscopy may mean that it's time for GI facilities to get a head start on alternative payment models.

"For a number of years, we have been demonstrating the quality and value of colonoscopy in terms of cancer reduction, but now we are facing unprecedented pressures in terms of cost. We are getting to a tipping point where the unit payment is going to be below the unit cost for many of us," Dr. Allen told Gastroenterology & Endoscopy News. "If we want to preserve this important lifesaving tool, we are going to have to start thinking about different ways of packaging it."

Dr. Allen says that shifting to value-based bundled payments from fee-for-service — especially for colonoscopy, where fees can dramatically differ from provider to provider — can help facilities draw in patients by providing high-quality care in a cost-efficient setting.

Many insurers, he says, including Medicare, are currently in the process of developing infrastructures for bundled payments for colonoscopy that focus on value-based reimbursements. Dr. Allen suggests GI centers be proactive and begin developing and negotiating their own bundled colonoscopy packages with contracted insurance companies.

AGA cites an example of a bundled colonoscopy package that comprises:

  • the pre-procedure period, which includes consultation and patient instruction and prep;
  • the procedure, including fees, sedation, equipment and pathology; and
  • a post-procedure warranty that includes repeating a procedure if there was poor prep, and follow-up communication with the patient.

Kendal Gapinski

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