ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond | October 2023-8_Issaka

8_Issaka_Health Advocacy for Coloscopy & Policy

Pdf Summary

The document centers around colorectal cancer (CRC) screening, with a primary focus on colonoscopy advocacy and policy, as discussed by Rachel Issaka, MD. It's structured to highlight current challenges and legislative actions related to the affordability and accessibility of colonoscopies.<br /><br />**Affordable Care Act (ACA) Provisions:** <br />The ACA mandates that CRC screenings for average-risk adults are covered without consumer cost-sharing. Despite these provisions, barriers like cost-sharing and prior authorizations hinder access. Patients often face out-of-pocket costs with variations among Medicare and commercial plans, leading to reduced screenings and follow-ups due to financial strain.<br /><br />**Impact of Prior Authorizations:**<br />Prior authorization policies can exacerbate healthcare disparities, particularly affecting American Indian/Alaska Native and non-Hispanic Black populations. These policies contribute to delays in surveillance colonoscopies and increase administrative burdens, leading to healthcare provider burnout and added costs.<br /><br />**Legislative Initiatives:**<br />Two notable bills aim to streamline prior authorization processes and reduce care delays:<br />1. **Improving Seniors Timely Access to Care Act:** Establishes an electronic prior authorization (PA) program, standardizing the PA process.<br />2. **Getting Over Lengthy Delays in Care as Required by Doctors Act of 2022:** Proposes a rational approach to prior authorizations, exempting frequently approved services.<br /><br />**Medicare and Payment Models:**<br />The Medicare Access and CHIP Reauthorization Act (MACRA) replaced the Sustainable Growth Rate (SGR) formula with the Quality Payment Program (QPP), including the Merit Based Incentive Payments System (MIPS) and Alternative Payment Models (APMs). The current payment models, however, fail to address the complexities of gastrointestinal conditions. Legislation mandating CMS collaboration with specialty societies and APMs specific to gastroenterology is necessary.<br /><br />**Advocacy Efforts:**<br />Recent advocacy still demonstrates success, with significant milestones such as the signing of the Medicare Loophole Bill into law and the CMS rule on follow-up colonoscopy coverage, both aimed at enhancing accessibility and reducing patient burden.<br /><br />**Conclusion:**<br />Ongoing advocacy, transparent policies, and legislative support are crucial for improving CRC screening processes and outcomes. Engaging with elected officials and supporting relevant legislation, alongside active participation in GI societies, can lead to meaningful changes in healthcare delivery for CRC.

Keywords

colorectal cancer screening

colonoscopy advocacy

Affordable Care Act

prior authorizations

healthcare disparities

legislative initiatives

Medicare payment models

Quality Payment Program

advocacy efforts

healthcare accessibility