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

Dr. Rachel Issaka's presentation at Fred Hutchinson Cancer Center highlights key issues in colorectal cancer (CRC) screening, with a focus on colonoscopy and the impacts of healthcare policies like the Affordable Care Act (ACA) and Medicare Access and CHIP Reauthorization Act (MACRA).<br /><br />**Key Points:**<br /><br />1. **Colonoscopy and the ACA**:<br />   - ACA mandates coverage for CRC screenings for average-risk adults without cost-sharing.<br />   - However, out-of-pocket costs persist, affecting screening rates and follow-up, particularly in certain Medicare and Medicaid plans.<br />   - Prior Authorizations: Insurance scrutiny delays care, increasing disparities and healthcare costs.<br /><br />2. **Implications**:<br />   - CRC deaths are highest in American Indian/Alaska Native and non-Hispanic Black populations due to limited access to screening.<br />   - Prior authorizations delay necessary surveillance and increase administrative burdens, contributing to physician burnout and higher healthcare costs.<br /><br />3. **Legislative Efforts**:<br />   - **Improving Seniors Timely Access to Care Act** aims to streamline prior authorizations by establishing electronic procedures and increasing transparency.<br />   - **Getting Over Lengthy Delays in Care as Required by Doctors Act** aims to exempt physicians from prior authorizations for frequently approved services.<br />   - MACRA replaced the Sustainable Growth Rate (SGR) formula with the Quality Payment Program (QPP), standardizing payments and offering incentives for alternative payment models (APMs).<br /><br />4. **Challenges with MIPS and APMs**:<br />   - Current MIPS measures do not adequately address gastroenterology needs.<br />   - APMs often fail to capture the complexity of gastrointestinal conditions, necessitating specialty-specific measures and stable reimbursements.<br /><br />5. **Advocacy Success**:<br />   - The Medicare Loophole Bill signed into law facilitated better follow-up colonoscopy coverage, demonstrating effective advocacy's impact on policy improvement.<br /><br />**Conclusion**:<br />While new policies bring hope, ongoing legislative support is essential to eliminate cost-sharing barriers, streamline prior authorizations, and develop payment models reflecting the intricate nature of gastroenterology. Advocacy, encouraged through GI societies, is crucial in pushing for such legislative changes.

Keywords

Colorectal Cancer

CRC Screening

Colonoscopy

Affordable Care Act

Medicare Access and CHIP Reauthorization Act

Prior Authorizations

Healthcare Disparities

Legislative Efforts

Quality Payment Program

Gastroenterology Advocacy