ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond | October 2023-Health Advocacy for Colonoscopy & Policy

Video Transcription

Video Summary

The speaker discusses several policies related to colonoscopy, including the Affordable Care Act, cost sharing, and prior authorizations. They highlight the importance of understanding these topics as they impact day-to-day medical practice. Under the Affordable Care Act, average-risk adults are required to be covered for colon cancer screenings at no cost to the patient. However, the speaker notes that threats to the Affordable Care Act still exist. Cost sharing refers to the portion of healthcare costs that patients must pay out-of-pocket. The ACA has placed limits on cost sharing for most plans, but some plans are not regulated and are exempt from these limits. Prior authorizations are used by insurance companies to determine if a prescribed product or service will be covered. The speaker discusses the challenges and implications of cost sharing and prior authorizations on patient outcomes, access to care, disparities, and healthcare costs. They also outline two bills in Congress that aim to address these issues. Lastly, the speaker addresses the Medicare Access and CHIP Reauthorization Act (MACRA) and its impact on physician reimbursements. They discuss the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs) under MACRA, highlighting the challenges and potential solutions for gastroenterology practices. The speaker emphasizes the importance of advocacy from healthcare professionals and the need for legislation to address these policy issues.

Asset Subtitle

Rachel B. Issaka, MD, MAS

Keywords

colonoscopy policies

Affordable Care Act

cost sharing

prior authorizations

Medicare Access and CHIP Reauthorization Act

gastroenterology practices