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Medicare officials have slashed payments for a common pathology code, a move likely to affect the bottom line for many gastroenterologists.
In the Medicare Physician Fee Schedule final rule, published on Nov. 1, officials at the Centers for Medicare and Medicaid Services (CMS) announced plans to cut the technical component for the surgical pathology CPT code 88305 (tissue exam by a pathologist) by about 50%. Although the professional component of the service will increase by 2%, the global payment will drop by about one-third, according to Dr. Lawrence R. Kosinski, AGAF, chairman of the practice management and economics committee of the American Gastroenterological Association. The changes take effect on Jan. 1.
"Everybody is going to make less money on this," said Dr. Kosinski, who practices in Elgin, Ill.
The cuts are significant, he said, because many gastroenterologists either run their own labs or partner with a pathology lab to retain some of the revenue, he said.
The cuts were made as part of a larger effort to reduce payments for diagnostic services provided to the same beneficiary on the same day. In about one-third of the claims for CPT code 88305, multiple specimens from the same beneficiary were examined at the same time by the same pathologist, according to CMS. The agency estimates that Medicare spent $1.3 billion on that code alone in 2010.
Endoscopic codes could be next on the chopping block, Dr. Kosinski said. "We’re trying to catch a falling knife."
Gastroenterologists may, however, have new opportunities to make money in this era of declining reimbursement if they are willing to reconfigure their practices around the idea of value-based payments, Dr. Kosinski noted.
With the federal government’s growing focus on lowering costs and bundling payments, gastroenterologists may be able to retain some of their revenue in the future by assuming risk for the full episode of care and working to keep costs down and patients out of the hospital.
"Whenever you have massive change, it creates opportunities for someone," he said.
Medicare officials have slashed payments for a common pathology code, a move likely to affect the bottom line for many gastroenterologists.
In the Medicare Physician Fee Schedule final rule, published on Nov. 1, officials at the Centers for Medicare and Medicaid Services (CMS) announced plans to cut the technical component for the surgical pathology CPT code 88305 (tissue exam by a pathologist) by about 50%. Although the professional component of the service will increase by 2%, the global payment will drop by about one-third, according to Dr. Lawrence R. Kosinski, AGAF, chairman of the practice management and economics committee of the American Gastroenterological Association. The changes take effect on Jan. 1.
"Everybody is going to make less money on this," said Dr. Kosinski, who practices in Elgin, Ill.
The cuts are significant, he said, because many gastroenterologists either run their own labs or partner with a pathology lab to retain some of the revenue, he said.
The cuts were made as part of a larger effort to reduce payments for diagnostic services provided to the same beneficiary on the same day. In about one-third of the claims for CPT code 88305, multiple specimens from the same beneficiary were examined at the same time by the same pathologist, according to CMS. The agency estimates that Medicare spent $1.3 billion on that code alone in 2010.
Endoscopic codes could be next on the chopping block, Dr. Kosinski said. "We’re trying to catch a falling knife."
Gastroenterologists may, however, have new opportunities to make money in this era of declining reimbursement if they are willing to reconfigure their practices around the idea of value-based payments, Dr. Kosinski noted.
With the federal government’s growing focus on lowering costs and bundling payments, gastroenterologists may be able to retain some of their revenue in the future by assuming risk for the full episode of care and working to keep costs down and patients out of the hospital.
"Whenever you have massive change, it creates opportunities for someone," he said.
Medicare officials have slashed payments for a common pathology code, a move likely to affect the bottom line for many gastroenterologists.
In the Medicare Physician Fee Schedule final rule, published on Nov. 1, officials at the Centers for Medicare and Medicaid Services (CMS) announced plans to cut the technical component for the surgical pathology CPT code 88305 (tissue exam by a pathologist) by about 50%. Although the professional component of the service will increase by 2%, the global payment will drop by about one-third, according to Dr. Lawrence R. Kosinski, AGAF, chairman of the practice management and economics committee of the American Gastroenterological Association. The changes take effect on Jan. 1.
"Everybody is going to make less money on this," said Dr. Kosinski, who practices in Elgin, Ill.
The cuts are significant, he said, because many gastroenterologists either run their own labs or partner with a pathology lab to retain some of the revenue, he said.
The cuts were made as part of a larger effort to reduce payments for diagnostic services provided to the same beneficiary on the same day. In about one-third of the claims for CPT code 88305, multiple specimens from the same beneficiary were examined at the same time by the same pathologist, according to CMS. The agency estimates that Medicare spent $1.3 billion on that code alone in 2010.
Endoscopic codes could be next on the chopping block, Dr. Kosinski said. "We’re trying to catch a falling knife."
Gastroenterologists may, however, have new opportunities to make money in this era of declining reimbursement if they are willing to reconfigure their practices around the idea of value-based payments, Dr. Kosinski noted.
With the federal government’s growing focus on lowering costs and bundling payments, gastroenterologists may be able to retain some of their revenue in the future by assuming risk for the full episode of care and working to keep costs down and patients out of the hospital.
"Whenever you have massive change, it creates opportunities for someone," he said.
