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SPRING 2015 NEWSLETTER 1
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SPRING 2015 NEWSLETTER
It has been exciting to be part of DHPA’s continued growth and achievements since our last newsletter to the membership six months ago. We’ve influenced policy
in Washington, D.C., grown our organization significantly, and established DHPA as the voice of independent GI practices.
When I was on Capitol Hill with many of our colleagues in March, I was inspired by the passion our members brought to their preparation and meetings with policymakers. Physicians from 29 of our then-45 member practices held 65 meetings with congressional offices over two days. We believe this was the single largest set of meetings ever held on Capitol Hill by a medical association that exclusively represents the voice of independent medical practices from a single specialty. And, we came armed with data—in the form of a White Paper we commissioned from national actuarial firm Milliman analyzing the most recent Medicare data on utilization and cost of anatomic pathology services.
I believe it’s this type of laser-like commitment to promoting, preserving and nurturing the integrated model of GI care furnished in the independent practice setting that makes DHPA special, and why we will continue to succeed in our individual practices and collectively as an association.
The scope of DHPA is remarkable. As of this writing, we stand at approximately 1,300 physicians in 52 member practices located in 28 states across the country. Our doctors care for more than two million patients each year in nearly three-and-a-half million distinct patient encounters.
As we have grown, our collective voice is being heard and making an impact. In our work to support repeal of the dysfunctional Medicare Sustainable Growth Rate payment formula this past March and April, DHPA member practices contacted members of Congress through nearly 2,000 phone
calls and personal emails. We could not have done this without each of our DHPA member practices taking ownership of this critically important issue. Ultimately, the Medicare Access and CHIP Reauthorization Act of 2015 was signed into law on April 16, 2015. I was struck by the response lawmakers had to our political action. Not only was DHPA recognized by the Congressional Leadership for our efforts supporting this bipartisan bill, but many DHPA members received personal response emails and phone calls from congressional offices. This feedback underscores to me exactly why we started this organization and why so many of our physician colleagues are actively participating. We have already made progress defining to policymakers the value of integrated GI care in the independent setting.
As we enter the second half of 2015 and the post-SGR political environment, DHPA will continue to defend our ability to deliver integrated care by confronting, with data, those who want to repeal the In-Office Ancillary Services Exception (IOASE) to the federal Stark Law. Additionally, we will remain vigilant about potential renewed efforts by CMS to threaten access to colonoscopy (we effectively defeated a similar effort last year). DHPA will also educate policymakers about how integrated care models in the independent medical practice setting provide high-quality care in a less costly setting than hospitals. Lastly, DHPA will expand our relationships with members of Congress who represent our patients and employees, as well as with other health care policymakers in Washington, D.C., while intensifying our efforts to safeguard the integrated care model from attack at the state level.
We hope you enjoy the contents of this newsletter, which offers a snapshot of our work during the first half of 2015. We also encourage you and your colleagues to continue to engage with us on key issues vital to our ability to continue delivering the highest quality care to our patients.
Dr. Scott R. KetoverPresident and Chairman of the Board, DHPAPresident and CEO, Minnesota Gastroenterology
MESSAGE FROM THE PRESIDENT:
Another Six Months of Success
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SPRING 2015 NEWSLETTER 2
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29 GIs. 65 Capitol Hill Meetings. 48 Hours in D.C.
By Dr. Fred Rosenberg DHPA Vice Chairman, Illinois Gastroenterology Group
A pillar of our mission is to protect the integrated model of care delivered by DHPA’s member practices by educating and advocating at the state and federal levels. Since our inception over a year ago, we have worked
hard to make our presence known on Capitol Hill. During our March 2015 fly-in, we strengthened and amplified our message to members of Congress and policymakers, as we developed new relationships and cultivated existing ones.
Over 48 hours, physicians from 29 DHPA member practices held 65 meetings with members of Congress and their key staff. Our message was focused and unique—promoting the high quality, cost-efficient, integrated care furnished in independent gastroenterology practices. We explained the value of our integrated care model and emphasized the need to protect it by preserving the In-Office Ancillary Services Exception (IOASE). We also advocated support for specific House and Senate legislation: the Electronic Health Fairness Act (H.R. 877) and the Removing Barriers to Colorectal Cancer Screening Act of 2015 (S. 624).
Our message on Capitol Hill was strengthened by sharing robust data. A DHPA-commissioned study by the national actuarial firm Milliman provided the congressional offices with the most current Medicare data available (highlighted below) regarding utilization and cost of anatomic pathology (AP) services.
• Colonoscopy utilization and related AP services have increased in recent years as changing standards of care demanded more frequent screening to detect colon cancer. Additionally, the U.S. Preventive Services Task Force grade A rating and the Affordable Care Act’s elimination of cost-sharing in 2011 have resulted in increased colonoscopy.1
• GI-related AP services grew more slowly in professional settings (physician offices and labs) at an annualized rate of 1.2% from 2009 to 2013, compared to the outpatient hospital setting of 3.5% during that period.2
• Medicare cut the major pathology code for GI-related biopsies by nearly 37% in 2013, resulting in a $300 million reduction in reimbursement for AP services.3
• While GAO examined data from 2004 to 2010, the DHPA-commissioned analysis of more recent data (2009 to 2013) shows overall AP utilization growth declining in recent years.4
We also presented the results of a preliminary DHPA study of adenoma detection rates (ADR), using aggregated data from over 200,000 colonoscopies performed by gastroenterologists in our member practices with integrated pathology labs. From July through December 2014, the combined ADR for male and female patients age 50 and older from our DHPA member practices (for all colonoscopies, not just screening colonoscopies) was nearly 40%.
Additional highlights from the March fly-in included lunch with Congressman Michael Burgess (R-TX), author of the SGR repeal bill, breakfast with Senator Michael Bennet (D-CO) who sits on the Senate Finance Committee and breakfast with Congressman Brett Guthrie (R-KY) who serves on the House Energy and Commerce Committee. Both of these Committees have jurisdiction over health care issues.
DHPA members should be proud of what we have been able to accomplish so far in 2015. To the best of our knowledge, our March meetings were the single largest set of meetings ever held on Capitol Hill by a medical association that exclusively represents the voice of independent medical practices from a single specialty. I know we all look forward to setting the bar even higher as we move forward together. 1Milliman, Medicare anatomic pathology utilization: 2009 through 2013, at 2 (Feb. 27, 2015).2Id. 3Id.4Id.
DHPA representatives on Capitol Hill in Washington, D.C. (March 2015)
SPRING 2015 NEWSLETTER 3
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Congress Takes Historic Action: SGR Patches Are No More
By Dr. Michael Weinstein DHPA Chair, Health Policy, Capitol Digestive Care, LLC
In mid-March, after DHPA’s visits to Capitol Hill, Congress turned its attention in earnest to permanently repealing the dysfunctional Medicare Sustainable Growth Rate (SGR) payment formula. Doing so would eliminate ever-looming and draconian payment
cuts to physicians, which created an era of uncertainty for physicians and patients.
Last year, the physician community worked closely with the authorizing committees to develop a bipartisan agreement that would not only repeal the payment cuts and need for temporary “patches,” but also create new opportunities to reward physician practices that improve quality and patient outcomes as well as constrain overall health care costs. The legislation did not advance at the time because consensus could not be achieved on whether and how to finance the package.
When Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) announced a bipartisan agreement to move the bill, H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, in March, DHPA and the broader physician community sprang into action to help enact the historic legislation. In total, DHPA member practices placed nearly 2,000 calls and emails to legislators in a very short period of time. We participated in a sign-on letter with 833 other physician organizations, supporting H.R. 2 and
encouraging SGR repeal. And, in Ohio—a key legislative state on this issue—Dr. Pradeep Bekal of DHPA member practice Ohio Gastroenterology and Liver Institute co-authored an op-ed, in the Cincinnati Business Courier.
The House passed H.R. 2 in late March by a vote of 392-37. After much debate, on April 14, 2015, the Senate approved the legislation, 92-8. With that vote, Congress approved a bipartisan solution to permanently repeal and replace the SGR formula. President Obama signed the legislation into law on April 16, 2015.
Looking to a post-SGR future, we are excited about the opportunity to improve health care delivery for patients. The law collapses three disparate incentive programs. Starting in 2019, existing Medicare quality-reporting and incentive programs, including the Physician Quality Reporting System, Value-Based Payment Modifier, and Meaningful Use, will be consolidated into a single program—the Merit-Based Incentive Payment System (MBIP). This single program will evaluate and reward or penalize physician practices based on how they perform against their peers. In addition, the new law provides bonus payments to practices that enter into innovative risk-sharing arrangements known as Alternative Payment Models.
DHPA has already hosted a webinar in which our policy consultant, John McManus, briefed our member practices to help us prepare for, and engage in, the unfolding regulatory process that will spell out important details of the program in the coming months. DHPA will continue providing our member practices with information needed to succeed in the new post-SGR environment!
By Dr. Gary Kirsh, The Urology Group, and Dr. Pradeep Bekal, Ohio Gastroenterology and Liver Institute
Dr. Pradeep Bekal
With Congressional dysfunction the norm for longer than most of us can remember, it’s refreshing that a bipartisan agreement to resolve a years-long problem in Medicare payments to physicians now seems possible. The House will vote on a historic bill this month to permanently repeal and replace the deeply flawed Sustainable Growth Rate formula – a solution which Congress has already deferred into the future 17 times.The issue is that the SGR formula ties physician reimbursement not to any medical parameter, but to Gross Domestic Product. This doesn’t take into account costs of care or the effect of an aging population.
To make matters worse, the payment cuts to physicians for services provided which are required by this SGR formula are cumulative and have ballooned over time from just 5 percent to about 21 percent – an amount so substantial that nearly every health care policy expert and patient group believes that a large number of physicians would simply drop out of the Medicare program, thereby undermining both access to and quality of care for all Medicare patients.
Click here to read the full article.
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1. Akron Digestive Disease Consultants, Inc. (Akron, OH)2. Allied Digestive Health (Red Bank, NJ)3. Anne Arundel Gastroenterology Associates (Annapolis, MD)4. Arizona Digestive Health, PC (Phoenix, AZ)5. Arizona Gastrointestinal Associates, PLC (Scottsdale, AZ)6. Asheville Gastroenterology Associates (Asheville, NC)7. Atlanta Gastroenterology Associates, LLC (Atlanta, GA)8. Borland-Groover Clinic, PA (Jacksonville, FL)9. Capital Digestive Care, LLC (Silver Spring, MD)10. Charlottesville Gastroenterology Associations (Charlottesville, VA)11. Cincinnati GI (Cincinnati, OH)12. Connecticut GI, PC (Hartford, CT)13. Consultants in Gastroenterology, PC (Independence, MO)14. Dayton Gastroenterology (Beavercreek, OH)15. Digestive Disease Associates (Gainesville, FL)16. Digestive Disease Specialists, Inc. (Oklahoma City, OK)17. Digestive Health Associates (Farmington Hill, MI)18. Digestive Health Specialists of the Southeast (Dothan, AL)19. Digestive Health Specialists, PA (Winston-Salem, NC)20. Digestive Health Specialists, PS (Tacoma, WA)21. Digestive HealthCare Center (Hillsborough, NJ)22. Gastro Health (Miami, FL)23. Gastro One (Memphis, TN)24. Gastroenterology Associates (Olympia, WA)25. Gastroenterology Associates, LLC (Baton Rouge, LA)26. Gastroenterology Associates, N.A., P.C. (Birmingham, AL)
27. Gastroenterology Center of Connecticut (Hamden, CT)28. Gastroenterology Consultants, LTD (Reno, NV)29. Gastroenterology Health Partners (Louisville, KY)30. Gastroenterology Specialties, PC (Lincoln, NE)31. Gastrointestinal Associates, PC (Knoxville, TN)32. GI Associates and Endoscopy Center, PA (Jackson, MS)33. GI Associates, LLC (Milwaukee, WI)34. GI Specialists of Georgia (Marietta, GA)35. Greater Boston Gastroenterology, PC (Framingham, MA)36. Huron Gastroenterology (Ypsilanti, MI)37. Illinois Gastroenterology Group (Elgin, IL)38. Jackson Siegelbaum Gastroenterology (Camp Hill, PA)39. Midwest Gastrointestinal Associates, PC (Omaha, NE)40. Minnesota Gastroenterology, PA (St. Paul, MN)41. Northwest Gastroenterology Associates (Bellingham, WA)42. Ohio Gastroenterology & Liver Institute (Cincinnati, OH)43. Ohio Gastroenterology Group, Inc. (Columbus, OH)44. Regional Gastroenterology Associates of Lancaster (Lancaster, PA)45. Richmond Gastroenterology Associates (Richmond, VA)46. Rocky Mountain Gastroenterology (Lakewood, CO)47. South Denver Gastroenterology, PC (Lone Tree, CO)48. South Florida Gastroenterology Associates, PA (Boynton, FL)49. Summit Gastroenterology (Lee’s Summit, MO)50. Texas Digestive Disease Consultants, PA (Southlake, TX)51. Tri-State Gastroenterology Associates, PSCS (Crestview Hills, KY)52. United Gastroenterologists (Murrieta, CA)
DHPA ACROSS THE COUNTRY
DHPA Surpasses 50 Member PracticesBy Dr. Scott R. Ketover, DHPA President and Chairman of the Board, Minnesota Gastroenterology
DHPA continues to grow—in both size and reach. In the past six months, we have added 14 new member practices to our organization, growing from 38 to 52 member practices. Today, our reach extends to 28 states and represents the voices of 1,300 physicians.
Surpassing 50 member practices is a huge accomplishment for our organization. We founded DHPA in February 2014 with 11 member practices. In 15 months, our membership has nearly quintupled—a clear indication of how our mission resonates with gastroenterologists who care for patients in independent medical practices.
Your efforts to identify other GI practices that share the same commitment as our current member practices to providing high quality, cost-efficient, and integrated care in independent practices have contributed to our sustained growth. Please take a look at the list below of our current member practices and let your group’s DHPA Board member know whether there are other “gold standard” practices in which you have colleagues around the country to whom we should reach out about potential membership.
Today, our reach extends to 28 states and represents the voices of 1,300 physicians
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Get to Know a DHPA Member Practice: Dayton Gastroenterology, Inc.
With such rapid growth during DHPA’s first 15 months of existence, most of the physicians in our member practices haven’t had the opportunity to meet their counterparts across the country, learn about each other’s practices, and find out what drew them to DHPA. With that in mind, we recently had the opportunity to talk about DHPA, the recent visit to Capitol Hill, and more
with new DHPA Board member, Dr. Sanjay Sandhir, who leads Dayton Gastroenterology’s growing practice in the Miami Valley region of Ohio. Dayton Gastro joined DHPA about six months ago and quickly became an integral member of the Association. Here’s a snapshot of our conversation with Dr. Sandhir.
DHPA: Tell us about Dayton Gastroenterology and what makes you unique in Dayton and as an independent GI practice?
Dr. Sandhir: Dayton Gastro is proud to be the oldest and most established group in the area—we’ve been here for more than 30 years. We have 23 physicians and over 200 staff in our practice, and we’re expanding to 25 physicians soon.
Dayton Gastro features one of the few ambulatory surgery centers in the country that can conduct an endoscopic ultrasound in the office. We provide high-quality care for our patients at a lower cost than hospitals.
DHPA: What were the main reasons your group decided to join DHPA?
Dr. Sandhir: In DHPA, we saw an opportunity to work with the best known clinical GI groups across the country. We wanted a seat at the table to influence important policy issues including successfully repealing the SGR and opposing repeal of the In-Office Ancillary Services Exception under the federal Stark law.
We identified with DHPA because we’re physicians who really believe in and are passionate about providing high quality care for patients in independent practices. The burden of GI disease is so large in this country, and we have the power to make a difference in society. By joining with DHPA, Dayton Gastro’s voice became that much louder.
DHPA: What was your key takeaway from your meetings on Capitol Hill during your trip to Washington, D.C., for the DHPA Board of Directors’ meeting in March?
Dr. Sandhir: While Dayton Gastro has participated in local and state level advocacy efforts, the March fly-in was our first foray—but definitely not our last—into the national scene. Our
meetings with members of Congress and their staff underscored the importance of DHPA’s collective voice. Together, we are becoming much more powerful advocating for a national health care framework that prioritizes patient access to high quality, low-cost care in the independent practice setting.
Not only do conversations with leaders in health policy have the potential to preserve independent practices, but more importantly, they have the potential to inform how patients receive and afford health care. I could truly feel the excitement and momentum advocating alongside colleagues from around the country, and I can’t wait to come back!
DHPA: What do you see as the greatest challenges and opportunities for DHPA to address for independent GI practices over the next year?
Dr. Sandhir: Our challenges over the next year are two-fold. On a local and state level, we must continue to be vigilant in monitoring legislation that threatens our integrated model of GI care. On a national level, we need to encourage legislators to protect affordable, accessible colonoscopies—our most critical tool in fighting colon cancer.
The power of 52 leading independent GI practices with 1,300 physicians from across the country working together is our greatest asset and provides an opportunity to make our voice heard. As a young and rapidly growing organization, we also have an opportunity to collaborate with the tri-societies to amplify our message about the value of GI care furnished by independent practices, such as ours in the Miami Valley region of Ohio.
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SCOTT R. KETOVER, MD DHPA President and Chairman of the Board Minnesota Gastroenterology, PA, St. Paul, MN
FRED ROSENBERG, MD DHPA Vice Chairman Illinois Gastroenterology Group, Elgin, IL
KYLE P. ETZKORN, MD DHPA Treasurer Borland-Groover Clinic, PA, Jacksonville, FL
THOMAS J. SHIREMAN, MD DHPA Secretary Consultants in Gastroenterology, PC, Kansas City, MO
MICHAEL L. WEINSTEIN, MD DHPA Chair, Health Policy Capital Digestive Care, LLC, Silver Spring, MD
ARIF AZIZ, MD DHPA Chair, Data Analytics GI Specialists of Georgia, Atlanta, GA
PRADEEP BEKAL, MD At-Large Member Ohio Gastroenterology and Liver Institute, Cincinnati, OH
LAWRENCE S. KIM, MD At-Large Member South Denver Gastroenterology, PC, Denver, CO
KEVIN HARLEN DHPA Assistant Treasurer Capital Digestive Care, LLC, Silver Spring, MD
www.dhpassociation.org
CONTACT THE DHPA EXECUTIVE COMMITTEE
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