Massachusetts Gastroenterology Association Statement on BCBSMA's Pause of Restrictive Sedation Policy, Upholding Quality Patient Care

The Massachusetts Gastroenterology Association (MGA) applauds the decision by Blue Cross Blue Shield of Massachusetts (BCBSMA) to pause the implementation of Policy #154, which aimed to restrict coverage of Monitored Anesthesia Care for many patients undergoing colonoscopy and other endoscopic procedures.

Policy #154 raised significant concerns within the medical community and among patients, including increased barriers to patient care access and creating inefficiencies in existing efficient medical systems, confusion and fear among patients, and highlighted the shortage of nurses trained to provide conscious sedation.

Over the past several months, the MGA, together with the Massachusetts Medical Society,  American Society for Gastrointestinal Endoscopy, American College of Gastroenterology, American Gastroenterological Association and Digestive Health Physicians Association, have actively opposed the implementation of this policy.  Our advocacy was driven by our commitment to protecting the physician-patient relationship and maintaining the high standard of healthcare that patients in Massachusetts expect and deserve.

We are pleased that BCBSMA has officially paused the implementation of this restrictive sedation policy, and that claims denied after January 1, 2024, will be retroactively approved, ensuring continuity of care for our patients. 

We appreciate BCBSMA's openness to continued dialogue and their acknowledgment of the policy's potential impact on our medical community. The MGA will maintain an active role in working with BCBSMA to prioritize patient health in any future policy considerations.

The MGA was founded on the principles of education, networking, and advocacy. Today’s decision underscores how important it is for the Massachusetts GI community to continue to speak with one voice. We extend our heartfelt thanks to our MGA members and the entire medical community for their unwavering support and advocacy in this matter. This outcome is not just a victory for healthcare providers but also for the patients we serve, reaffirming our commitment to accessible and quality healthcare in Massachusetts.

Sincerely,

Lauren Bleich, MD MPH; MGA President

To the Members of the Massachusetts Gastroenterology Association,

On behalf of the MGA board of directors, along with strong support from gastroenterologists throughout the state, along with support from the Massachusetts Society of Anesthesiologists (MSA), I am reaching out with an update regarding our efforts in opposition of the Blue Cross Blue Shield (BCBS) policy number 154 regarding the coverage of monitored anesthesia care (MAC) in GI procedures. This policy is set to be enforced as of July 1, 2023. As you are aware, one of the MGA’s primary missions is to promote high quality and cost-effective GI care for the patients in our state. Whether you are a part of a private practice, hospital-based group, multi-specialty group or other setting, we can all benefit from working together.

The MGA has been working with members of the MSA, MHA (Massachusetts Health & Hospital Association), MMS (Massachusetts Medical Society), and MAASC (Massachusetts Association of Ambulatory Surgery Centers). We are also in discussions with ASGE regarding updates to the 2018 guidelines that BCBS is utilizing to argue that conscious sedation is sufficient for patients undergoing GI procedures, as well as ACG, AGA, DHPA and MNA (Massachusetts Nursing Association).

Our arguments against this BCBS policy include:

• The current backlog in procedure availability as a result of the COVID-19 pandemic, as well as recent recommendations to lower the screening age to 45 years old
• Patients have received propofol for at least 10 years (one CRC screening cycle for average risk patients), and now expect this type of anesthesia for their procedures
• Sedation choices should be determined by patient & their physician, not dictated by insurance
• -Concerns regarding increased risk for possible failed procedures, inadequate sedation, pain and post-procedure nausea
• Legalization and increased usage of marijuana products, leading to increased needs for sedation
• Conscious sedation will require training of nurses and GI physicians (recent graduates) who lack sufficient training, in the setting of a significant labor shortage in the healthcare industry

As a result, this suggested policy will limit access to high-quality care for BCBS members.

We will continue to update you in our efforts to oppose this consequential policy. Please continue to support the MGA by asking your GI colleagues and fellows to join the MGA (Massachusetts Gastroenterology Association - Join (massgi.org). Together we will continue to work to provide the best care for our patients.

Sincerely,

Lauren Bleich, MD- MGA President 

(6) DHPA Toolkit - State Regulation of PBMs.pdf

Medical Society Releases Practice Guide on New State and Federal Price Transparency Requirements

The Massachusetts Medical Society is pleased to share a comprehensive practice guide developed by the MMS to support physician practices navigating new state and federal price and transparency disclosure requirements related to surprise billing. 

 

These new, overlapping disclosure requirements on physicians related to notice and price transparency have created significant challenges for physicians seeking to comply in good faith with both laws. While the implementation of the state requirements has been delayed, some version of these state requirements is likely to take effect on July 31, 2022. Most of the federal requirements are currently in effect, as of January 1, 2022. As such, this resource is intended to help physician practices prepare to understand whether and how both the state and federal disclosure requirements may apply for any given patient and to provide considerations for operationalizing these new requirements.

 

For more information, please visit the Medical Society’s Surprise Billing and Patient Notice Resource Center.

Baker-Polito Health Care Legislation Overview_ March 2022 (002).pdf

There are important changes ahead which may impact endoscopic practice and patient access to care in both private and academic centers. This article provides a nice review. 

MGA remains committed to representing gastroenterologists and our patients in Massachusetts.

Sincerely,
The MGA Board

In response to the Blue Cross Blue Shield "site of service differential," and specifically, the June 1, 2013 notice of further reduction in reimbursement for endoscopic procedures performed in hospitals, we took the following actions:

1. Retained the counsel of attorney Michael Blau, Esq from Foley and Lardner, LLP.
2. Solicited the input of our national GI societies.
3. Filed a formal complaint (93A Demand for Relief August 27,2013) with the Massachusetts Commissioner of Insurance, the Massachusetts Attorney General, and the State Bureau of Consumer Affairs.

The MGA believes this policy is unfair and unsafe for patients and consumers by limiting necessary hospital services and intruding inappropriately on the patient-provider relationship. We believe it violates Massachusetts law by flouting anti-kickback statutes, and restricting treatment for patients without adequate education of consumers and without approval from the appropriate state officials.

We await a response and will keep you informed.

Sincerely,
The MGA Board