Proposed Bundled Payment Framework for Colonoscopy

On January 1, 2014, the U.S. Centers for Medicare and Medicaid Services (CMS) instituted payment reductions for upper endoscopy procedures. They acted on recommendations from the Relative Value Uptake Committee (RUC) of the American Medical Association, making even deeper cuts than recommended. The RUC recently reached decisions on payments for colonoscopy; these are now before the CMS for final decision-making on reimbursement changes that will take effect on January 1, 2015.

In the context of these reimbursement cuts, which will likely spread to private payers, interest in alternative payment structures is increasing, including reference payment (i.e., payers fix the price for a given service for all providers) and bundled payment (i.e., h…