Recent data, including 2009-2013 Medicare data relating to the cost and utilization of anatomic pathology (AP) services, demonstrates that the GAO report fails to tell the full story about cost and utilization:
- Colonoscopy utilization—and related anatomic pathology—increased in recent years as the standard of care demanded more frequent screening to detect colon cancer, including the U.S. Preventive Services Task Force grade A rating and the Affordable Care Act’s elimination of cost-sharing in 2011.
- 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.
- Medicare cut the major pathology code for GI-related biopsies by nearly 37% in 2013, resulting in a $300 million reduction in reimbursement for pathology services.
While GAO examined data from 2004 to 2010, an analysis of more recent data (2009 to 2013) shows overall AP utilization growth declining in recent years.