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    Medicare, imaging cuts squeeze urologists, patients

    Physicians, lawmakers turn up heat to reform DRA-mandated cuts


    Washington—Urologists and other physicians are facing another battle over Medicare fees, with a 9.9% cut looming for 2008 and further reductions that will be imposed on physicians who provide in-office imaging services as a result of the Deficit Reduction Act of 2005.

    The scramble to avoid that huge reduction by the Centers for Medicare & Medicaid Services is under way, as physician and specialty organizations lobby Congress to provide relief, as it did last year, and to find a more permanent solution by reforming the sustainable growth rate (SGR) formula that is blamed for causing the continuing fee schedule cuts.

    Bob Gatty
    Meanwhile, a divided Medicare Payment Advisory Commission (MedPAC) on March 1 offered Congress two different pathways for dealing with the SGR, solutions that were met with skepticism by influential members of Congress during a hearing on the subject. MedPAC also recommended an increase in Medicare fees averaging 1.7% for 2008.

    At the same time, legislation has been introduced to delay deep payment cuts in medical imaging services for Medicare patients, which took effect on Jan. 1. On Feb. 28, Reps. Carolyn McCarthy (D-NY), Gene Green (D-TX), and Joseph Pitts (R-PA) introduced a bill to delay further implementation of the cuts for 2 years and to require a study by the Government Accountability Office to evaluate the impact of the DRA payment reductions on patient access and service issues.

    The Access to Medical Imaging Coalition (AMIC) released a study by The Moran Co., a Washington-based health care and research consulting firm, that shows the DRA-required cuts will reduce total reimbursement for imaging services in physician offices and in imaging centers by 18% to 19% below total reimbursement for similar services provided in hospital outpatient departments.

    Fast Facts
    All of these developments pose significant challenges for urologists as they seek to serve Medicare patients effectively and still receive equitable reimbursement for their services.

    In its report dealing with the SGR, MedPAC emphasized the urgent need to slow Medicare's rising costs, particularly when those costs are coupled with the projected growth in the number of Medicare beneficiaries. Unless a solution is found, the impact will be felt by taxpayers and beneficiaries alike, the commission said.

    The SGR determines the annual update to the physician payment rate, consistent with an expenditure target tied to growth in the gross domestic product.

    "Significant disagreement exists within the Commission about the utility of expenditure targets," the MedPAC report said. "Moreover, the complexity of the issues make it difficult to recommend any option with confidence."

    Thus, MedPAC suggested these two options:

    • scrap the SGR in favor of a calculation reflecting physician practice costs
    • expand the SGR spending limits to all of Medicare, eventually including hospitals, nursing homes, and providers in the formula.

    "As long as spending targets remain in place, this annual cycle has no end in sight," Cecil B. Wilson, MD, chair of the American Medical Association's board of trustees, declared at a Senate Finance Committee hearing on the MedPAC reports.

    "We are perplexed as to why MedPAC would, one minute, state the SGR is broken and unsustainable, and in the next breath, recommend extending it to all health care providers," added Thomas R. Russell, MD, executive director of the American College of Surgeons. "If it is broken, fix it; don't expand it."

    Can Congress mend Medicare?

    While Committee Chair Max Baucus (D-MT) said experience shows that a target-based system that cuts payment rates may not effectively control the volume of services or overall spending, Sen. Gordon Smith (R-OR) doubted that this Congress would deal with the issue.


    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.


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