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    Physicians regroup, prep strategies during fee reprieve

    Advocacy conference aims for government-urologist dialogue


    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.
    Washington—Urologists and other physicians who treat Medicare patients have been given a short reprieve from the across-the-board 10.1% reimbursement cut that was scheduled for Jan. 1, and have even received a little bit of a raise. Now they must join in the battle to prevent that cut from taking effect July 1.

    Efforts are under way at AUA to defend against actions to require accreditation for in-office imaging services as Congress considers legislation to cope with the physician pay cut. Such a move was apparently attempted in December, when legislation to derail the reduction was passed.

    Fast Facts
    "We are grateful that they replaced that reimbursement reduction with a modest (.5%) increase," said Brian Reuwer, government relations manager at AUA. "But we would have preferred it to be good for a year, rather than just 6 months, or, even better, a permanent fix."

    As Reuwer and other AUA representatives worked Capitol Hill during the latter part of 2007 as part of the overall campaign by organized medicine to replace the looming Medicare pay cut with even a modest increase, they learned of a possible effort to include in the legislation a mandatory accreditation requirement for in-office imaging.

    AUA members were alerted, and, within 3 days, more than 1,000 telephone calls and e-mails flooded Capitol Hill in opposition to the idea. Apparently, that effort paid off: The ultrasound provision was not included in the final legislation, which was part of the extension of the State Children's Health Insurance Program (SCHIP).

    "We don't feel that the government needs to be involved in such an unnecessary mandate involving the operation of physicians' offices," Reuwer said of the possible imaging mandate. "It is important that our urologic patients have adequate access to care."

    Now the new battle is under way, and AUA intends to use the AUA-American Association of Clinical Urologists Joint Advocacy Conference in Washington (March 30 to April 1) to present urologists' case to members of the House and Senate.

    The conference will include presentations by representatives of the Centers for Medicare & Medicaid Services, members of Congress, and other top officials. On April 1, urologists will meet face to face on Capitol Hill with congressmen and senators and have an opportunity to personally discuss the potential impact of the Medicare reimbursement reductions, as well as the in-office imaging issue and other top legislative concerns.

    "We want to encourage our members to participate in this conference," Reuwer said. "The timing couldn't be better, and it will be important to have a strong turnout."

    The American Medical Association, the Alliance of Specialty Medicine, of which AUA is a member, and other medical groups sought, and continue to seek, a permanent solution to the payment formula problem that lies at the heart of the fee schedule dilemma that has forced Congress to intervene year after year as pay cuts are threatened. However, the Congressional Budget Office estimates that the cost of replacing that formula with one more favorable to physicians will continue to skyrocket and will make the likelihood of enacting such legislation during 2008 remote, at best.

    Instead, it is considered likely that Congress will use the 6-month reprieve that it passed in December to develop a longer-term approach, perhaps one that is long enough to move the issue to the new Congress in 2009, which many expect will consider major health care reform legislation.

    While that interim remedy is being considered, however, there is concern over what steps Congress will take to cover the cost. According to the Congressional Budget Office, the 6-month reprieve for physicians will cost $1.4 billion over 5 years. Those costs were offset by cuts to a special stabilization fund for Medicare Advantage plans.


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