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    SGR patch includes ‘troubling’ provision

    Urology groups also wary of proposals to curb Stark exception

    Bob GattyBob GattyWashingtonOn April 1, President Obama signed H.R. 4302, the Protecting Access to Medicare Act of 2014, which avoids the scheduled 24% Medicare payment cut, provides a 0.5% payment update through Dec. 31, and extends the deadline for payment reform until April 1, 2015.

    That action came despite opposition from major urologic and other physician organizations that are all tired of decade-long delays and want the sustainable growth rate (SGR) formula reformed now. But this politically divided Congress was unable to achieve that, and so in passing H.R. 4302, simply punted the ball to the new Congress that will take over in January.

    Especially troubling to urology is a provision that instructs Medicare officials to review the value of some procedures and sets a target for reductions of misvalued codes. The bill orders the Government Accountability Office (GAO) to study the American Medical Association’s process for setting the value of procedures.

    The AUA opposed that provision, noting that the vast majority of physician services have been reviewed, resurveyed, and revalued over the course of the past few years, and said the provision would disproportionately affect specialty physicians.

    Provision ‘not acceptable to urology’

    “The AUA was hoping that, this year, Congress would provide a fair and permanent fix to the ongoing SGR problem. Instead, Congress has proposed a patch which, instead of finally putting the issue to bed, will allow the Secretary of Health and Human Services (HHS) to bypass the RUC (Relative Value System Update Committee) process and determine the reimbursement for physician services. This is not acceptable to urology and will potentially reduce access to necessary health care for millions of elderly Americans,” said AUA Health Policy Council Chair David F. Penson, MD, MPH.

    That provision is consistent with a recommendation by the Medicare Payment Advisory Commission (MedPAC) in its March 2014 report to Congress. MedPAC noted it had previously recommended a change in the process for identifying overpriced physician services.

    “The Commission’s recommendations would give the Secretary (of HHS) a numeric target for the amount of overpriced services to be adjusted,” MedPAC said.

    Continue to next page for more.

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

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