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    CMS fails to use AUA data in practice expense RVU update

    AUA also takes issue with CAP policy on drug payments


    Bob Gatty
    Washington—When 2006 began, there was somewhat of a mess in Washington involving Medicare reimbursement, and that was especially true for urologists. At press time, some of those issues were being resolved, but, even so, there will likely be fallout that will at least inconvenience urologists and their staffs.

    Before Congress' year-end recess in December, lawmakers failed to give final approval to the Deficit Reduction Act of 2005, which implements the 2006 federal budget and rescinds a 4.4% reduction in overall Medicare payment levels. That meant that new rates, including the cuts, went into effect Jan. 1.

    However, on Feb. 2, the House gave final approval to that budget bill for 2006, which is designed to save nearly $40 billion over 5 years by imposing cuts in many domestic programs, including Medicaid. President Bush signed the measure on Feb. 8.

    Two additional issues remained, and AUA representatives have voiced their concern. These issues involve the following:

    • The Centers for Medicare & Medicaid Services' failure to follow requirements of the Medicare Modernization Act and to use AUA data to update practice expense relative value units for all urologic procedures.
    • Inequities involved in reimbursement under the Competitive Acquisition Program (CAP) with respect to leuprolide acetate and goserelin acetate.

    The Medicare payment fiasco began late last year when the House and Senate passed differing versions of the Deficit Reduction Act. In order to avert the 4.4% Medicare payment cut, Congress had to reconcile differences in the final versions and pass a compromise version of the bill, which then went to President Bush for his signature.

    On Jan. 3, AUA officials sent a pointed letter to CMS Administrator Mark McClellan, MD, PhD, saying it was "extremely disappointed" that CMS did not use AUA's supplemental practice expense survey information to update the 2006 practice expense RVUs for all procedures performed by urologists.

    Signed by AUA President Joseph N. Corriere, Jr, MD, and Health Policy Council Chair James B. Regan, MD, the letter noted that CMS used AUA data to update RVUs for urology drug administration, but had failed to reflect updated calculations in its documentation. The letter urged CMS to publish a correction as soon as possible, and to make the changes retroactive to Jan. 1.

    "We also strongly object to the reasoning that CMS withdrew its practice expense proposals in the final rule in part due to a calculation error that caused almost all the practice expense RVUs published in the Aug. 8, 2005, proposed rule to be incorrect," AUA declared, adding that "...urologists are paying for CMS's error through the loss of practice expense payments rightfully due them."

    Fast Facts
    The letter noted that CMS has indicated that survey data still could be used in 2007, and that it hopes to hold meetings in which AUA will participate.

    "Nevertheless, it is unfair and inequitable that implementation of our survey data has been delayed and that we are forced to go through an entirely different process than [do] groups who had supplemental survey data accepted prior to 2006," AUA officials wrote in their letter.

    CAP confusion

    Regarding the CAP drug issue, current CMS policy means that carriers will only pay for the less-expensive drug, goserelin (using code J9202), even when physicians bill for leuprolide (code J9217).


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