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    Reimbursement reprieve won, but war with CMS continues

    Future battles: imaging payments, extending fee-cut freeze

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    Bob Gatty
    Washington—As one of its final acts late last year, the Republican-controlled 109th Congress rolled back a pending 5.1% average Medicare fee cut for physicians and paved the way for a new pay for performance program. But in so doing, lawmakers failed to fix a key component of the Medicare formula, leaving open the likelihood that a similar reprieve will be needed again next year.

    Certainly, canceling the fee cut was welcome news for urologists, but it may be a little like robbing Peter to pay Paul. Unless the formula is reformed or the system is changed, this year's planned cut will accumulate and could result in a 10% reduction starting in 2008.

    Two other important developments occurred with passage of the legislation. A 1.5% bonus was included for physicians participating in the Physicians Voluntary Reporting Program (PVRP) and reporting information about their practices. This incentive is seen as the first step toward establishing a broad-based pay for performance mechanism for Medicare payments.


    Fast Facts
    The measure excluded a proposed plan to require accreditation for ultrasound equipment, a move strongly opposed by AUA.

    AUA, the American Medical Association, and other specialty societies have long contended that the sustainable growth rate (SGR) formula, an important factor in Medicare reimbursement, is the cause of unjustified fee cuts and must be eliminated. However, Congress has failed to act, and Medicare leaders have opposed eliminating the SGR formula.

    In a memorandum issued to members, AUA pointed out, "The freeze in Medicare payments to physicians will only last 1 year, and that means in 2008, we will need to go to Congress to seek another physician Medicare payment fix."

    The memo said urologists may face a 10% cut in 2008 to help pay for this year's freeze.

    "You will receive a bonus payment equal to the amount it would take to bring 2007 payments to 2006 levels," the AUA memo advised. "This is paid through a new bonus fund created to pay for quality improvement initiatives and updates to physician payment.

    "The good news is that this new fund means physicians will not be penalized for further prevention of a cut in physician Medicare payments because updates will come from outside the current reimbursement formula CMS [the Centers for Medicare & Medicaid Services] uses to pay physicians."

    AUA explained that past fixes in the reimbursement formula resulted in physicians, in effect, owing money to the federal government; however, this new fund will be used to make up for further cuts, so the situation has not worsened.

    In addition, physicians participating in the PVRP for 1 year will receive a 1.5% bonus payment to help cover the additional costs associated with reporting on quality measures to the government. The PVRP starts in July. In 2008, additional measures will be added, such as electronic health records and electronic prescribing technology, but there will be no additional bonus paid next year.

    Urologists' influence felt

    In a memo, AUA credited members with blitzing Congress with requests that accreditation not be required for the use of ultrasound equipment.

    "In a span of just 4 days, urologists and their supporters sent more than 2,200 e-mails, faxes, and letters and placed countless phone calls to Capitol Hill on the ultrasound issue," the memo reported.

    However, the AUA memo noted that several members of Congress and CMS are concerned about "inappropriate over utilization" of imaging services, and cautioned that other steps could be taken that might prevent urologists "from getting timely test results necessary to provide high-quality patient care."

    Late last year, CMS proposed new rules that would place more restrictions on the ability of physicians to refer patients to facilities in their own offices or to facilities shared with other doctors for imaging scans.

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

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