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    Urologists take their case to the Hill; link laws, outcomes

    Reimbursement, research, liability are chief among concerns


    Bob Gatty
    Washington—Seventy urologists came to the nation's capital early this spring seeking to let the policymakers in Congress and the administration know just how their decisions affect the delivery of health care in communities across the nation.

    The urologists gathered as part of the Joint Advocacy Conference held by AUA and the American Association of Clinical Urologists, which featured briefings on key legislative issues, a White House briefing, and visits with members of Congress on Capitol Hill. (Also see, "States are battlegrounds for pivotal legislative issues".)

    During those meetings, the physicians had a chance to do the following:

    • urge Congress to fix fundamental problems with the Medicare payment system and prevent reimbursement reductions in 2007 and the years beyond
    • ask Congress to reconsider reductions in imaging services that were part of the 2005 Deficit Reduction Act
    • discuss implications of the pay for performance (P4P) Medicare reform policy initiative now under consideration
    • learn more about the Competitive Acquisition Program being implemented for pharmaceuticals, including office-administered drugs
    • seek co-sponsors for a bill that would authorize the National Institute of Diabetes and Digestive and Kidney Diseases to establish a new Division of Urology to advance research
    • encourage Senate support for medical liability reform legislation approved last year by the House.

    Medicare fee schedule

    Fast Facts
    The message taken to lawmakers was twofold: that the sustainable growth rate (SGR) formula on which annual Medicare payment updates are based is flawed and that physicians face at least 6 years of Medicare payment cuts that will average about 5% per year.

    Physicians would have been forced to accept a 4.4% fee schedule reduction for 2006, but Congress approved budget legislation Feb. 1, 2006 that froze reimbursement rates at last year's levels. However, it took congressional action for that to happen, something that cannot be counted on in years ahead.

    "Medicare payment rates are not keeping up with the cost of providing services," Robin Hudson, AUA manager of regulatory affairs, said during a briefing for participants before their congressional visits. "Fees are going to fall 31%, while costs are increasing by 19%."

    Hudson said the current formula does not accurately reflect the cost of caring for Medicare beneficiaries, including changes and improvements in technology, shifts in point of service, and changing demographics of the Medicare population.

    She pointed out that the cost of drugs delivered in physician offices is inappropriately included in the payment formula and should be removed.

    "Physicians don't control the cost of drugs, and they are not paid for under the fee schedule," Hudson said. "They should not be included in the formula."

    An important step advocated by AUA is elimination of the sustainable growth rate entirely, especially if a new pay for performance system is to be established.

    "The SGR has to be fixed before we can play under P4P," Hudson said.

    During their Hill visits, urologists urged House members to co-sponsor legislation sponsored by Rep. Nancy Johnson (R-CT) that would eliminate the SGR and "take a rational approach to P4P," according to Hudson.

    Imaging services

    When Congress prevented the 4.4% Medicare fee reduction at a cost of $7 billion, it turned to imaging procedures for the offsetting savings required by law. The result was a cap on the technical component of the Medicare fee schedule payment and a 25% reimbursement cut for imaging exams on contiguous body parts made during the same session in 2006, with an additional 25% reduction in reimbursement to take effect in 2007.


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