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    ‘I can’t keep up’: Pay cuts, prior authorization take their toll

    State-level advocacy, effective communication crucial to addressing administrative burdens



    State legislatures could help

    Many of these burdens are not under the purview of HHS. In fact, a few of the issues would be better addressed at the state level from a legislative standpoint. We know of at least a few urologists who are actively working with their state legislators to make changes to prior authorization requirements for all private payers. The state regulatory path may in fact become a primary relief point for many issues dealing with private payers.

    Read: How to improve health information online for our patients

    From a practice standpoint, as long as the rules and regulations remain, your choice to adapt to survive is clear. We have helped many practices and seen many others make changes to employee responsibilities, implement clinical pathways, and change work flow to free up clinical staff to provide more efficient care to all patients. These changes are not easy, but they can be done with good planning and execution, which in turn is driven by focused and cohesive leadership. Most making these changes feel that the investment in change is well worth the outcome, both financially and emotionally, regardless of what happens in the future.

    Local Coverage Determinations and medical record review are best addressed with direct contact with your carriers. Do not underestimate the power of physician-to-physician communication. It is easy to remain busy solving the daily crises and avoid the long-term intervention that would better address the issue. Stay in contact with your urology Carrier Advisory Committee member and other local urologists and demand what is best for you patients. Likewise, it is important to participate in RVU studies when called upon. In the end, no one cares for urology or your patients like you do.

    Global changes, modifier definitions, RAC processing, and medical record requests are reflective of a clear mistrust of physicians. Along with MIPS implementation, HHS has a say in how these programs are approached.

    We would encourage you, your practice, and your patients to make it known to your state and national representatives that the continual burdening of all physicians with additional administrative and payment oversight to avoid abuse by a few bad apples is counterproductive to long-term savings in the system. Medicare has the capability through claims statistics to identify those physician groups that are not participating in Medicare in a manner consistent with current policy.

    Further, we encourage you to support the American Association of Clinical Urologists, the AUA, and UROPAC to provide a unified voice in changing the current system for Medicare in particular and the system as a whole.

    If change is coming, it is only the voices that speak that can be heard.

    More from Urology Times:

    CMS releases pay, Quality Payment Program rules

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    The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.

    Subscribe to Urology Times to get monthly news from the leading news source for urologists.


    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.


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