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    American Urological Association protests suggested imaging pay cuts

    Reductions in payment could limit access, Dr. Schlossberg warns

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    Washington—The Medicare Payment Advisory Commission (MedPAC) has made recommendations to Congress that, if implemented, would limit or reduce payments to urologists for in-office imaging services.

    MedPAC, during its April 7 meeting, approved these recommendations:

    • The Secretary of Health and Human Services (HHS) should accelerate and expand efforts to package discrete services in the Physician Fee Schedule into larger units for payment.
    • Congress should direct the HHS secretary to reduce the professional component of the fee schedule for diagnostic imaging services provided by the same practitioner in the same session.
    • Congress should direct the HHS secretary to reduce the physician work component of imaging and other tests that are ordered and performed by the same practitioner.
    • Congress should direct the HHS secretary to establish a prior authorization and prior notification program for practitioners who order substantially more advanced diagnostic imaging services than their peers. This recommendation was opposed by MedPAC Commissioner Ron Castellanos, MD, of Southwest Florida Urologic Associates, Fort Myers, who said prior authorization for imaging services should first be pilot-tested.

    In an April 6 letter to MedPAC Commission Chair Glenn M. Hackbarth, JD, the AUA took issue with the panel's then-pending recommendations and flatly denied that self-referral for imaging services results in over-utilization and unnecessary cost. The letter was signed by Steven M. Schlossberg, MD, MBA, the AUA's health policy chair.

    "The AUA opposes further reductions to payment for diagnostic imaging that are not based on actual time and effort spent in rendering the services," Dr. Schlossberg wrote.

    The AUA urged MedPAC to recommend that any funds generated by cuts to physician payment remain in the pool that funds services under the Medicare physician fee schedule.

    "We question the discussion of clinical appropriateness of imaging, which wrongly suggests that imaging provided in physician offices is less appropriate than imaging provided in other settings," wrote Dr. Schlossberg. "While we are pleased that MedPAC is not simply recommending the elimination of the in-office ancillary exception but rather examining constructive ways to address perceived problems with ancillary use, nonetheless these recommendations seem to concentrate more on reducing payment than promoting clinical appropriateness."

    The proposed reduction in the professional component of the Medicare fee formula for imaging and other diagnostic tests that are ordered and interpreted by the same physician was based on the assumption that the physician who refers to himself will spend less time reviewing the chart in the pre-service period and in post-service follow-up.

    However, said Dr. Schlossberg, "This is not exactly correct," because physicians must review a patient's history after receiving the results of the first image before they perform the second imaging test. Although consultation is not necessary, the physician must generate and review a report for inclusion in the medical record for each image test and for payers, he explained.

    "AUA believes this recommendation constitutes an arbitrary reduction to physician payment for imaging, and strongly objects to any such recommendations," Dr. Schlossberg said, noting that physician payment for imaging has declined "significantly."

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

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