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    AUA objects to 2011 Centers for Medicare & Medicaid Services payment policies

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    Bob Gatty
    Washington—With huge Medicare reimbursement cuts for physicians now off the table for this year, the Medicare Payment Advisory Commission (MedPAC) has proposed a 1% increase for 2012 as a way of encouraging physicians to continue to treat Medicare patients.

    If accepted by Congress, that increase would be in addition to a 0.7% increase in the physician practice expense portion of the fee schedule formula. But the key phrase is "If accepted by Congress," as the current Congress, obsessed with slashing the federal deficit, is looking for every conceivable way to cut spending—not increase it.

    Moreover, the elephant in the room continues to be the sustainable growth rate (SGR) formula, on which Medicare fees are based and which was responsible for the scheduled 25% reduction that would have taken effect Jan. 1 had Congress not passed a 1-year reprieve. That delay was intended to provide time to consider ways to revise the SGR—a multi-billion dollar proposition.

    In the meantime, the AUA is not happy with changes made by the Centers for Medicare & Medicaid Services (CMS) in its payment policies for fiscal year 2011, and said so in a detailed letter to CMS Administrator Donald Berwick, MD, on Dec. 30, 2010, signed by AUA President Datta G. Wagle, MD.

    Among the objections noted were:

    • Elimination of recognition of consultant codes. "Urologists feel that consultative services provided in both the inpatient and outpatient settings should be recognized as distinct from initial office, hospital, and nursing facility visits because they appropriately entail additional documentation and reporting to the referring entity," the AUA said. In the letter, Dr. Wagle asked CMS to evaluate how its action would affect coordination of care and access of beneficiaries to specialty physician services.
    • Reduction in practice expense relative value units for urology due to adoption of the Physician Practice Information Survey (PPIS). "We feel the urology PPIS data is flawed and does not accurately represent practice expenses incurred by urologists," the AUA said, adding that it is interested in working with CMS to develop methods beyond surveys to collect accurate and reliable practice expense data.
    • Interim work values. In its final fee schedule rule, the American Medical Association accepted 207, or 71%, of the AMA Relative Value Scale Update Committee (RUC) recommendations for 291 CPT codes. The AUA said it continues to support the RUC process, "which relies on the input of practicing procedural and cognitive physicians as well as other health professionals," and questioned whether the clinicians who participated in the CMS review process were experienced in performing the procedures in question.
    • Multiple procedure payment reduction for imaging. The AUA objected to CMS's plan to reduce by 50% the technical component of second and subsequent computed tomography, CT angiography, magnetic resonance imaging, magnetic resonance angiography, and ultrasound procedures "furnished to the same patient on contiguous and non-contiguous body parts across modality in the same session." The AUA explained that urologists provide ultrasound followed by CT in some patients, such as those who receive an ultrasound for symptoms of a kidney stone with a mass being detected. The CT would follow to image the mass, with the two procedures performed in different rooms by different technicians.

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

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