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    Imaging reimbursement fight intensifies for urologists

    AUA, other groups defeat imaging cut provision of trade proposal

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    Bob Gatty
    Washington—The attack on Medicare payments for advanced imaging services is intensifying in Washington as both lawmakers on Capitol Hill and regulators at the Centers for Medicare & Medicaid Services target them for cuts.

    During the past 3 months, there have been these developments:

    • The AUA and a group of allied medical groups beat back a surprise effort to use imaging cuts to provide $400 million to finance a portion of costs associated with the Trade Adjustment Assistance program.
    • The Medicare Payment Advisory Commission (MedPAC), in its June 2011 report to Congress, recommended payment cuts for imaging services, including the physician's interpretation of imaging results.
    • In its proposed rule to implement the new 2012 physician fee schedule, which would slash overall Medicare physician payments by 29.5%, CMS agreed with MedPAC and seeks to reduce payments for physician interpretation of advanced imaging services.

    Clearly, the impression that physicians and others that provide advanced imaging services are profiting at the expense of taxpayers has taken hold.

    Medical groups fight imaging provision

    Physician groups, including the AUA, the American Association of Clinical Urologists (AACU), and the Large Urology Group Practice Association, were forced to respond quickly in late June when it was discovered that the Trade Adjustment Assistance Extension Act of 2011, being considered by the Senate Finance Committee, contained a provision that would increase utilization rates for advanced diagnostic imaging services.

    The measure puts into effect free trade agreements with South Korea and will also come before Congress with similar trade agreements for Panama and Colombia. It would have increased the rate at which Medicare assumes equipment is in use at the average facility from 75% to 80% in 2012 and 90% in 2013 and thereafter, effectively reducing payments.

    "It was definitely a last-minute surprise," said Karen Lencoski, JD, MBA, the AUA's government relations and advocacy manager. "But we mobilized quickly and got it resolved. However, I think we are going to see more of these last-minute attacks when the budget/debt limit comes up."

    The urology groups were part of a coalition of 21 physician groups that fired off a letter to the Senate Finance and House Ways and Means committees strongly objecting to the provision on the grounds that further payment cuts would make it difficult for many patients to obtain imaging services.

    "Continued reductions to imaging services cannot be absorbed by physician practices without impacting quality and access to high quality care," the groups wrote.

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

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