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    Urologists take a stand on Medicare Payment Advisory Commission payment proposal

    AUA, Baucus discuss health reform, specialists' concerns

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    Bob Gatty
    Washington—As the Obama administration and the 111th Congress move forward on health care reform, increased sentiment for finding ways to support primary care physicians appears to be building. Unfortunately, urologists and other specialists could be asked to ante up.

    With that in mind, and concerned that Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, is hearing only the primary care side of the story, AUA flew Montana urologist Kevin Kronner, MD, to Washington in December to meet with Baucus' staff. Dr. Kronner was joined by Bill Monnig, MD, chair of the AUA Legislative Workgroup, which is charged with communicating to Congress the legislative challenges facing urology, as well as Priscilla Chatman, AUA director of government relations and advocacy, and Kim Parker, a consultant with Hart Health Strategies. They met with Chris Dawe, a member of Baucus' staff who is helping to draft the Medicare physician payment sections of proposed health care reform legislation.

    The meeting followed by just a few days a staff recommendation to the Medicare Payment Advisory Commission (MedPAC) that it urge Congress to implement a 1.1% increase in physician payment rates in 2010, rather than the 21% decrease that would be required under the current sustainable growth rate formula. However, MedPAC also indicated that it will recommend that primary care physicians receive a larger increase, which could come at the expense of specialists.

    The danger for specialists such as urologists is that MedPAC proposes to pay for the increase by establishing a "budget-neutral payment adjustment for primary care services billed under the physician fee schedule and furnished by primary care-focused practitioners." To maintain budget neutrality, the proposal would take money from subspecialty services.


    Fast Facts
    That recommendation dovetails with a proposal by Baucus that is regarded as the basis for reform legislation expected to emerge from his committee. As we reported in January (see, "Health care reform 'Call to Action': Mixed bag for urologists," page 29), the Baucus working document makes this point: "Primary care is the keystone of a high-performing health care system. Access to primary care that successfully manages and coordinates patient care, particularly for the chronically ill, is a proven determinant of high-quality, cost-effective care. Yet America's current system undervalues primary care relative to specialty care," leading to fewer medical students choosing primary care careers.

    Baucus contends that payments for primary care physician visits "are undervalued, particularly compared to procedures and services furnished by specialists." He writes that "overvaluation of procedures in the Medicare physician fee schedule has created financial incentives to provide unnecessary services and served as a disincentive for physicians to become primary care physicians."

    "To avoid cost inflation, this proposal should be made budget-neutral," Baucus writes, noting that any increase to primary care providers "requires a corresponding cut to specialty services."

    "Since Chairman Baucus said he had not heard from specialty care, we decided that he would, indeed, hear from urology," Chatman told Urology Times. In fact, because Dr. Monnig has an office in Ohio, the group also met with both Ohio senators, Republican George V. Voinovich and Democrat Sherrod Brown. Brown is a member of the Senate Health Education and Labor Committee chaired by Sen. Edward M. Kennedy (D-MA).

    According to Chatman, Dr. Kronner said that although he supports providing primary care with additional funding, it should not come at the expense of specialists, and certainly not urologists, who spend many extra years in residency and accumulate huge student debt.

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

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