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    Urologists take action on worrisome definitions of 'quality'

    American Association of Clinical UrologistsBased on a partnership with Urology Times, articles from theAmerican Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or [email protected] for more information. 

    Health care reform requires the simultaneous pursuit of three goals, according to economists and government officials. As defined by these non-medical experts, the so-called "triple aim" seeks an improved experience of care, improved health of populations, and reducing per capita costs. To measure patients' subjective experience on all three components, public and private payers, as well as clinically focused physician groups, are scurrying to define "quality." There is some urgency to this effort because the law that repealed the Medicare sustainable growth rate (SGR) formula requires physician payments to be largely based on quality as of January 2019.

    If defining quality is left only to payers, there is cause for alarm. Two recent proposals from the Centers for Medicare & Medicaid Services (CMS) stray far from the Institute of Medicine's definition of quality: "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."

    Related - ACA's 'grace period' shows physician-led reform must be grassroots

    A public policy research firm working on CMS's behalf turned a blind eye to current professional knowledge by proposing that providers be penalized for recommending PSA-based screening for prostate cancer. Using the flawed U.S. Preventive Services Task Force recommendation against PSA testing as its primary source, the CMS contractor concluded that the intent of its proposal "is to discourage the use of PSA-based screening in the general population of men," and that less testing indicates better performance.

    Next: Individuals, organizations mobilize in opposition to recommendation


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