What reform could mean for urologists
Despite being outspoken on his intentions to focus on entitlement reform in 2018, Speaker Ryan has yet to give any indication of what that might look like in the Medicare program. However, recent changes and existing efforts provide a glimpse into what reform could mean for providers in the coming year.
One example is the recent push by the Centers for Medicare & Medicaid Services to develop and examine new and “innovative” payment models to reduce costs and improve quality of care while also rolling back mandatory participation in certain programs. This effort was made clear with the agency’s decision to eliminate two mandatory bundled payment models—under which multiple providers are reimbursed with a single lump-sum payment for a complete episode of care—and reduce participation in a third. CMS plans to replace these models with new voluntary payment bundles soon, which will have a renewed focus on voluntary, not mandatory, participation and fewer regulations in an effort to decrease the regulatory burden on physicians.
In all, the ongoing efforts of CMS to discover and test new payment models that seek to reduce costs while maintaining quality care for patients indicates the agency’s desire to find ways to restructure how physicians are reimbursed for services under Medicare.
CMS also recently indicated that it will begin taking a more proactive, targeted approach to auditing and recovering fraudulent and erroneous Medicare payments to providers by expanding the Targeted Probe and Educate program it began 3 years ago. This likely means that physicians will see an increase in Medicare audits as their billing practices come under more scrutiny.
CMS also announced in November the 2018 premiums, deductibles, and coinsurance amounts for Medicare Parts A and B, which indicated that some beneficiaries will see increases in their cost-sharing obligations under the program.
But perhaps the biggest Medicare reform concern for urologists is the potential for provider reimbursements cuts, a threat that has continued to loom over the health care community for some time. If recent events are any indication, this threat is moving closer to becoming reality, perhaps best evidenced by the massive cuts to the payment rate for certain Medicare Part B drugs purchased by many hospitals through the 340B Drug Pricing Program. These cuts reduced the amount hospitals participating in the program are reimbursed from a rate of the drug's average sales price plus 6% to 22.5% less than the average sales price, constituting a 28.5% reduction in reimbursement payments for drugs purchased under the 340B program.
Threat of IPAB still looms
What’s worse, despite widespread efforts to repeal by the AACU and numerous other advocates in the health care field, the threat of the Independent Payment Advisory Board (IPAB) still exists. If triggered, IPAB would likely make significant cuts to Medicare payments for physicians and ultimately have a devastating effect on patient access to care.
Congress has failed to pass a bill repealing IPAB, despite widespread bipartisan support in both the House and Senate, and while IPAB managed to avert being triggered this year, the July Medicare trustees' determination report predicted that its triggering is likely as early as 2021. The continued threat of IPAB combined with the new threat to additional payment cuts as part of Medicare reform in the coming year is quite ominous for the urology community.
The AACU is committed to advancing and advocating for the interests of urologists across the country, and will continue to actively engage with lawmakers in 2018 to ensure any attempt at Medicare reform will not harm the urology community.
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