When Congress passed and President Obama signed legislation in 2015 to scuttle the troublesome (to say the least!) sustainable growth rate (SGR) formula for Medicare payments for physician services, urologists joined the rest of organized medicine in breathing a huge sigh of relief.
After years of complaining, lobbying, and suffering with constant threats of huge reimbursement cuts due to the SGR, finally sense and reason would come to the process of paying health care providers for treating Medicare patients.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), in repealing the SGR methodology for updates to the Physician Fee Schedule (PFS), replaced it with a new approach to payment—the Quality Payment Program, which rewards the delivery of high-quality patient care through Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS.
Providers who participate in an Advanced APM through Medicare Part B can earn 5% incentive payments for participating in an innovative payment model. Those who participate in MIPS will earn a performance-based payment adjustment. Providers—physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists—can participate in the Quality Payment Program if they treat 100 patients and bill Medicare at least $30,000 per year.
But with anything so complex as paying physicians for their services for thousands of specific procedures and doing so based on quality of their work rather than volume, there were bound to be complexities and new requirements imposed on providers that must be met if they expected to be paid the maximum amount possible for their work.
And so it is. However, the reporting requirements imposed on providers are numerous and complex, such that Bryan Mehlhaff, MD, of the Oregon Urology Institute (OUI), Springfield says it’s a distraction in their efforts to care for their patients.
“All of us view it as like a hangnail,” he commented.
But, said Dr. Mehlhaff, “I fully understand this is bipartisan and that MACRA is not going away. After all, it’s the replacement for the failed SGR, which we’re all happy is gone.”
So, to help make it easier and more efficient for urologists to submit these needed reports and get properly paid, the OUI, a member of LUGPA, took it upon itself to develop two electronic Clinical Quality Measures specific to urology.
LUGPA President Neal D. Shore, MD, said: “As leaders in the field, LUGPA's members are committed to advancing best practices and patient outcomes. OUI represented this approach when it took the initiative to begin working on these quality measures and then sharing them with LUGPA's leadership for input.”