2014 Year in Review: Health Policy/Practice Management

December 19, 2014

Urology Times looks back on the top health policy and practice management stories of 2014, including coverage of the Affordable Care Act and changes in reimbursement.

As Urology Times' 2014 State of the Specialty report resoundingly demonstrated, urologists continue to rank increasing government regulations and declining reimbursement at the top of their concerns. Articles on these topics, along with others ranging from achieving fair compensation to protecting your practice from dangerous patients, topped this year's coverage of health policy and practice management. Here's a look back at that coverage, along with commentary by Urology Times Editorial Council member William F. Gee, MD, and UT Clinical Practice Board member Henry Rosevear, MD.

The Affordable Care Act: 10 essentials you need to know

The Affordable Care Act (ACA) will have a sweeping impact on urologists’ practices, including changes in the number of patients you treat, what you’re paid, and how you practice. In this top-read article, urologists with expertise in health policy outlined 10 aspects of the ACA that all practicing urologists should know.

Dr. GeeDr. Gee: The ACA dominated the news in 2014, and physicians are concerned about it.

Most urologists have not seen an increase in patient volume directly related to the ACA. Primary care physicians still refer when there is a problem and thus far most practices are not seeing more urologic problems. More of your patients will have a high deductible, and many do not understand that it means thousands of dollars in out-of-pocket costs to them. Many of the “poor” who are purchasing insurance for the first time under the ACA truly do not have the money to pay.

With the Republicans taking over Congress, there will be changes to the ACA, but it will not be totally repealed. Whether or not these changes impact physician practices is unknown at present.

A strange dichotomy is occurring. Just as accountable care organizations (ACOs) and insurance plans are talking about more “bundling” of payments, the Centers for Medicare & Medicaid Services is proceeding to “unbundle” all “90-day global” procedures by 2018, making them “0-day globals.” This will dramatically lower the reimbursement for thousands of procedures.

How to use CPT 52356 for removing multiple stones

Billing for removal of multiple stones has been ongoing source of confusion-and a source of many questions-among urologists. In this “Coding Q&A” article, Ray Painter, MD, and Mark Painter tackled a reader’s question about this challenging scenario.

Dr. Gee: This article earned high readership because of the continuing confusion about how to bill for treating multiple stones on the same day.

Coding for stone surgery is complex, and many times there is no “right or wrong” answer. Always remember that many private payers have coding rules that differ from Medicare. As long as you carefully document what you did, don’t be afraid it charge for it.

Unfortunately, we are going to see more “bundling” of procedures into “episodes of care”-in this case, perhaps one payment for all of the care related to the stones regardless of how many procedures are done on one day and on subsequent days.  Be careful how you contract with payers and ACOs.

Next: Achieving fair compensation and other top articles from 2014

 

Fair compensation: How to achieve what you deserve

Many urologists either in practice or entering practice are unaware of fundamental negotiating techniques, which may put them at a disadvantage in the negotiations process, says urologist Deepak A. Kapoor, MD. In this article, Dr. Kapoor provides an overview of existing benchmarks used in determining physician compensation and basic tools that can assist in the negotiating process.

Dr. RosevearDr. Rosevear: It's no surprise that Dr. Kapoor's article was one of the top-read articles published by Urology Times over the last year because it addressed a topic which is vital to the practice of medicine and receives almost no discussion of during training; namely, compensation. For me, the two most important take-home messages were to further understand the range of metrics that are used to define my own productivy, whether that be revenue or some form of adjusted relative value unit, and to place that information in the context of what I am looking for in a practice.

In 2015 and beyond, as the trend of more and more physicians leaving private practice and working directly for hospitals continues, the information that Dr. Kapoor provided will only become more important.

More top health policy/practice management articles from 2014:

The Affordable Care Act: A urologist’s survival guide (BLOG)

How to get paid for drugs administered in the office

Coding and Reimbursement: Health care market shift presents opportunities

How to select a code for stone removal procedures

2015 final rule reflects shift from fee for service

PAs make big strides, but still face hurdles

Violence against urologists: Data, communication needed

Prior authorization blues: Time, money not well spent

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