With overall Medicare cuts of more than 21% looming by the end of February unless Congress acts, urologists are confronted with an additional 3% reduction because of new practice expense data now being used by the federal government in the formula used to set fees for urologists.
Late in December, Congress approved a 2-month extension, delaying the scheduled 21% cut until March 1, a move that AUA and other physician groups hoped would provide time needed to find a permanent solution to the annual Medicare fee cut crisis.
Data switch leads to reduction
"The AUA is aggressively fighting these PE cuts simultaneously on several fronts-regulatory, legislative, and legal," said Beth Kosiak, PhD, associate executive director for health policy at AUA. "We have met with CMS officials to argue our case and will continue to do so. We've consulted our legal counsel to assess the most effective options, and have begun to approach members of Congress to support our case."
Dr. Kosiak said AUA was discussing with representatives of the American College of Cardiology (ACC) the possibility of joining forces in order to combat the reductions, which are also being imposed on cardiologists.
The ACC has sued the federal government, alleging that the 2010 Medicare Physician Fee Schedule, which includes the cut, unlawfully adopted the payment rates for cardiology services in a manner that threatens patient access to care and precipitously increases Medicare costs. ACC sought a preliminary injunction to prevent the cuts from taking place.
According to Dr. Kosiak, AUA was considering joining ACC in its lawsuit or pursuing "other legal options." However, she said, such an action would limit AUA's ability to discuss regulatory relief with CMS officials because the matter would be pending in court.
"We think this 3% reduction for urology is based on inaccurate data," she said.
Survey data 'problematic'
The issue developed when the fee schedule rule, issued last July, included a provision implementing the results of an AMA-sponsored Physician Practice Information Survey (PPIS), in which AUA participated along with some 50 other specialties to update the fragmented data CMS had on file for most specialties' PE values-an important part of the fee-setting formula.
Dr. Kosiak explained that urology, along with cardiology and radiology, found that the AMA results differ significantly from previous data, including AUA's own supplemental survey data that CMS had been using to calculate urology PE values.
She said a thorough statistical analysis conducted by AUA staff demonstrated that the AMA data inaccurately reflected the distribution of urology practices and thus produced "problematic" values.
"The AMA had a higher proportion of urology practices that are 10 doctors or larger," Dr. Kosiak explained.
"We were able to show that practice expenses increase as the practice size increases, but then decreases after the practice reaches 10 doctors."
The result of relying on practice expense information for the larger practices would be to underestimate costs for the many smaller practices that predominate, she said.
In a Dec. 28 letter to Charlene M. Frizzera, CMS acting administrator, Steven M. Schlossberg, MD, AUA's health policy chair, pointed out that the AMA data, developed by The Lewin Group, was based on information from just 80 urology practices, less than 1% of the 9,000 urologists in clinical practice.
Several other findings that resulted from AUA's analysis of the AMA data also "suggest that the sample obtained by the PPIS survey is problematic," Dr. Schlossberg wrote.
AUA opposes alternatives
Given the problems resulting from the survey, The Lewin Group has recommended two possible options to rectify the extreme losses to specialties that received lower PE values as a result of the PPIS. One strategy is to transition over time to the new PPIS values. That approach, Dr. Schlossberg said, does not address the fact that the data are inaccurate for urologists. The second strategy would be to blend PPIS data with supplemental survey data from AUA, which AUA also opposes.
"There is not currently a sound and logical reason to determine the blend percentages," Dr. Schlossberg explained.
AUA urged CMS to continue using its supplemental survey data until more accurate PE data can be obtained.
"Accurate practice expense data is vital for calculating accurate reimbursement, which urologists rely on to provide the best quality of care possible to Medicare beneficiaries," Dr. Schlossberg wrote.
Meanwhile, the effort continues to replace the entire fee schedule system with one that will not subject physicians to continued fee reduction threats year after year. However, at an estimated cost of $210 billion over the next decade, at a time when Congress was trying to keep overall health care reform to something under $1 trillion, the outlook remains clouded at best.
Bob Gatty UT Washington CorrespondentBob Gatty, a former congressional aide, covers news from Washington for Urology Times.