AUA balks at health care reform bill endorsement

September 1, 2009

AUA expressed 'strong opposition' to the health care reform legislation amendment eliminating the self-referral exemption for in-office ancillary services such as CT scans on the same day The Washington Post ran an article with the headline 'Doctors Reap Benefits By Doing Own Tests.'

The story, which couldn't have provided better ammo for the American College of Radiology and other opponents of in-office tests, went on to cite a urology practice that provides CT scans for its patients. Within 7 months of installing the equipment, "they were ordering scans at a rate that had climbed more than 700%," the article said.

There it was. Right on their desks. In black and white. One way to help cut the costs of health care reform. Just get rid of the in-office ancillary exception (IOAE) that allows physicians to "self refer" for such services and reduce the number of unnecessary tests and their attendant costs to Medicare.

"We are concerned this amendment would undermine the patient-physician relationship and diminish the ability of physicians to ensure that their patients have access to the right care at the right time in the right setting," the letter said.

It pointed out that urologists who are experienced in diagnostic radiologic methods are fully competent to supervise performance of and interpret imaging studies in their offices for the evaluation and management of certain conditions.

"Many urologists perform the immediate and timely interpretation of imaging studies, correlate these studies with clinical findings, and assume the responsibility for determining the treatment of their patients," the AUA letter added. "The quality and accuracy of imaging studies and interpretations performed by these urologists are consistently high."

According to AUA, rather than eliminating advanced imaging from the IOAE, Congress should focus on a combination approach that includes:

AUA applies the brakes

But the imaging issue is not AUA's only concern in the health care reform drama unfolding in Washington.

The association posted a notice on its web site that, unlike some medical groups (eg, the American Medical Association and the American College of Surgeons), it has not endorsed the bill cobbled together by the House Energy and Commerce, Ways and Means, and Education and Labor Committees just before the August congressional recess.

Although that bill includes a "fix" for the sustainable growth rate problem that will cause a 21.5% cut in physician Medicare payments in 2010 unless action is taken, and although it provides for increased pay for primary care physicians without cutting specialists' reimbursement rates, and although it does not require physician participation in its "public option" provision, some less-favorable provisions still concern AUA. These include:

"AUA has decided not to support the House Tri-Committee bill for reform, H.R. 3200, at this time," the statement said. "We continue to lobby hard to ensure that urology's voice is heard by your representatives in Congress."

Meanwhile, as the Senate Finance Committee's leadership intends to wrap up that panel's work on health care reform legislation by Sept. 15, other key issues are at stake, including whether the Medicare Payment Advisory Commission (MedPAC) should be empowered to impose Medicare payment rates, rather than simply making recommendations to the Centers for Medicare & Medicaid Services. For the past several years, Congress has overruled fee reductions recommended by MedPAC as required by law because of the sustainable growth rate formula used to calculate the reductions.

Early in July, AUA and other members of the Alliance of Specialty Medicine wrote to Rep. Jim Cooper (D-TN) opposing his proposal to expand MedPAC's authority.

"We find it extremely troubling if MedPAC's reimbursement and cost reduction recommendations would go into effect unless opposed by a joint resolution of the Congress," the letter said. "We believe that this takes many important Medicare reimbursement rules and decisions outside the purview of Congress and places them in the hands of unelected and largely unaccountable 'experts'."

Giving MedPAC such power has been suggested by some lawmakers as a way to reduce the political influence of interest groups on such matters. A similar step was taken by Congress several years ago to deal with the closing of military bases.

Several positive provisions in the House bill may be revised or excluded by the Senate, including the $245 billion tab for fixing the sustainable growth rate fee schedule problem and increas-ing Medicare pay for primary care doctors without cutting pay for specialists. Those and other difficult issues will no doubt be negotiated in a House-Senate conference before a final bill is enacted.

Bob Gatty UT Washington CorrespondentBob Gatty, a former congressional aide, covers news from Washingtonfor Urology Times.