AUA takes initiative in shaping its pay for performance role

September 1, 2006

Specialty groups asking for time to develop effective measures

Beth Kosiak, PhD, who joined AUA in February as associate executive director of health policy, now has oversight responsibility for the association's government affairs, guidelines and outcomes, regulatory and reimbursement, and practice management programs.

"P4P is coming soon to our neighborhood, and we are working on crafting a strategy to educate and support members for this new environment, whether it's for federal or state programs or for third-party payers," she told Urology Times. "We are trying to make sure that we have a plan for urologists to survive in an environment based on payments that are calibrated on how well you perform."

Specialty organizations are attempting to meet "an incredibly onerous timetable" of completing the required measures for physician service payments by January 2007, Dr. Kosiak said, adding that the Alliance of Specialty Medicine is helping Congress to understand that more time is needed because of the complexity of the task at hand. However, she emphasized that AUA is "well positioned" in the process, having already developed evidence-based, scientifically sound guidelines upon which measures are built.

Specialty societies such as AUA can develop specific physician-level measures in concert with the Physician Consortium for Performance Improvement, convened by the American Medical Association. The Consortium includes representatives from more than 70 national medical specialty and state medical societies, the AHRQ, the Centers for Medicare and Medicaid Services, and others.

"We have been chosen to be the lead organization with the AMA to develop prostate cancer measures," Dr. Kosiak said. "This is really a plum position for us."

Once they have been approved by the Consortium, Dr. Kosiak said, the measures will be submitted to the National Quality Forum (NQF) for consideration. NQF is a private, not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting. NQF's endorsement encourages standardization and enables the measures to be used by all payers involved.

While P4P is a major challenge for Dr. Kosiak and her team at AUA, they face other key issues, including the following:

"That's $7.6 million for just one code for prostate patients," Dr. Kosiak said. "We think we're making some headway."

Language has been inserted by Sen. Arlen Specter (R-PA) into Senate appropriations legislation for the Department of Health and Human Services to have a separate urology branch created at the National Institute of Diabetes & Digestive & Kidney Diseases.

"We are very optimistic that this will be part of the appropriations bill when it gets passed," Dr. Kosiak commented.

"We are still holding to a $250,000 cap," Dr. Kosiak said.

"We're working collaboratively on a lot of issues," Dr. Kosiak said. "There is much to do, and P4P is certainly taking our time and attention. I don't think Congress really understands the complexity involved. It takes a minimum, once guidelines are in place, of a year and a half to 2 years to develop these measures. We're trying to do it in a year or so. We're trying to educate Congress so they understand what's really involved.

"If payment is to be based on those measures, they have to be scientifically and statistically valid so that real quality differences between physicians can be detected. It is an extremely important and complex undertaking."

Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.