Conflicting, ambiguous federal rules create biggest headaches for urologists

More than 2,000 physicians and medical specialties responded, citing a number of regulatory issues they find problematic, such as conflicting requirements of quality initiatives, unfunded federal mandates, and the elimination of consultation codes.

Urology Times asked urologists what regulations create the most issues in their practices, and how the rules could be changed to make them more palatable. Conflicting rules topped the list of the urologists' responses.

"The ambiguity of some of the rules concerning e-prescribing, PQRI [the Physician Quality Reporting Initiative], and meaningful use is something that's been frustrating me," he said. "The rules are so ambiguous. You think you're doing it right and it turns out you're not.

"It's almost as though they dangle this carrot of bonuses-1% of your Medicare charges-in front of you, but you don't know exactly how to get it. Then you're afraid if you don't do it right, you're going to be penalized down the road.

"The requirements for meaningful use and PQRI are not clearly defined."

The regulations regarding e-prescribing are somewhat easier, Dr. Bullock adds.

"To qualify for meaningful use, you have to document a series of measures on 80% of eligible patients, known as the numerator, but it's still hard to figure out what the numerator is," he pointed out.

"The biggest problem is that you only file reports at the end of the year, so you can think you're doing everything right, and when it's too late to change anything, you file the report and find out you've missed a decimal point. Then all your effort was for nothing."

"You get points toward PQRI by e-prescribing. That makes total sense to me," he said. "I would love to e-prescribe, but my special interest is testosterone deficiency. I see a lot of patients who need testosterone, and I can't e-prescribe testosterone. Testosterone is a highly controlled substance, so I have to fax or handwrite a prescription. I lose out on that as a quality measurement big time, simply because I'm not allowed to do it. I don't know how that will affect my overall quality measurement. I have to hope I can make it up in other ways."