Health care reform or not, reimbursement will drop

October 1, 2009

As the debate over health care reform rages, one thing is certain: Regardless of what happens in Washington, changes will occur in 2010 that will directly affect your practice.

As you know, there have been a number of changes in the payment system over the past several years, and if the proposed Medicare payment rules as published in July are adopted in November, next year will be no exception. Some of the more impactful changes in the payment system relative to urology have involved drugs administered in the office, office-based surgery, and minimally invasive services such as transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA). Although some of these changes have been positive for urology, others have not. It certainly seems that any time the Centers for Medicare & Medicaid Services identifies an area of profit, it quickly changes the reimbursement rules to take that profit away.

As a result, many of your office-based surgeries and all minimally invasive prostate therapies will be reimbursed at a lower rate. For urology, CMS has estimated that the changes to the system in 2010 overall will result in a 7% decrease for the same services next year if the conversion factor remains unchanged. Those of you with intensity-modulated radiation therapy centers will feel an even larger impact from these changes-some key services will decline an estimated 38%.