LUGPA urges CMS to reject outpatient payment caps

September 23, 2013

A proposed rule from the Centers for Medicare & Medicaid Services that would cap payments for more than 200 physician services at outpatient prospective payment system or ambulatory surgery center rates would threaten patient access to optimal, cost-effective health care, according to the Large Urology Group Practice Association.

A proposed rule from the Centers for Medicare & Medicaid Services that would cap payments for more than 200 physician services at outpatient prospective payment system (OPPS) or ambulatory surgery center (ASC) rates would threaten patient access to optimal, cost-effective health care, according to the Large Urology Group Practice Association (LUGPA).

In a comment letter to CMS, LUGPA said the proposed rule-the Medicare Revisions to Payment Policies Under the Physician Fee Schedule, Clinical Laboratory Fee Schedule & Other Revisions to Part B for CY 2014-would negatively affect Medicare beneficiaries with bladder cancer, among others.

“This proposed rule is seriously misguided and, if implemented, will threaten patient access to comprehensive, cost-effective integrated care,” said Deepak A. Kapoor, MD, LUGPA president. “Specifically, LUGPA is concerned that the proposed OPPS/ASC Cap will jeopardize Medicare beneficiaries’ access to a variety of services that can are routinely performed in a physician’s office.”

As an example of the policy’s impact, LUGPA pointed out that reimbursement for the fluorescence in situ hybridization (FISH) test for bladder cancer (CPT code 88120) would be reduced to levels substantially lower than the cost of the assay.

In addition, LUGPA said it opposed the substantial disparity in reimbursement that exists between FISH testing performed for urine specimens compared to any other body fluid. CMS’s current reimbursement for a FISH test on urine, but not other bodily fluids, is already so low that many physician practices and labs are unable to offer it to their patients, the association said.

“It simply makes no sense to reimburse an assay differently for urine when it is performed in the same manner as other body fluids,” Dr. Kapoor said. “Patients with bladder cancer deserve an assurance from CMS that these tests will continue to be available to them. CMS must not apply the OPPS cap to reimbursement for urine specimen manual FISH, and should not discourage performance of this test on urine by artificially under-reimbursing for the study.”

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