Medicare 'adjustments' draw concern from American Urological Association

October 1, 2009

The Centers for Medicare & Medicaid Services is in the process of finalizing proposed Medicare policies and payment rate changes for health care providers that would have significant impact on many urology practices.

This month, the agency will complete its review of comments submitted regarding the adjustments, including a 17-page analysis submitted Aug. 30 by Anton Bueschen, MD, president of AUA. In it, Dr. Bueschen said, AUA "has serious concerns" about a number of the proposed provisions.

The final rule is to be issued by Nov. 1 and implemented on or after Jan. 1, 2010.

"We were happy to see, in the technical correction, that modest cuts and eventually, an increase in the payment update will result," AUA told CMS.

AUA has challenged the accuracy of the AMA data as it relates to urology practices, and had urged CMS to postpone using it in 2010 and to continue using AUA's supplemental survey information regarding urology practice costs until differences can be resolved.

CMS reasons that as the use of the equipment in-creases, per-treatment costs for purchasing, maintaining, and operating the equipment declines, making a reduction in payment appropriate.

AUA has urged CMS to "recognize a broad array of accreditation organizations that will respect the needs of different specialties in performing imaging."

Under the new plan, practitioners would use existing E&M service codes when providing these services instead, with savings being redistributed to increase payments for existing E&M services. If adopted, AUA has said, the proposal would introduce different coding standards for Medicare and private payers and would undercut the goal of administrative simplification that was part of the Health Insurance Portability and Accountability Act of 1996.

Urging Congress to continue incentives for PQRI beyond 2010, AUA has said CMS "should maintain flexibility and uniformity in reporting time frames for all PQRI reporting options." Further, "urologists have become very frustrated because they have not received any feedback from CMS on their PQRI submissions." AUA has urged CMS to provide feedback reports regarding whether physicians' submissions comply with the program and stating that quality information is being successfully reported.

AUA also warns that CMS is underestimating the costs that physicians incur in submitting PQRI information.

"CMS should recognize that electronic health record (EHR) systems are extremely expensive, with costs well beyond the CMS estimate of $1,500 to over $4,500 to purchase an EHR product," Dr. Bueschen said in the AUA letter.

"For many physicians, the CMS 'conservative estimate' of a cost of $2,750 for an eligible professional to report PQRI data through electronic health records is too low, and should be revised to yield more realistic projections."

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