Reimbursement fights to intensify for urologists and other physicians in 2012


Urologists and other physicians across the country now find themselves in the midst of a high stakes game of "chicken" on Capitol Hill, with their level of compensation for treating Medicare patients at stake.

At press time, the House of Representatives had rejected a Senate-passed bill to extend a payroll tax cut for American workers for 2 months, legislation that also included a physician payment freeze until Feb. 29. Without action by Congress, a 27.4% reduction is mandated under current law. The House was pushing for a full year's extension of the payroll tax cut, and its bill provided for a 2-year "doc fix" and a 1% payment update for 2012 and 2013.

Meanwhile, the Centers for Medicare & Medicaid Services notified physicians that Medicare claims would be held for the first 2 weeks of 2012 to give Congress time to act.

"We have not and will not let deep cuts to doctors' payments occur," said Health and Human Services Secretary Kathleen Sebelius. "The Obama administration is 100% committed to fixing the flawed Medicare payment system and protecting Medicare beneficiaries and doctors."

Since the bipartisan Joint Select Committee on Deficit Reduction (the "super committee") established by Congress in last year's Budget Control Act failed to agree on a plan to slash $1.2 trillion from the U.S. budget as required by law, it did not deal with reforming the Medicare payment system and left in place a fallback maximum 2% across-the-board cut that is slated to take effect in 2013.

The legislation exempted Medicare patient benefits from being affected by the automatic spending cuts, leaving health care providers "on the chopping block," in the words of a press release from the American Medical Association.

However, unless a sharply divided Congress can overcome election-year politics and find a way to cover the estimated $300 billion cost of replacing the sustainable growth rate (SGR) formula used to determine Medicare physician fees, still further reductions will be threatened again for next year under that system.

Meanwhile, physician groups, including the AUA and the American Association of Clinical Urologists (AACU), oppose a proposal by the Medicare Payment Advisory Commission (MedPAC) that would eliminate the SGR but slash the conversion factor for specialist services by 5.9% each year for 3 years, or a total of almost 18%, followed by a 7-year freeze. For primary care physicians, Medicare payments would simply be frozen over 10 years.

The AUA endorsed a November 2011 letter to the House of Representatives leadership signed by some 80 House members from both parties opposing MedPAC's recommendations. Lawmakers said the proposal "would threaten the ability of seniors and disabled Americans to access care from qualified physicians and providers when faced with a potentially life-altering or even life-threatening illness."

"We are committed to finding a legislative solution that addresses the shortcomings of the current Medicare payment system, but we believe we must do so in a way that improves access to care-not in a manner that makes an already tenuous situation worse," said the letter, initiated by Reps. Michael C. Burgess, MD (R-TX), and Gene Green (D-TX).

Another letter on Nov. 10 to Rep. Jeb Hensarling (R-TX), co-chair of the Deficit Reduction Committee, and signed by the AUA and AACU, among other physician groups, pleaded with the panel to resolve the SGR issue, noting that "even as physicians are facing draconian cuts, they are being required by Medicare legislation to make significant changes to their practices that involve both financial investments and a series of workflow changes that affect their productivity."

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