Urologists can claim substantial victories as a result of the Bipartisan Budget Act of 2018, signed into law by President Trump in February-including an end to the Independent Payment Advisory Board, which had been established by the Affordable Care Act to help control Medicare spending.
Bob GattyUrologists can claim substantial victories as a result of the Bipartisan Budget Act of 2018, signed into law by President Trump in February-including an end to the Independent Payment Advisory Board (IPAB), which had been established by the Affordable Care Act to help control Medicare spending.
“That’s a tribute to the tireless work of urologist volunteers who went to Capitol Hill every year and to our staff in Washington, DC,” said Tom Rechtschaffen, MD, chairman of the AUA Legislative Affairs Committee. “This is a huge moment because of the tireless work that they did.”
Ending the IPAB had been the objective of the AUA as well as the American Association of Clinical Urologists (AACU) and LUGPA, whose leaders hailed its demise.
“While this agency was never empaneled, it served as a looming threat to Medicare reimbursement for independent physicians,” said LUGPA President Neal D. Shore, MD. “We believe that restoring this authority to Congress is the right way to maintain oversight of Medicare costs.”
“Today, along with the stability engendered by having a federal budget that spans more than a few weeks, Medicare payments have an opportunity to achieve some steadiness now that IPAB has been repealed,” said AACU President Patrick McKenna, MD.
The IPAB was to recommend specific savings if Medicare spending per beneficiary was projected to grow faster than certain benchmarks. Congress could have blocked the recommendations, but they did not need congressional approval to take effect. Opponents said that placed too much power in the hands of unelected board members whose decisions could affect their livelihoods.
Indeed, urology organizations had fought IPAB virtually since its inception. Dr. Rechtschaffen recalled calling on Congress in 2010 and urging its repeal.
“This gives us back some say in the process,” Dr. Rechtschaffen said, “because it gives us the ability to bring solid data to the Centers for Medicare & Medicaid Services (CMS) and MedPAC (the Medicare Payment Advisory Commission) when reimbursement cuts are proposed to demonstrate what impact that would have on our patients.”
The new budget also removes Part B drugs from penalties and bonuses under the Merit-based Incentive Payment System (MIPS), established by the Medicare Access and CHIP Reauthorization Act (MACRA)-another objective of the key urology organizations.
That action, Dr. Shore explained, means that providers will not be financially penalized for administering Part B drugs to patients.
“In the original plan, we would have been on the hook for the cost of those drugs, which was absolutely unfair,” said Dr. Rechtschaffen. “The new budget law removes that provision so we will not be charged (in MIPS calculations) for Part B drugs.”
Another victory gained in that legislation, he added, is a 2-year extension from 2021 to 2023 of the deadline for providers to comply with electronic medical records and quality reporting requirements.
“They heard us,” Dr. Rechtschaffen said, referring to members of Congress with whom urologists and AUA representatives had met to express concerns about the burden faced by physicians. “We asked for relief and they heard us.”
Dr. McKenna noted that the AACU last year filed formal comments asking that urologists be given more flexibility in terms of EHR adoption.
“The new budget removes a mandate that meaningful use standards become more stringent over time,” he said. “This will ease the burden on physicians as we will no longer have to ask federal regulators for a hardship exception if we fall slightly short.”
Dr. Shore said LUGPA welcomes a provision in the new budget law that extends the reimbursement rate freeze for radiation oncology, which the organization had supported.
“The rate freeze extension will allow for additional time to develop an alternative payment model for radiation services, a process LUGPA stands ready to support with our expertise,” he said. “The rate freeze also reinforces the importance of site neutrality in reimbursements, which will preserve patient access to radiation oncology services in the setting of their choice.”
In addition, Dr. Shore said the budget law’s improvements in the alternative payment model review process within the Physician-Focused Payment Model Technical Advisory Committee (PTAC) “will allow fluid communication between the committee, organizations like LUGPA, and the secretary of CMS. We anticipate it will increase participation in APMs under the QPP (Quality Payment Program).”
Yet another positive result from the budget bill ends an effort by CMS to reclassify radiation for prostate cancer, resulting in reduced reimbursement rates for prostate cancer radiation only.
“The budget deal freezes that discussion so the current state of affairs remains in effect. It’s a very happy day for us,” Dr. Rechtschaffen said.
The AACU’s Dr. McKenna noted that the budget accelerates the elimination of the Medicare Part D coverage gap, or “donut hole.” The new law requires drug manufacturers to give larger discounts to beneficiaries in the coverage gap, starting in 2019.
Also by Bob Gatty: How would MedPAC replace MIPS?
“All of this is very affirming for all of the work that’s been done and it emphasizes the value and importance of urologists having a presence in Washington,” Dr. Rechtschaffen said. “These victories are worth literally hundreds of millions of dollars for AUA members. It’s a clear indication of why our Washington office is so important.”
Now, it’s time to look ahead, he said, and focus on new initiatives that include prostate cancer testing and prevention, research, and establishing a new Office of Men’s Health.
At the AACU, Dr. McKenna said, “Urologists will push for polices that reduce administrative burdens imposed by public and private payers, as well as sound the alarm on work force shortages that threaten access to care.”
He said President Trump’s proposed budget for 2019 “would be catastrophic: cutting GME funding by $48 billion over 10 years and moving all training programs under the same roof, with no specifics on where funding will come from or how shortage areas will be determined.”
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