Is your urology practice prepared for 2012 Medicare pay cuts?

December 1, 2011

We once again approach the end of the year with the American Medical Association, many legislators, and Health and Human Services Secretary Kathleen Sebelius calling for a permanent fix to the sustainable growth rate formula, with no action by Congress.

Prepare for the worst

To prepare for a tumultuous year, we recommend that you:

Additionally, Medicare continues to phase in the changes in practice expense values. These changes will amount to a 2% drop in payments for services provided in urology offices in addition to any drops in the conversion factor. Urologists have seen drops in office service payment for the past 2 years and will continue to see proportional drops the next 2 years. The work values for 2012 have also seen a few revisions, as the results from the mandated 5-year review of work values have been included in the final rule. These changes will have a limited effect on most urologists.

The GPCI update is also negative, as the 1.0 work adjustment floor has been removed for all states, with the exception of Alaska. The frontier states of Montana, Wyoming, North Dakota, Nevada, and South Dakota retain a 1.0 floor for the practice expense GPCI. Although many states will not be affected, for those that will decrease, the average drop in GPCI across all states and territories is –1.68%. This aspect of the update is required to be budget neutral.

The Physician Quality Reporting System (PQRS) program will continue in 2012 with a 0.5% bonus for those successfully reporting PQRS measures. The 6-month reporting period for claims and electronic health records reporting has been eliminated. However, for those using a certified data registry, a second 6-month reporting period from July 1, 2012 through Dec. 31, 2012 is still available.

We still recommend that you participate in the program regardless of when you begin. It is clear from current success rates that the best reporting methods require the use of a registry. Medicare will publish a list of certified registries in the summer of 2012. Finally, if practices do not submit satisfactory PQRS reports during 2013, the practice will have payments from Medicare reduced to 98.5% of Medicare-allowed amounts in 2015.