2008 AACU State Society Network Advocacy Conference

Mark your calendars!

Plan to attend the first AACU State Society Network Advocacy Conference on September 12-14 at the Hyatt Regency O’Hare in Rosemont, Illinois.

Join your colleagues and learn about trends in legislation across the country in a fully interactive discussion. The primary objectives of this meeting are to support the growing network of urologists engaged in advocacy activities, to facilitate an exchange of information among urology's advocates on the state level, and to prepare for the coming state legislative sessions.

Click here for more meeting information & registration!

Urologists United Against Payment Cuts

Update: On Tuesday, July 15, the President vetoed HR 6331, legislation to prevent the scheduled 10.6% cuts to Medicare payment to physicians for 18 months. The House and Senate immediately passed a veto override, and HR 6331 is now the law of the land.

While this remarkable victory for medicine should be celebrated, this issue is not truly resolved. Urologists will face cuts in Medicare payment of greater than 20% in 18 months. Congress must now act to seek lasting changes to the physician payment formula.

The flawed Sustainable Growth Rate (SGR) formula must be reformed more broadly. Not only has the SGR formula generated pay cuts - it has kept current Medicare physician payment rates about the same as they were in 2001. As a result, physicians are prevented from investing in the staff, equipment, and health information technology needed to provide optimal care. The Medicare program’s own predictions are that by 2016, total payment cuts to physicians under the SGR will equal about 40%, while over the same period, physician practice costs will increase nearly 20% - at least a 60% shortfall to the average urology practice.

It is essential that urologists – who, as a whole, bill Medicare for at least half of their total gross charges – demand that Congress use the time afforded by this 18 month reprieve to act on the guidance previously provided by MedPAC to seek lasting reform to the physician payment formula, and replace payment cuts with positive updates based on expected increases in practice costs.

For updates on the effort to reform Medicare payment, please contact the AACU at any time by sending an email to info@aacuweb.org.

2008 AACU State and Federal Legislative Priorities

AACU has made available its legislative priorities for 2008. Physician payment, eliminating excessive regulation on the practice of Urology, promoting men's health, defending effective medical liability reform, and supporting practice management are among the issues that AACU will be focusing its efforts on this year. The 2008 priorities can be seen in their entirety here.

AACU State Society Network Blueprint for Advocacy

AACU Staff has traveled to the Southeastern, South Central, North Central Sections and the Florida Urological Society to educate urologists on new models for grassroots advocacy. Through leverage advocacy, urologists can amplify their voice, create strong relationships with legislators, and make a great impact for urology within their region. AACU has created the following document to give insight into the simple steps you can take everyday to change the face of your specialty. Contact AACU to find out more, and to receive custom state specific data that can get you started in your personal advocacy at statesociety@aacuweb.org or (847) 517-1050.

Recovery Audit Contractor (RAC) Expansion

Update: Last November, Congresswoman Lois Capps (D-CA 23rd) introduced legislation to place a moratorium on expansion of the RAC program. This legislation has gained momentum following the 2008 Urology Joint Advocacy Conference, as advocates for urology used their visits to Capitol Hill to urge co-sponsorship of the bill. The Medicare Recovery Audit Contractor Program Moratorium Act of 2007 (HR 4105) would place a one-year moratorium on the RAC demonstration program, prevent it from beginning in any other states, require CMS to detail the number and nature of claims as well as the outcomes of all appeals, and require GAO to evaluate the RAC program for efficiency, integrity and compliance. The legislation is concurrently being considered by the House Ways and Means and Energy and Commerce Committees, and as of this writing, has 97 co-sponsors.

Background: As part of the Medicare Modernization Act of 2003, Congress authorized the Medicare Recovery Audit Contract (RAC) Program, beginning with a demonstration project in three states (California, Florida, and New York). The program provides contingency payments to auditing firms that identify improper payments from Medicare.

The goal of seeking cost savings in Medicare is laudable. However, the methods used by auditors in the program have been very questionable. Auditors participating in the program are allowed to retain their 30% contingency fee even in the case of denials that are overturned on appeal. These audits place an enormous and unanticipated burden on physician practices, with some offices receiving 50-100 letters asking for multiple patient records on previously paid charges reaching as far back as 3 years to be submitted in a matter of weeks. The egregious nature of these audits potentially threatens the financial solvency of practices subjected to them, with obvious implications not only for the professional lives of urologists, but for their patients who may face shuttered office doors.

The RAC program is now set to expand to more states. In the Tax Relief and Health Care Act of 2006, Congress authorized the Centers for Medicare and Medicaid Services (CMS) to expand the demonstration program to all fifty states by 2010. CMS has already expanded the RAC program to include Arizona, Massachusetts, and South Carolina, and the program is on schedule to be rolled out across the entire country. This will essentially implement an incomplete program without any opportunity for evaluation, or solve the problems it currently poses to physicians. Congress should place a moratorium on the program, and seek a review of the program and the practices of RAC contractors in order to ensure that the problems faced by urologists in the demonstration states are not allowed to expand nationwide.

PQRI Feedback Reports and Incentive Payments Available Soon

2007 Physician Quality Reporting Initiative (PQRI) Final Feedback Reports will be available in mid-July 2008 via a secure Web site, the Centers for Medicare and Medicaid Services (CMS) has announced. PQRI incentive payments for satisfactory 2007 reporting will be available thereafter, in mid to late July 2008.

CMS recommends that practices set up their online accounts as soon as possible so that reports will be accessible immediately after they are available. Practices participating in the PQRI must register for access through a new CMS security system known as Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC).To establish their practice as an IACS-PC organization, participants must register a "security official" for the organization. The process of verifying the designated security official's authorization to access the practice's confidential information is not fully automated and can take some time, so such practices should begin registering their representatives for IACS-PC accounts now. Reports will be available to each practice, identified by Taxpayer Identification Number (TIN), in which at least one eligible professional reported 2007 PQRI quality measures data. Reports will include information on reporting rates, clinical performance, and incentives earned by individual professionals, with summary information on reporting success and incentives earned at the practice level. Only practices with multiple professionals or individual professionals with staff members who will access the PQRI feedback reports should register in IACS-PC, and there is no need to register if you did not submit PQRI quality-measures data for 2007.

CMS has hosted a series of conference calls on the Physician Quality Reporting Initiative (PQRI). The calls are intended to provide guidance to physicians seeking to participate in the program, with detailed information on how to submit claims-based reporting of PQRI quality data. Related to these calls are a number of presentations that CMS has compiled on its Web site. These presentations and other information are available on the CMS Sponsored Calls section of the CMS PQRI Web pages.

States enact sweeping managed care contracting and silent/rental PPO reforms this session

The past five months have seen four bills limiting the use of rental PPOs passed in the state legislatures, with three signed into law thus far, making 2008 a very successful year so far in this area. Most recently, Governor Rell of Connecticut signed legislation in mid-May that regulates the rental PPO market. The bill requires companies to notify the physician in the contract that they intend to sell the discounted rate to a third party. They must also make available at the time of contract and later through an Internet web site or toll-free telephone number a list of the third parties to which the network has been or will be given access. Third parties must follow all of the terms and conditions of the original contract and must disclose on all remittances to physicians the name of the contracting party through which the discount is being claimed.

In late March, Governor Strickland of Ohio signed the state’s new Healthcare Simplification Act. The law makes numerous changes that improve insurer transparency, but also severely restricts the rental PPO market by prohibiting the sale or rental of a provider contract unless it is disclosed in the contract and the third party abides by all terms of the contract.

Indiana enacted a law almost identical to that in Connecticut when in mid-March Governor Mitch Daniels signed legislation to restrict the rental or sale of PPO discounts. Like Connecticut, it requires the contract to state specifically that the discounts will be sold or rented and the list of third parties given access must be made available to providers.

In addition, the Florida legislature passed a bill limiting the rental or sale of the discounts, which was signed into law by Governor Crist in late June. This bill is similar to that in Connecticut. It also requires that a disclosure of the intent to sell or rent the PPO discounts be included in the contract with the provider and that the list of entities to which the discounts have been provided be made available to the providers.

Four other states had introduced legislation as well, but did not pass it before their legislatures adjourned for the year. The fight will continue when the legislatures reconvene for their new sessions next year.

For more information on these and other state legislative efforts affecting urologists, please contact Bonnie Shadid, AACU State Affairs Manager at statesociety@aacuweb.org.

Four States Name September 2008 as Prostate Cancer Awareness Month

California, Colorado, Florida, and Pennsylvania have all passed resolutions naming September 2008 “Prostate Cancer Awareness Month.” The resolutions urge all men to become more aware of the risks associated with prostate cancer and to take preventative measures to reduce those risks, including speaking with their doctors about regular prostate cancer screenings. These efforts advance the goal of prostate cancer awareness not only for patients, but also with members of state legislatures in promoting further legislation regarding prostate cancer screenings and reimbursements and men’s health issues in general. Please contact the AACU at statesociety@aacuweb.org if you are interested in learning more about prostate cancer screening and diagnosis campaigns and coalitions. You can also log on to the Men’s Health Policy Center at www.menshealthpolicy.com/advocacy to see a collection of advocacy resources available from the Center.