Comments to CMS on the 2009 Medicare Physician Fee Schedule

AACU has submitted comment to CMS on the proposed regulatory changes in the 2009 Medicare Physician Fee Schedule. In addition to provisions affecting physician payment, there are numerous proposed changes to requirements relating to in-office imaging, application of anti-markup rules, nonpayment for Hospital Acquired Conditions beyond the hospital setting, drug acquisition and pricing, and many other issues. See the comments submitted by AACU to CMS as well as a summary of the 2009 Medicare Physician Fee Schedule from CMS here.

A copy of the court’s opinion can be found by clicking here.

AACU Member Satisfaction Survey

Your feedback matters to us. Please take a few moments to take our AACU Member Satisfaction Survey by clicking here.

Thank you for taking part in the survey, and for your continued involvement in AACU.

2008 AACU State Society Network Advocacy Conference

The inaugural AACU State Society Network Advocacy Conference was held on September 13-14 in Rosemont, Illinois and was a great success. Over 70 participants from 33 states spent the weekend learning and sharing ideas on legislative advocacy and the issues that are important in maintaining and growing urology practices throughout the country. Participants left the conference more informed on the issues affecting their practices and ways in which they can combat the legislative threats that they face in their states. Thank you to everyone who participated and lent his or her talents to make this event such a success. Please e-mail statesociety@aacuweb.org for more information on the conference and the materials from the meeting or the State Society Network in general.

Please click HERE for more information from the conference.

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.

Federal Trade Commission and the U.S. Department of Justice Release Statement Opposing Certificate of Need Laws

In response to a request for comment from the Illinois Task Force on Health Planning Reform, the Federal Trade Commission and the Antitrust Division of the U.S. Department of Justice recently entered a joint statement in which they called on states to abolish their Certificate of Need (CON) laws for health care services.

The Department of Justice originally undertook a detailed investigation of CON laws in 2004 that ultimately found that these laws do not reduce health care costs and, to the contrary, impose additional costs and may lead to anti-competitive actions. The report notes that the federal mandate that was the original impetus behind the creation of CON laws has since been repealed because of changes in government and private insurance reimbursement processes.

Finally, the statement lists several instances where the CON process itself has been exploited to encourage non-competitive behaviors by both current certificate holders and regulators themselves. Most notable was in Illinois when a member of the planning commission charged with administering the CON process in the state pled guilty to a kickback scheme using his position on the board to secure CON approval for a particular hospital.

Currently, thirty-six states have CON laws in place. Several states, including Illinois, are examining their laws, however, to determine if they should be changed or abolished. In addition to the statement in Illinois, similar statements have been issued by the agencies to Georgia in 2007, and to Alaska and Florida earlier this year.

Please click HERE for a copy of the statement issued to the Illinois Task Force. A copy of the original Department of Justice report can be found here.

For more information, please contact Bonnie Shadid, State Affairs Manager, at statesociety@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.

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.

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.