The law signed April 1 that avoided the slated 24% Medicare physician payment cut for this year will intensify federal scrutiny of the current system for valuing specific medical services, a procedure that is at the heart of how much doctors get paid.
The latest SGR patch includes a provision that instructs Medicare officials to review the value of some procedures and sets a target for reductions of misvalued codes, which has drawn the criticism of organized urology.
New AUA Director of Government Relations and Advocacy Brad Stine intends to advocate for the AUA’s SGR policy: to gain affirmative repeal of the formula that has proven so troublesome over the years for urologists, whose patient population includes a large percentage of Medicare enrollees.
Congress may be ready to trade in the SGR for a VBP and an APM to fix the difficult physician fee schedule situation that has plagued urologists and other Medicare physicians for a decade. But while the AUA wants the SGR to go away, the organization has significant reservations about this latest plan.
It appears that Congress is finally determined to provide a permanent solution to the annual Medicare fee payment crisis, and there is a possibility that the process also could reduce pressure to end an exception to the Stark self-referral law upon which many urologists have come to rely.
While it is still unclear whether and how Congress will reform the Medicare sustainable growth rate formula in time to avoid a 25% payment cut beginning in January, many physician groups, including the AUA, are adamantly opposed to another key component of the proposed 2014 Medicare Physician Fee Schedule.
For the first time since the Medicare fee schedule crisis began after the sustainable growth rate formula was included in the Balanced Budget Act of 1997, there is realistic hope that Congress will reform the way Medicare physicians are paid for their services.
Major organizations representing urology are livid at the conclusions of a new report by the U.S. Government Accountability Office, which basically accuses urology practices with in-office intensity-modulated radiation therapy facilities of ripping off Medicare.