October 2013
The essential resource for your practice
Volume XXI, Number 10

What You Should Know about PQRS: Preventive Care Measures Group

Participation in the Physician Quality Reporting System (PQRS) has become critical in 2013 because a provider’s participation will now be tied to Medicare reimbursement. However, there are a variety of options when it comes to participation. While the majority of healthcare professionals (including urologists) choose to report individual measures, the Centers for Medicare & Medicaid Services (CMS) provide other reporting methods. One which you might want to consider is measures groups. see more>>

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Coding Corner:

New HCPCS Code for Zoledronic Acid

SGR Repeal Remains Hot Topic on Hill

Repeal of the sustainable growth rate (SGR) formula is a hot Congressional topic again this year.  Unlike previous years, the SGR repeal is receiving bipartisan support this year in the U.S. House of Representatives. SGR repeal is just one of many financial proposals currently being considered by lawmakers on the Hill, along with pending debt ceiling discussions and, more urgently, passing a continuing resolution to fund the government for fiscal year 2014. (The AUA is monitoring the government shutdown; more information will be shared as it is available.) 

Hill staff has been holding meetings with stakeholder groups, including the AUA who has been an active participant in speaking up on behalf of urology.  The AUA has submitted several comment letters detailing our suggested revisions and responded to draft proposals with urology’s concerns.  The Hill has made revisions based on specialty medicine’s comments. A bill was introduced in August outlining policy to repeal and replace the SGR that accommodated many of our concerns. The American Medical Association says it best in these comments:

Physicians treating Medicare beneficiaries have been in a precarious position for years. The SGR first cut Medicare rates by 4.8 percent in 2002. In 2003, Congress enacted the first of 15 temporary patches to the Medicare payment system — some retroactive — that otherwise would have reduced pay for patient services. Short-term solutions to SGR cuts have stopped payments from falling off a cliff, but they also have contributed to ongoing uncertainty in the program.

Repeal of the SGR has been scored at a sale price of $138.3 billion over a 10-year period.  Previous cost estimates have been as high as $300 billion.

Health Insurance Marketplaces Enter Open Enrollment Today

October 1, 2013 marks an important milestone in Affordable Care Act (ACA) implementation as open enrollment begins in the Health Insurance Marketplaces (formerly Health Insurance Exchanges). The Marketplaces are interactive websites, where consumers can compare multiple insurance plans and premiums from several participating insurers, and purchase coverage appropriate for their needs through an online enrollment process.  The Marketplaces also will be able to direct consumers to premium tax credits or their state’s Medicaid program if they meet certain eligibility requirements.

Surgical Quality Alliance Meeting Focuses on Medical Homes, Alternative Payment Models

The AUA is a member of the Surgical Quality Alliance (SQA) which is a collaborative effort of over 20 surgical specialty societies dedicated to improving quality of care for surgical patients, monitoring  and responding to federal and private sector quality programs, and advancing accurate performance measurement for surgeons. As such, the SQA meets twice a year to discuss emerging issues in the quality arena and share methodologies for developing meaningful tools for quality improvement.

At its recent meeting, the SQA discussed the medical home model, focusing on an oncology medical home that the Community Oncology Alliance is developing based on quality as well as value. Developed by a multi-stakeholder panel of patients, payers, and providers, the alliance emphasizes the importance of patient satisfaction as well as end-of-life discussions. The alliance uses National Comprehensive Cancer Network (NCCN) guidelines and patient guides as resources. Additionally, Anesthesiology has developed a Perioperative Surgical Home that goes beyond just anesthesiologists and includes all surgeons involved in the care of the patient.