November 2013
The essential resource for your practice
Volume XXI, Number 11

United Healthcare Drops Physicians from Medicare Advantage Networks

The AUA continues to monitor United Healthcare’s (UHC) decision to terminate its contract with more than 2,000 physicians in Connecticut who participate in the Medicare Advantage network. This included both primary care physicians and specialists.

Table of Contents

  

Coding Corner:

New Cystourethroscopy, with Ureteroscopy and/or Pyeloscopy; with Lithotripsy Code for 2014

AUA Co-Sponsors Policy Roundtable to Discuss ACOs and Alternative Payment Models

On October 31, 2013, the AUA, as a member of the Alliance of Specialty Medicine, cosponsored a Physician Policy Roundtable with industry leaders to discuss Accountable Care Organizations (ACOs) as an evolving approach to payment reform and alternative payment models.  The expert panel moderated by Brock Bakewell, MD an ophthalmologists in Tucson, AZ, included the following speakers: John Pilotte, Director, Performance-Based Payment Policy for the Centers of Medicare & Medicaid Services (CMS), Mark McClellan, MD, former CMS administrator and current director of Health Care Innovation and Value Initiative at the Brookings Institution, Bill Rogers, MD, Director of CMS’ Physician Regulatory Issues Team (PRIT), Courtney Lawrence, Legislative Assistant to Rep. William Cassidy, MD (R-LA), and Karen Fisher,  Dan Todd and Brett Baker, professional staff of the Senate Finance Committee.

Since the inception of the Medicare Shared Savings Program (MSSP), the ability for specialty physicians to fully participate and engage in ACOs has been limited by CMS’ patient attribution process, which restricts specialist from participating in more than one ACO. Physicians are, however, permitted to obtain more than one TIN (Tax Identification Numbers) or enroll with multiple ACOs using a single TIN as a way around the exclusivity provision.  Both of these options are administratively challenging and have potential legal ramifications. 

For The Record

Looking for 2013 PQRS Interim Claims Feedback?

Individual eligible professionals (EPs) who reported at least one 2013 Physician Quality Reporting System (PQRS) quality-data code (QDC) via claims can now access the Dashboard online tool to view 2013 quarter 1 (January through March) data regarding their submissions. The Dashboard is available through the Physician and Other Health Care Professionals Quality Reporting Portal, with Individuals Authorized Access to the CMS Computer Services (IACS) sign-in. 

AUA to Launch the AUA Quality (AQUA) Registry

The AUA Board of Directors has formally approved the development and launch of the AUA Quality (AQUA) Registry.

The AQUA Registry will initially focus on prostate cancer and gradually expand to other urological conditions. Significant features of the AQUA Registry and key benefits for both urologists and patients will be the guideline-informed physician practice and evidence-based patient decision support mechanisms and the ability to report measures on quality of care and performance.  The AQUA Registry will be a powerful tool for urologists to observe the course of disease; understand variations in treatment and outcomes; examine factors that influence prognosis and quality of life of patients; assess effectiveness; monitor safety and harm; measure quality of care; and compare themselves with their peers at at an aggregate level. 

The AQUA Registry will be implemented in a phased manner (design phase, pilot phase and full operation phase) over two years in terms of number of participating practices, system scope and functionality. The registry will be built with electronic medical record (EMR) data integration capability to reduce or eliminate the burden of data entry to physicians.