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

AUA Advocates Against Narrowing of Medicare Advantage Networks

The AUA continues to monitor the narrowing of the Medicare Advantage (MA) Networks. This issue surfaced last month when members of the AUA Practice Managers’ Network (PMN) reported that United Healthcare (UHC) was terminating MA contracts in the northeast. These terminations were “without cause” and included both primary care and specialists.

Table of Contents

  

Coding Corner:

Request a Review of Your 2012 PQRS Participation Results

MedPAC Considers Synchronizing Medicare Payment Policy Across Delivery Systems

The Medicare Payment Advisory Commission (MedPAC) convened on November 7-8, 2013   and covered a variety of issues dealing with everything from synchronizing Medicare policy and quality measures across delivery systems, repealing the sustainable growth rate (SGR), and policy reforms for the second phase of accountable care organizations (ACOs).

Synchronizing Medicare Policy Across Delivery Systems

Within the Medicare program, there are different delivery systems with different payment policies. Among the options are traditional fee-for-service (FFS), which pays a set rate per service with no risk; accountable care organizations (ACO), which pay a set rate for services with bonuses and penalties; and Medicare Advantage (MA), which uses a risk-adjusted capitation payment model. MedPAC staff presented data on the characteristics of the different delivery systems. The Commissioners were asked to think about how these options relate to one another and to consider approaches to synchronize spending variations within the same area and whether benchmarks should be set at the area or group level. The Commissioners discussed a number of incentives to neutralize payment and level the playing field.. While changing incentives and new payment models are important, MedPAC Chairman Glenn Hackbarth stressed the need for mechanisms to shift resource use from high volume to low volume.

For The Record

Urology Meaningful Users of Electronic Health Records (EHR) and the Systems They Use

Recently published data from two surveys of users of EHR systems reveal important facts about eligible providers who are involved in the Medicare/Medicaid Meaningful Use incentive and penalty programs. On September 30, 2013, HealthIT.gov published a comprehensive dataset of certified EHR products used to attest to Meaningful Use along with the types of eligible providers (EPs) who use them. The AUA Data Department analyzed this dataset and identified the systems most frequently used by urology EPs to qualify for Meaningful Use in 2011-12.

Senators Introduce Urotrauma Amendment to NDAA

AUA Optimistic that 2013 Could Mark Major Progress to Advance Treatment, Awareness of Devastating War Injuries

On November 18, Senators Ben Cardin (D-MD) and Roy Blunt (R-MO) introduced an amendment to the Senate version of the National Defense Authorization Act (NDAA, S. 1197) that would require a comprehensive policy on improvements to care and transition of members of the armed forces with urotrauma. Earlier this year, the same amendment was introduced to the House version of the NDAA (H.R. 1960) by Rep. Brett Guthrie (R-KY). Rep. Guthrie has been a long-standing champion for the issue of urotrauma.

The Senate will be voting on the NDAA in the coming weeks, and then both chambers will move to conference on the bill, a major piece of annual legislation that specifies the expenditures and budget of the U.S. Department of Defense.  Barring any major issues, it is indeed possible that we will be victorious in our long-standing mission to raise awareness of and improve care for our nation’s veterans with urotraumatic injury, which accounts for up to 10 percent of all war-related injuries.