August 2011
The essential resource for your practice
Volume XXI, Number 8

CMS Plans MAC Reconsolidation

According to its Web site, the Centers for Medicare & Medicaid Services (CMS) plans to reduce the number of A/B Medicare Administrative Carriers (MACs) from 15 jurisdictions (currently designated numerically) to 10@blurbend, to be designated alphabetically. Of the current MAC jurisdictions, the geographic areas of 10 will be modified and five will remain unchanged.

Under this consolidation plan, MACs will be designated as follows:

Jurisdiction E (No changes): Includes California, Hawaii, Nevada and the Pacific Islands (currently Jurisdiction 1; current MAC: Palmetto Government Benefits Administrators).

Jurisdiction F: Includes Alaska, Idaho, Oregon and Washington (Jurisdiction 2; currently no MAC selected), as well as Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming (Jurisdiction 3; current MAC: Noridian Administrative Services).

Jurisdiction G: Includes Iowa, Kansas, Missouri and Nebraska (Jurisdiction 5; current MAC: Wisconsin Physicians Services) and Illinois, Minnesota and Wisconsin (Jurisdiction 6; currently no MAC selected).

Jurisdiction H: Includes Colorado, New Mexico, Oklahoma and Texas (Jurisdiction 4; current MAC: TrailBlazer Health Enterprises) and Arkansas, Louisiana and Mississippi (Jurisdiction 7; currently no MAC selected).

Jurisdiction I: Includes Ohio and Kentucky (Jurisdiction 15; current MAC: CIGNA Government Services) and Indiana and Michigan (Jurisdiction 8; currently no MAC selected).

Jurisdiction J (No changes): Includes Alabama, Georgia and Tennessee (Jurisdiction 10; current MAC: Cahaba GBA).

Jurisdiction K: Includes Connecticut and New York (Jurisdiction 13; current MAC: National Government Services) and Maine, Massachusetts, New Hampshire, Rhode Island and Vermont (Jurisdiction 14; current MAC: National Heritage Insurance Corp.).

Jurisdiction L (No changes): Includes Delaware, Washington DC, Maryland, New Jersey and Pennsylvania (Jurisdiction 12; current MAC: Highmark Medicare Services, Inc.).

Jurisdiction M (No changes): Includes North Carolina, South Carolina, Virginia and West Virginia (Jurisdiction 11; current MAC: Palmetto GBA).

Jurisdiction N (No changes): Includes Florida, Puerto Rico and the U.S. Virgin Islands (Jurisdiction 9; current MAC: First Coast Service Options).

Jurisdictions not currently assigned to a MAC will remain with their current state (legacy) carrier until the next round of consolidations. Those whose boundaries are unchanged by this consolidation will have to re-compete as their current contracts run out. MAC contractors may change as a result.

We will continue to monitor this consolidation plan and keep you informed in upcoming issues of the Health Policy Brief. For more information, please e-mail rr&

Table of Contents


AUA’s Inaugural “Afternoon on the Hill” a Rousing Success

Special Issue: AUA Health Policy Groups Gather at AUA2011 Annual Meeting in Washington, DC

Advocacy in Action at the AUA2011 Annual Meeting

The AUA Annual Meeting is the world’s largest urology meeting, filled with an abundance of educational and networking events for AUA members and other attendees. The Annual Meeting is also an opportunity for AUA members to learn about health policy issues facing urology today, and for the AUA’s health policy committees to meet to discuss current issues, new initiatives and upcoming activities. This issue of the Health Policy Brief highlights the many health policy meetings and events held in Washington, DC, during the AUA2011 Annual Meeting.

*AUA2011 Annual Meeting photography provided by Oscar Einzig, unless otherwise noted.

For The Record

As the effects of the Meaningful Use (MU) incentive program gain traction and urology practices evaluate their compliance with the MU measures, it is natural for practice leaders to think about how to meet some of these new demands more efficiently.@blurbend The current buzzword for actions taken to leverage the power of electronic health records (EHRs) is “optimization.” Recent studies sponsored by the Medical Group Management Association show that practices engaged in optimization enjoy lower costs and higher productivity than practices not using their EHRs to the fullest.

Conversations on the AUA Practice Managers’ Network (PMN) listserv have arisen about such topics. Examples include the use of machines that measure vital signs (required by MU) while directly downloading them into the patient’s electronic record, or the most effective way to provide patients with electronic information and/or clinical summaries within three business days.

For the latter challenge, you may want to talk to your EHR vendor about installing a Web-based patient portal, which is designed to electronically facilitate communication between patients and providers. The provider authorizes patient access via a username and password to a secure Web connection. Using this portal, a patient can request appointments, view lab results, ask for prescription refills, complete information forms, etc. The provider can communicate with patients on an individual basis more efficiently by sharing visit summaries, issuing appointment reminders, or even communicating about financial issues. The practice maintains control over the data items that can be accessed by the patient through a patient portal. It does not open the door to the entire EHR. According to Health Information Technology experts, an EHR is not essential for a patient portal, but the two electronic processes are naturally compatible. Plus, exploring the cost to install a patient portal on a practice Web site is very timely since the government recently issued requirements about communicating specific information from an EHR to active patients within the MU criteria.

For more information, please e-mail

FDA Issues New Safety Communication about the Use of Mesh to Treat Pelvic Organ Prolapse

On July 13, 2011, the U.S. Food and Drug Administration (FDA) issued a new safety communication about the use of mesh for pelvic organ prolapse (POP) surgery. This warning is an update of a previous FDA warning that was issued in October 2008. Based on continuing adverse event reports that have been received by the FDA since the initial warning in 2008, the FDA now states that serious complications associated with surgical mesh for transvaginal repair of POP are not rare.@blurbend In addition, the FDA conducted a systematic review of the published literature from 1996-2011, and concluded that transvaginal POP repair with mesh does not improve symptomatic results or quality of life when compared with non-mesh repairs, and that mesh used for POP repair introduces risks that are not present in traditional non-mesh surgery. Mesh erosion and contraction (shrinkage) were identified as specific complications which can result in pelvic pain, dyspareunia, bleeding and infection.

The FDA then issued new recommendations, which state that healthcare providers should:

  • Recognize that most cases of POP can be treated successfully without mesh
  • Choose mesh surgery only after weighing the risks and benefits of surgery with mesh vs. all other alternatives
  • Consider that surgical mesh is a permanent implant which can make future POP repairs more challenging, can cause complications which require additional surgery, and can be difficult or impossible to remove
  • Inform patients about treatment alternatives that do not require mesh placement
  • Notify patients that mesh will be used, and provide the patient with information about the specific product used
  • Ensure that the patient understands the risks of mesh surgery and the limited long-term outcomes data

Importantly, the FDA explicitly states that the announcement only pertains to the use of transvaginal mesh for POP, and does not concern the use of mesh for the surgical treatment of stress urinary incontinence.

This announcement reinforces the importance of discussing the potential for these complications with prospective patients prior to performing POP surgeries that utilize mesh, and of documenting that discussion in the patient's medical record.

For more information, the FDA report can be viewed here.