December 2013
The essential resource for your practice
Volume XXI, Number 12

AMA Adopts Policy on AUA Legislative Priorities

The American Medical Association House of Delegates adopted numerous policies on key issues that impact physician practices and patient health. The Interim Meeting, held November 16-19, just outside of the nation’s capital in National Harbor, Maryland debated several of AUA’s lead priorities.

Table of Contents


Coding Corner:

American College of Surgeons Provides New PQRS Reporting Tool for Its Members

Final Rule: CMS Withdraws Proposal to Cap Physician Payment Rates in 2014

On November 27, 2013, the Centers for Medicare & Medicaid Services (CMS) released the final rule (link removed) updating policies and payment rates for physician and other health care provider services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year (CY) 2014.

In the MPFS final rule, CMS did not adopt the proposal to cap practice expense payments for non-facility services at the hospital outpatient department (OPD) or ambulatory surgical center (ASC) facility rate if the non-facility payment amount exceeds the facility payment amount for the same service. This is a major victory for the AUA and the physician medical community as a whole. Had the proposal been adopted, payment amounts for several urology services would have been cut more than 50 percent. The AUA successfully advocated against the payment cap by identifying several flaws in the proposed methodology.  In response to issues raised by the AUA, and the medical community, the agency plans to consider more fully the comments it received and address the issue in future rulemaking. 

The MPFS final rule reflects a 20.1 percent reduction in the conversion factor (CF), however, when adjustments to the relative value scale are combined with the CF change, the net reduction in payment rates will be about 24 percent.  The reduction, generated by the flawed sustainable growth rate (SGR) formula, will significantly reduce the 2014 CF to $27.2006 from the current CF of $34.0230. The AUA has been working closely with Congress to permanently repeal the SGR and replace it with a new payment system.

For The Record

2014 PMN Subscription Campaign Features New Options and New Benefits

Based on extensive market research, the Practice Management Department has modified the Practice Managers’ Network (PMN) for 2014 to accommodate the needs of various size practices and practices owned by hospitals.  The results of a recent survey of subscribers showed us that with the movement of urology practices to large multi-specialty institutions or hospitals, their desire for interaction with other group managers exceeded their need for external coding advice. Therefore, for subscribers who renew or purchase a new subscription in 2014, there is an option with unlimited Coding Hotline access and one without for a reduced price.

Proposed Legislation Limits ACA Metrics Use in Malpractice Cases

New legislation authored by Senators Pat Toomey (R-PA) and Tom Carper (D-DE) is designed to discourage unnecessary lawsuits brought about by reporting metrics in the Affordable Care Act. Under Senate Bill 1769, ACA metrics such as meaningful use stage two, the Physician Quality Reporting System (PQRS), the Hospital Readmission Reduction Program (HRRP) or others cannot be used to determine the appropriate standard of care patients must receive or as the sole grounds for a lawsuit.

This idea, designed to close a potentially exploitable loophole, has also received support in the House of Representatives.  Similar, bipartisan legislation has been introduced by Representatives Dr. Phil Gingery (R-GA) and Henry Cuellar (D-TX).