Health Law & Policy

Having completed a well-deserved victory lap after the recent repeal of the SGR, it's time to tune up our engines and head right back to the race track to advance the specialty's remaining advocacy priorities.

Finally, I can stop writing about the Medicare SGR formula and efforts to reform it, and you can stop worrying about whether you’re going to get whacked with untenable payment cuts about this time every year.

Not-so-obvious coding errors and self-referral practices are a growing target for the government and contractors, health care attorneys say.

What can urologists do to protect themselves from being accused of and charged with health care fraud and abuse? Urologist Jeffrey Kaufman, MD, and attorneys J.D. Thomas, Esq and Laura F. Laemmle-Weidenfeld, Esq provide these four suggestions.

Legislation that ends the sustainable growth rate (SGR) formula was hailed by leading urology groups as a historic, watershed event.

Urologist Gary M. Kirsh, MD, says it’s time to bid farewell to fee for service and embrace the concept of value-based compensation in medicine.

In this column, Daniel R. Shaffer of the AACU discusses the recent Urology Joint Advocacy Conference and how urology may have helped move the needle on a promising new SGR proposal.

Are you ready for value-based compensation? If not, these 6 steps can help you prepare.

The major organizations representing urologists are continuing their push for congressional approval of legislation designed to reform the operations of the U.S. Preventive Services Task Force, which in May 2012 recommended against PSA-based screening for prostate cancer.

Narrow provider networks are gaining ground among insurers and could impact patient access to urologists. While insurers tout the approach to care as a way to control costs and preserve quality, urologists and others question whether the payment model is all about cost.

In this column, Ross E. Weber of the AACU examines where various proposals to address the specialist physician shortage currently stand.

In this interview, Patrick H. McKenna, MD, former chairman of the AUA’s Judicial & Ethics Committee, discusses self-referral as well as the AUA expert witness program, conflicts of interest, and live surgical demonstrations.

Have the stars finally become aligned in such a way that Congress resolves the perennial Medicare physician fee fiasco? The signs seem to point that way.

Urologists attending the 2015 Urology Joint Advocacy Conference will have the opportunity to make their voices heard on Capitol Hill at a pivotal time for physicians.

Urologists contacted by Urology Times do not expect the current makeup of Congress to have much of an impact on health care.

Just over a year ago, the Office of Inspector General of the Department of Health and Human Services issued a report declaring that Medicare payments for vacuum erection systems were “grossly excessive” and recommended steps to remedy the situation.

The 2015 omnibus spending bill canceled a $10 million appropriation for the Independent Payment Advisory Board (IPAB). Congress also approved a bill that cuts Medicare funding for vacuum erection systems. Rationing care, whether undertaken by the IPAB or Congress, must be opposed when it arbitrarily selects services based on public perception and not medical necessity, writes Ross E. Weber of the AACU.

Urology Times looks back on the top health policy and practice management stories of 2014, including coverage of the Affordable Care Act and changes in reimbursement.

You can expect the new Congress, now controlled in both the House and Senate by Republicans, to take a shot at repealing the Independent Payment Advisory Board.

In Urology Times’ ninth annual State of the Specialty survey, an astounding 87% of respondents perceived “increasing government regulations” with trepidation. Unfortunately, while nearly nine in ten urologists identify the problem, far fewer take steps to address it.

In this article, Ray Painter, MD, and Mark Painter provide some facts about the 2015 Medicare fee schedule and share some insights on how its changes will impact your practice in the New Year.

Even with the GOP more firmly entrenched on Capitol Hill, a permanent fix of the sustainable growth rate formula is still a possibility, say urologist James Ulchaker, MD, and Brad Stine of the AUA.

Here is a collection of ICD-10 resources for urologists, including a checklist and links to articles, FAQs, and more.

For physicians who have small practices and might still be struggling with EMRs and other government regulations, ICD-10 implementation could be the last straw, says W. Jeff Terry, Sr., MD. Here are some possible fixes suggested by Dr. Terry.

Mark Painter, CEO of PRS Urology, and Jonathan Rubenstein, MD, a urologist in Baltimore and member of the AUA’s Coding and Reimbursement Committee, recommend this checklist for ICD-10 urology practice transition.

When provisions of the Affordable Care Act (ACA) related to the expansion of Medicaid to low-income childless adults took effect in January 2014, 25 states and the District of Columbia had approved laws to broaden their programs' eligibility requirements. Since then, under pressure from various interests groups, including state hospital associations, lawmakers in at least three more states-Iowa, Michigan, and Pennsylvania-expanded their health care safety net programs and thereby gained access to federal dollars that would have otherwise been left on the table.

Urologists know the International Classification of Diseases-10 (ICD-10) goes into effect Oct. 1, 2015. Whether they understand the transition’s impact and what they need to do to fully prepare are questionable.

The effort to draw attention to the importance of prostate cancer detection was given a big boost in September when conservative Sen. Jeff Sessions (R-AR) and liberal Sen. Barbara Boxer (D-CA) joined together to sponsor legislation to create the National Prostate Cancer Council.

Leaders of state, national, and subspecialty urologic societies from around the country converged in Rosemont, IL in September for a weekend of health policy discussions and advocacy tips with public officials, policy experts, and fellow urologists. One of the themes reinforced at the 7th Annual State Society Network Advocacy Conference, hosted by the AACU, was the importance and impact of physician engagement in the political process.

Physicians, including urologists, now have another headache to deal with-making certain information about them published on the Internet by as part of the National Physician Payment Transparency Program (Open Payments) is accurate and not misleading to patients who want to know about the financial benefits their doctors receive from manufacturers of drugs, devices, and biologic and medical supplies.