CAP program not popular with urologists

An e-mail survey conducted in late July 2005 asked Urology Times readers whether they would participate in the Medicare Competitive Acquisition Program (CAP) in 2006, and why they would or would not. Here is a sampling of their responses:

"I have made it a policy NOT to participate in drug purchases for patients in any way. I would need a strongly persuasive argument to change this practice."
Michael Lemmers, MD

"I'd like to eliminate the possibility of negative reimbursement, ie, getting paid less than my costs. Even if we get 106%, it actually isn't a significant profit, as billing alone costs 3%."
Padraic McCahill, MD

"It is poorly organized, too cumbersome, and has inadequate opt-in/opt-out provisions. CMS totally ignored all comments presented by urologists during the comment period."
Noel Sankey, MD

"At this time, I am not willing to give up control of my medication inventory for patient care, nor am I willing to hire an additional employee to track an outside agency's policy and procedures to obtain their medication for my patients."
Carol Lunceford, MD

"I still can't afford to administer the CAP program. It will, as it is written, require additional clerical help in the office with no reimbursement for the cost involved."
Martin Dineen, MD

"[My] current profit on LHRH agonists is minimal at best. Getting the product out of our office will eliminate ordering, storage, and reimbursement issues, thereby freeing up some time for our staff to concentrate more on patient care."
David S. Martoccia, MD

"It is not financially advantageous, easy to use, or efficient for patient treatment. It is better if the patient purchases his medication and we administer it."
Ramon Perez, MD

"With the program, the vendor bills the patient. The doctor must accept what the vendor sells (as decided by CMS to lower costs) and then bundle these administrative costs, which are, of course, trivial. The medication will be acceptable, but not necessarily the most effective. Would a contractor accept just any wood, or a bakery owner accept just any generic flour? I don't think so. It [CAP] appears to be a case of responsibility without any authority."
James K. McAleer, MD

"If the paperwork is to onerous, I will not participate. I'll either send patients to the hospital for treatment or have them arrange to get the medicine on their own, and my office will administer it to them."
Joe LaNasa, Jr., MD

"Having two purchasing systems, one for Medicare and one for all other patients, is too difficult for my solo office, where the volume of purchases is very low to begin with. Purchasing is one of many duties for the RN. Making it more complex makes it more error-prone, meaning that any savings are likely to be wiped out by a single 'error.' "
Laura S. Gordon, MD

"With the decrease in fee amounts for all urological drugs, CAP is a good idea. The only holdback for us is the patient not wanting to do anything extra in order to obtain the drugs. We operate in a rural area with a moderate amount of patients with a low educational level. It will take a lot of extra time to explain how CAP works and why we are using that program."
Heather Witherspoon, Office Manager