Urology-specific quality measures are coming

Bob GattyWhen Congress passed and President Obama signed legislation in 2015 to scuttle the troublesome (to say the least!) sustainable growth rate (SGR) formula for Medicare payments for physician services, urologists joined the rest of organized medicine in breathing a huge sigh of relief.

After years of complaining, lobbying, and suffering with constant threats of huge reimbursement cuts due to the SGR, finally sense and reason would come to the process of paying health care providers for treating Medicare patients.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), in repealing the SGR methodology for updates to the Physician Fee Schedule (PFS), replaced it with a new approach to payment-the Quality Payment Program, which rewards the delivery of high-quality patient care through Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS.

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Providers who participate in an Advanced APM through Medicare Part B can earn 5% incentive payments for participating in an innovative payment model. Those who participate in MIPS will earn a performance-based payment adjustment. Providers-physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists-can participate in the Quality Payment Program if they treat 100 patients and bill Medicare at least $30,000 per year.

But with anything so complex as paying physicians for their services for thousands of specific procedures and doing so based on quality of their work rather than volume, there were bound to be complexities and new requirements imposed on providers that must be met if they expected to be paid the maximum amount possible for their work.

And so it is. However, the reporting requirements imposed on providers are numerous and complex, such that Bryan Mehlhaff, MD, of the Oregon Urology Institute (OUI), Springfield says it’s a distraction in their efforts to care for their patients.

“All of us view it as like a hangnail,” he commented.

But, said Dr. Mehlhaff, “I fully understand this is bipartisan and that MACRA is not going away. After all, it’s the replacement for the failed SGR, which we’re all happy is gone.”

So, to help make it easier and more efficient for urologists to submit these needed reports and get properly paid, the OUI, a member of LUGPA, took it upon itself to develop two electronic Clinical Quality Measures specific to urology.

LUGPA President Neal D. Shore, MD, said: “As leaders in the field, LUGPA's members are committed to advancing best practices and patient outcomes. OUI represented this approach when it took the initiative to begin working on these quality measures and then sharing them with LUGPA's leadership for input.”

Next: Two quality measures developed

Two quality measures developed

The first quality measure, which will mandate a bone-density screening for men who are being prescribed androgen-deprivation therapy with the intent to treat for a year or greater, has been approved by the Centers for Medicare & Medicaid Services (CMS) and will take effect Jan. 1, 2018. The bone density screening has to occur prior to the ADT or within 3 months of initiation.

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The second, mandating BCG treatment for those with high-grade nonmuscle-invasive bladder cancer, will take effect the following year.

“eClinical Quality Measures are vitally important to maintaining quality of care, and they reflect a commitment from LUGPA and its members to pursue best practices that consistently advance the practice of urology,” Dr. Mehlhaff said.

Now, additional measures are expected to be developed by LUGPA for the treatment of osteopenia or osteoporosis in men with non-metastatic prostate cancer who are on androgen-deprivation therapy, for International Prostate Symptom Score or AUA Symptom Index change 6-12 months after diagnosis of BPH, and for the use of active surveillance for low-risk prostate cancer patients.

All of these eClinical Quality Measures will be available for use by all urologists, according to Dr. Mehlhaff and Colleen Parker, RN, also of the Oregon Urology Institute, who did the majority of the heavy lifting to get the initial two measures developed in conjunction with a panel of technical experts.

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“We’re designing these measures for all of urology, and we have to get it right,” Dr. Mehlhaff declared.

Next: How the measures work

How the measures work

What exactly are these “measures” and how are they used?

Simply put, to earn the incentive payments-and to avoid penalties-providers must send data to CMS by March 31, 2018 explaining how the practice used EHR technology. Providers who do so can earn their incentive payments or payment adjustments in 2019.

The electronic measures developed by Dr. Mehlhaff and Parker on behalf of LUGPA can be used as templates to make the reporting process easier.

“Depending on the service, the physician puts in information and the EHR translates it to a code,” Parker said. “For example, if a patient has diabetes out of control, the template will exclude him from the measure. A man with BPH has voiding symptoms, but so do diabetics and it may not necessarily be due to their prostate. The urologist doesn’t want to go into great detail about their diabetes, so this template automatically excludes them. You just do that with a data entry and it’s automatically carried forward so the physician doesn’t have to keep entering that information.”

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Using the bone density evaluation measure, the urologist can easily indicate whether or not a bone density scan was performed on a patient on androgen deprivation therapy, Dr. Mehlhaff explained.

“It’s a relevant measure because the vast majority of urologists didn’t learn about osteoporosis, but we are actually creating it,” he said. “So it’s valid that we would manage this. I view this as a relatively simply measure to comply with, and I would guess that urologists are fairly amiss at paying attention to this currently.”

“CMS likes you to look at things that are preventive,” added Parker, “because that reduces disease, poor outcomes, and cost.”

By doing this scan and identifying osteoporosis, you’re preventing fractures, reducing cost, reducing pain. After all, when our patients have fractures, their lives can spiral downward quickly.”

The bladder cancer measure helps providers report accurately on the treatments provided to these patients, she added, explaining that it automatically excludes patients whose immune systems have been compromised or if they have active tuberculosis, for example.

“The important thing here is that these eClinical Quality Measures are being developed by urologists regarding things that are pertinent to urologists,” said Dr. Mehlhaff. “And since we are doing this in conjunction with LUGPA, they are measures that every urologist in the country can use and take advantage of.”

Dr. Shore added, “LUGPA has made it a priority to continue leading initiatives in value-based care in order to advance all of our urology colleagues whether practicing within independent or academic practice settings.”

For more details on the Quality Payment Program, visit qpp.cms.gov.

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