November 2022 AUA Public Policy Council Update For MAS

From the Chair
MAAUA Chair 2020

I am pleased to share updates from the AUA Public Policy Council that may benefit your Section members. Our updates include information on the Calendar Year 2023 Medicare Physician Fee Schedule Final Rule and November’s American Medical Association House of Delegates meeting.

AUA Summit Registration is Open!

Registration is now open for the 6th Annual Urology Advocacy Summit taking place in Washington, D.C., February 27 – March 1, 2023. The dynamic conference includes a day of Capitol Hill meetings and features two days of in-person educational and trending policy sessions with an opportunity for attendees to earn continuing medical education credits.

AUAPAC Charitable Match Program Open

The American Urological Association’s Political Action Committee (AUAPAC) is dedicated to advancing urology’s top policy issues with lawmakers and your donation helps the us achieve changes that impact you and your patients. Non-partisan and representative of the entire urologic community, our goal is to work with and to help elect candidates to Congress who understand and can address the issues directly affecting our specialty.

Over the next few weeks, your contribution to AUAPAC will be matched by a dollar-for-dollar donation to a charity of your choice*! Whether it’s the Urology Care Foundation, AUA Section Education Funds, or another charity you feel passionately about – we know that urologists and urologic professionals around the country have many important philanthropic interests they support each year. Go to www.myAUAPAC.org to learn more and give.

CY 2023 Medicare Physician Fee Schedule Released by CMS

On November 1^st, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for CY 2023 (CMS-1770-F). This rule updates payment policies and payment rates for Part B services furnished under the MPFS, as well as makes changes to the Quality Payment Program (QPP). A pre-publication version of the rule can be found here. A press release and fact sheet are also available.

Conversion Factor: The CY 2023 Medicare conversion factor (CF) is set at $33.06, a decrease of 4.5% from the 2022 CF of $34.61. The decrease is mainly the result of the expiration of a 3% increase funded by Congress through 2022. The other 1.6% decrease is the result of budget neutrality requirements due to changes in the inpatient E/M codes and hospital observation, emergency department, nursing facility, and home or residence services. The AUA has been lobbying Congress to avert this payment cut, as there is nothing the agency can do without an act of Congress.

Specialty Level Impact: Table 128 of the final rule outlines the financial impact of finalized policy. Urology is projected to see a decrease of 1% in Medicare payments. The impact amounts in Table 128 only includes changes to rate setting and changes to RVUs under the budget neutral system, not the impact of the conversion factor decrease. Note that the impact to individual or group practices varies based on practice type and mix of patients and services provides to those patients.

Code Level RVUs: In the 2023 rule, CMS accepted the Relative Value Scale Update Committee’s (RUC) recommended work and PE relative value units (RVUs) for laparoscopic simple prostatectomy procedures as reported by CPT codes 55821, 55831, 55866, and 55867. The AUA participated in the RUC survey for these codes and is pleased to see CMS finalized RUC recommended values.

Prior to release of the 2023 rule, the AUA submitted comments objecting to CMS’ proposed RVUs for percutaneous nephrolithotomy (50080 and 50081), which were lower values than the RUC recommended values for these services. CMS rejected the arguments of commenters that the RVUs proposed by RUC were not appropriate. The agency noted that in general, when the time for a service decreases, then the work RVU should have a corresponding decrease. The agency did, however, add in additional RVUs (0.30) for performing fluoroscopy, as this work was not accounted for in the proposed values.

Split/Shared Services: CMS continues to stand by its policy for billing split/shared services by time and has again reiterated that in 2024 a split/shared service is billed by the practitioner who provides a substantive portion of the visit using time as the determining factor. This policy applies only to services provided in the facility setting. However, CMS has delayed the implementation of this new policy for an additional year. The AUA advocated to the agency that using time rather than medical decision making to determine the substantive portion will undermine the agency’s efforts to move towards team-based care as physicians will be less likely to perform these visits.

Telehealth Services: The AUA advocated for CMS to add, on a permanent basis, telephone-only services (99441-99443) to the telehealth services list, however the agency has finalized its proposal to NOT add telephone-only services to the telehealth services list but will continue to pay for these services for 151 days after the PHE expires. At day 152 after the PHE ends the telephone-only E/M services will revert as unpayable and considered bundled under the MPFS.

Discarded/Wasted Drugs: In the proposed rule, CMS considered whether to use the authority granted by Congress to raise the applicable percentage of waste that triggers a refund for drugs with unique circumstances. Specifically, the agency considered drugs that must be reconstituted with hydrogel noting that a substantial amount adheres to the vial wall during preparation. The agency speculated 35 percent may be appropriate to account for the portion of the drug that adheres to the vial. The AUA commented that CMS should use its authority and finalize policy that raises the applicable percentage to 35 percent for wastage associated with drugs reconstituted with hydrogel. With this rule, CMS has finalized its proposal to allow for 35% wastage, and in this case, only one drug Jelmyto^®(mitomycin for pyelocalyceal solution).

The AUA will publish a more thorough analysis, including final impact tables for commonly billed urologic codes, in the coming days as we continue to review the final rule. For questions or comments, please contact Bhavika Patel, Manager for Physician Payment and Reimbursement at bpatel@auanet.org

American Medical Association House of Delegates (HoD): Medicare Physician Reimbursement and Workforce Shortages Highlight Interim Meeting

On November 12-15, AUA Delegates – Hans Arora, MD; Jason Jameson, MD; Richard Pelman, MD; and AUA Resident/Fellow Section Delegate Ruchika Talwar, MD represented the AUA at the 2022 American Medical Association (AMA) House of Delegates (HoD) Interim Meeting. The AMA HoD is the principal policy-making body of the AMA. It represents the views and interests of a diverse group of member physicians from more than 170 societies. These delegates meet twice a year to establish policy on health, medical, professional and governance matters.

The delegates first participated in a variety of specialty caucus pre-meetings, including those hosted by the Surgical Caucus organized by the American College of Surgeons, the Cancer Caucus organized by the American Society of Clinical Oncology, and the Specialty and Service Society Caucus.

In addition, the AUA delegation was active in six different reference committee meetings covering more than 150 distinct reports and resolutions relating to clinical practice, payment, medical education and public health topics. They provided testimony on multiple issues, including on Resolution 304 “Protecting State Medical Licensing Boards from External Political Influence” and Resolution 916 “Non-Cervical HPV Associated Cancer Prevention” to include the broad term genital cancers, rather than penile cancers, to be more inclusive of various urologic cancers when promoting HPV vaccinations.

To read more about each day of the meeting, follow along on the Policy & Advocacy Brief:

Day 1: https://community.auanet.org/blogs/policy-brief/2022/11/12/2022-ama-house-of-delegates-interim-meeting-day-1

Day 2: https://community.auanet.org/blogs/policy-brief/2022/11/14/2022-ama-house-of-delegates-interim-meeting-day-2

Day 3: https://community.auanet.org/blogs/policy-brief/2022/11/15/2022-ama-house-of-delegates-interim-meeting-day-3

Day 4: https://community.auanet.org/blogs/policy-brief/2022/11/16/2022-ama-house-of-delegates-interim-meeting-day-4

ICYMI: Updates from the AUA Policy & Advocacy Brief blog

AUA Urges Congress to Stabilize Medicare in MACRA Request for Information (RFI)

Representatives Ami Bera, MD (D-CA-7) and Larry Buschon, MD (R-IN-8), along with their colleagues, requested feedback from stakeholders on actions Congress should take to stabilize the Medicare payment system while ensuring successful value-based care incentives are in place. Specifically, the RFI asked that responses should address the effectiveness of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); regulatory, statutory, and implementation barriers that need to be addressed for MACRA to fulfill its purpose of increasing value in the US health care system; how to increase provider participation in value-based payment models; and provide recommendations to improve the Merit –Based Incentive Payment System (MIPS) and Alternative Payment Models programs. The AUA submitted a letter in response on October31.

The AUA states that Medicare physician payment, which has stagnated, cannot be stabilized without eliminating the budget neutrality requirement and implementing an inflationary adjustment like those included in other Medicare payment systems. Additionally, data utilized in determining cost components such as the Medicare Economic Index (MEI) or practice expense inputs are outdated; utilizing current data to update the MEI is critical to ensuring fair updates to physician payment.

The AUA urges Congress to revise the Quality Payment Program (QPP), which includes MIPS and APM, to support the delivery of value-based care and improved quality without creating administrative burden. CMS needs authority and resources to create programs that are meaningful to all providers and specialty types, while lowering the burden to participate in these programs. Therefore, it is important that CMS or other agencies are authorized to underwrite measures that are used in these programs.

For a copy of the final letter, please contact the AUA’s Policy & Advocacy Director Ray Wezik, JD at RWezik@AUAnet.org.

AUA Joins ZERO in Endorsement for The PSA for HIM Act (H.R. 1176)

On October 11, the AUA joined with ZERO – The End of Prostate Cancer, along with more than 20 patient advocacy organizations and other stakeholders from across the prostate cancer community, in sending a letter of support to Representatives Bobby Rush (D-IL-1) and Larry Buschon, MD (R-IN-8) for the Prostate Specific Antigen Screening for High-risk Insured Men Act (PSA) for HIM Act (H.R. 1176). The PSA for HIM Act waives deductibles, copayments and coinsurances for prostate cancer screenings for those with a family history of prostate cancer or who are African-American.

The letter aims to show broad organizational support for the bill and stir new interest in advance of its reintroduction next year in the new congressional session. For a copy of the final letter, please contact the AUA’s Policy & Advocacy Director Ray Wezik, JD at RWezik@AUAnet.org.

Of Interest: Prior Authorization Cited as Largest Regulatory Burden for Group Practices

Eighty-two percent of group practice executives say prior authorization is very or extremely burdensome, according to the Medical Group Management Association’s “Annual Regulatory Burden Report.” The survey, released October 11, includes responses from executives representing more than 500 group practices. Read the full report here.

Below are insurance updates from national insurance carriers. If you have questions about insurer issues, contact Bhavika Patel at bpatel@AUAnet.org.

Cigna

Cigna reviewed its Male Sexual Dysfunction Treatment (Non-pharmacologic) Policy with the following changes:

Added application of amniotic-derived allografts to nerve bundles during a radical prostatectomy to list of experimental, investigational, or unproven procedures for erectile dysfunction.

Updated experimental, investigational or unproven procedure regarding nerve grafting.

Added codes 64912, 64913, Q4100 as experimental/investigational/unproven.