(UroToday.com) During the AUA Summit, leaders in urology participated in a panel discussion reviewing several important aspects of physician payment reform that have placed significant strain on urologists and urology practices. Dr. Anurag Das provided an overview of the history of physician payment models and the Medicare Physician Fee Schedule (MPFS).
Medicare releases their proposed rule in July, with a comment period of 60 days, and subsequent final rule that is applied in January of the following year. He highlighted that although value-based care was the goal of several health policy shifts over the past decade, bonuses for high quality providers have not been feasible due to the high number of high performers and financial burden of such initiatives.
Dr. Mara Holton then placed healthcare costs in the setting of patient financial toxicity. Like Dr. Das, she also stressed the rising burden of healthcare costs, which correlated to an increase in patient out of pocket financial burden. Further, the US had the highest rate of rising costs in the world. Cancer care has driven much of these rising costs.
One in five Americans diagnosed with cancer declared bankruptcy or lost their home due to eviction or foreclosure.
She stressed that physician decision do drive costs, and physician reimbursement is now focused on penalizing and rewarding doctors. She states that it is essential to engage other stakeholders, such as health systems, payors, and legislators to find sustainable solutions outside of physician salary adjustment. Ensuring that urologists actively participate in solutions to this important problem, through advocacy and political donations will be critical.
Dr. Reha framed physician reimbursement in the setting of inflation, recognizing that physician reimbursement was cut, worsening the strain on private practices across the country. The provided estimates that practice costs increased 39% over the past 20 years, while Medicare physician pay dropped 22%. During the same time period, payment to hospitals increased nearly 60%. All of these issues have led to an increase in physicians turning towards hospital-based employment. Integrated practices had major financial advantages over private practices, even in private insurance markets. Additionally, he demonstrated that Merit-Based Incentive Payment System did not provide a financial advantage, especially since high performing practices received only a 1% positive payment adjustment while incurring significant costs to implement such programs. He stressed that all of these issues have made private practice in urology less feasible.
Dr. Das concluded by stating that we need a structural overhaul of Medicare’s financing system that considers inflation, budget neutrality, and will require specialty society, individual, and practice input.
Presented by:- Anurag Das, MD, Chief of Urology at the Smith Institute for Urology at Staten Island, Interim Chairman of the Department of Urology at Staten Island University Hospital, and Professor of Urology at Zucker School of Medicine at Hofstra/Northwell
- Mara Holton, MD, Anne Arundel Urology (AAU), Annapolis, MD
- William Reha, MD, MBA, President, AACU, Sentara Northern Virginia Medical Center, Woodbridge, VA
References:
- Mariotto AB, Enewold L, Zhao J, Zeruto CA, Yabroff KR. Medical Care Costs Associated with Cancer Survivorship in the United States. Cancer Epidemiol Biomarkers Prev. 2020;29(7):1304-1312. doi:10.1158/1055-9965.EPI-19-1534
- Rae M, Claxton G, Amin K, et al. “The Burden of Medical Debt in the United States.” https://www.kff.org/health-costs/issue-brief/the-burden-of-medical-debt-in-the-united-states/