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On January 13, 2017, Reps. Marsha Blackburn (R-TN-7) and Bobby Rush (D-IL-1) introduced the USPSTF Transparency and Accountability Act of 2017. This bipartisan legislation calls for significant changes to the U.S. Preventive Services Task Force (USPSTF) and the process by which the group makes formal recommendations regarding preventive care services. The AUA applauds Reps. Blackburn and Rush for introducing the legislation, and we will once again offer our support and work to promote this measure during the 115th Congress. The USPSTF is an independent panel of private-sector experts in prevention and primary care issues sponsored by the Agency for Healthcare...
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This week’s update includes information on surgical mesh, potential congressional deliberations on no-fault liability, an announcement of our new Gallagher Scholar and a forthcoming AUA webinar on the Quality Payment Program. 2017 AUA Award Winners: Dr. David Penson Honored Last week, the AUA announced the list of 2017 AUA Award recipients who will be recognized at the Annual Meeting in Boston, MA this May. Dr. David Penson will be presented with the Distinguished Service Award, presented annually to individuals who are deemed to have made outstanding contributions to the goals of the AUA. Dr. Penson will receive the award for outstanding leadership...
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On January 3, members of the 115th Congress convened for the first time and immediately found on the legislative calendar initial plans to roll back major components of the Affordable Care Act (ACA), which is undoubtedly the signature achievement of the outgoing Obama administration and one that majorly overhauled our nation’s health care delivery system. This should come as no surprise, since Republicans have unanimously opposed the ACA and have repeatedly tried to repeal it since enactment in 2010. President-elect Donald Trump will be sworn into office on January 20. And, for the first time in a decade, Republicans will also hold the majority...
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Late last month, the U.S. Department of Veterans Affairs (VA) finalized a rule that will allow advanced-practice registered nurses (excluding certified registered nurse anesthetists) to practice to their full authority at VA clinics independently of a physician’s clinical oversight and regardless of individual state law. This rule comes in the wake of a very public scandal in 2014 and subsequent harsh criticism of the VA for inordinate wait times and poor patient care at some of its facilities. While the agency has begun hiring more providers, officials have said bureaucratic barriers have slowed the process. As a result, the VA believes the rule will...
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On December 20, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized regulations for the highly anticipated ACO Track 1+ model under the Medicare Shared Savings Program (MSSP). The new payment model has more limited downside risk than ACO Tracks 2 and 3, but still qualifies as an Advanced Alternative Payment Model (APM) that will allow approximately 70,000 clinicians to qualify for incentive payments under the Quality Payment Program. Last October, CMS announced new opportunities for clinicians to participate in Advanced APMs. Starting with the 2018 performance year, accountable care organizations (ACOs) participating in Track...
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The Centers for Medicare & Medicaid Services (CMS) has granted Axumin an A-code and transitional pass-through status, effective January 1, 2017. Beginning January 1, 2017, Axumin will have Medicare Pass-Through Status in the hospital setting and a permanent HCPCS code: A9588 fluciclovine F 18, diagnostic, 1 mCi. (Unit Alert: The descriptor for A9588 is per 1 mCi, not per study dose – be alert to the units billed on claims. The recommended dose of Axumin is 10 mCi.) Additionally, as of January 1, 2017, all local Medicare Administrative Contractors (MACs) have determined that Axumin would be covered for its label indication. Axumin™ (fluciclovine...
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Did you miss the AUA’s December 6 webinar on Physician Quality Reporting System (PQRS) reporting for 2016? Slides from that webinar are now available , and the AUA encourages the urology community to review this material before closing out PQRS reporting for 2016. Those who fail to report to PQRS for 2016 will incur a 2 percent PQRS payment adjustment (penalty). Additional penalties will be levied through the Value-Based Payment Modifier. Why make these unnecessary financial sacrifices when the AUA is providing free educational resources to help you with PQRS reporting? The 2015 PQRS reporting deadlines are fast approaching: Friday, February...
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The Centers for Medicare & Medicaid Services (CMS) recently published data for select 2015 individual clinician and group practice Physician Quality Reporting System (PQRS) measures on Physician Compare . This CMS website is designed to help patients make informed decisions on their healthcare by comparing the federal quality reporting performance scores of physicians and other clinicians enrolled in Medicare. CMS believes that patients may use this information to select those who will best meet their healthcare needs in addition to encouraging clinicians to provide the best care possible. This release includes 2015 data on: 90 individual...
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This week’s update includes information on our upcoming presentations at the American Medical Association/Specialty Society Relative Value Scale Update Committee, this week’s Congressional business, and news on this year’s patient advocacy presentations at the AUA Annual Meeting. RUC Meeting: AUA Presenting two CPT Codes On January 11-15, AUA Relative Value Scale Update Committee (RUC) Advisor Dr. Thomas Turk and AUA RUC group presenter Dr. James Dupree will present on two codes at the American Medical Association /Specialty Society RUC meeting. Specifically, they will present survey data on a new CPT code for peri-prostatic implant...
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Register now for the Practice Management Conference on Thursday, May 11 and Friday, May 12, 2017, at the Hilton Boston Logan Airport in Boston, Massachusetts. Some of the topics offered will include Strategies for Maximizing your Revenue Steam, MACRA Updates, Value Based Reimbursement, Implementing Clinical Trials for your Practice, Contract Negotiating and Physician Compensation Models. Speakers include Deepak Kapoor, MD, Arthur Tarantino, MD, Mark Fallick, MD, David Albala, MD, Frank Gaylis, MD, Michael Fabrizio, MD and Neil Baum MD. Do not miss out on this valuable education opportunity for both you and your practice, Register today! The AUA...
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On December 15, the Obama administration announced that it would be halting its controversial Medicare Part B drug demonstration, which was proposed to decrease the cost of prescription drugs. The program would have changed the current drug reimbursement rate from the Average Sales Price (ASP) with a 6 percent add-on to ASP with a 2.5 percent add-on plus a $16.80 flat fee. The demonstration had received strong opposition from the AUA, as well as other members of the physician and pharmaceutical communities since its introduction. In June, the American Medical Association’s House of Delegates passed policy opposing the drug demonstration. In addition,...
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On December 8 and 9, the House and Senate extended the Continuing Resolution (CR) ( H.R. 2028 ) required to keep the government funded and avoid a shutdown. This measure allows many federal programs to remain in operation at 2016 funding levels through April 28, but stalls any program dependent on new appropriations. Aside from bipartisan criticism that the CR underscores Congress’ failure to meet one of its most fundamental responsibilities – passing legislation to fund the government – and that the delay was due to pressure from the incoming administration to stop progress until it can influence decisions (according to House Speaker...
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This week’s update includes information on the Quality Payment Program, CVS Health’s formulary and advancement of AUA Alternative Payment Model efforts with the American College of Surgeons and Brandeis University. This the last Advocacy Snapshot for 2016. Quality Payment Program: AUA Issues Final Rule Comments On December 19, the AUA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the Quality Payment Program final rule. The comment letter supports several of the modifications in the final rule and thanks CMS for adopting many of the AUA’s recommendations that will allow urologists to gradually transition...
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Insurance updates for Blue Cross Blue Shield North Carolina Medicare Advantage cards to change in North Carolina Effective January 1, 2017, Blue Cross Blue Shield of North Carolina will change their Medicare Advantage cards. The member identification cards will no longer display out of pocket liabilities, copay and/or coinsurance amounts for services obtained such as office visits, emergency room visits and inpatient hospital stays. Benefits and eligibility should be obtained about a specific member’s coverage. Reminder when Submitting Radiology Claims BCBS of North Carolina reminds practices that, when submitting radiology claims, list...
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The FDA issued a final rule to ban powdered surgeon’s gloves, powered patient examination gloves and absorbable powder for lubricating a surgeon's glove because these products present unreasonable and substantial risk to health care providers, patients and other individuals. While medical gloves play a significant role in protecting patients, health care providers and other individuals in close proximity, powdered gloves are very dangerous for a variety of reasons. These devices are associated with an extensive list of potentially serious adverse events, including severe airway inflammation, hypersensitivity reactions, allergic reactions (including...
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The Food and Drug Administration (FDA) announced that MS Bionic, Inc. is conducting a voluntary nationwide recall of its product Megajex Natural Male Sex Enhancer capsules. An FDA laboratory analysis revealed that the item contains tadalafil and s ildenafil, FDA-approved pharmaceutical ingredients used to treat erectile dysfunction. While there are no reports of illness associated with Megajex Natural Male Sex Enhancer, the product could pose a threat to consumers because the undeclared ingredient can interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower blood pressure to dangerous levels. Consumers with diabetes,...
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The Food and Drug Administration (FDA) has concluded that use of the Type 2 diabetes medicine pioglitazone (Actos, Actoplus Met, Actoplus Met XR, Duetact, Oseni) may be linked to an increased risk of bladder cancer. The labels of pioglitazone-containing medicines already contain warnings about this risk, and FDA has approved label updates to describe the additional studies reviewed. See the FDA Drug Safety Communication for more details, including a data summary. Background : The FDA alerted the public about the possible risk of bladder cancer in September 2010 and June 2011 based on interim results from a 10-year epidemiologic study. The FDA changed...
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Over the next year, the Centers for Medicare & Medicaid Services (CMS) will be conducting focus groups and interviews with participants willing to provide input ontools and processes related to CMS provider enrollment, quality reporting, and the Quality Payment Program. The goal of this initiative is to gain feedback and input into what is being developed to assist providers and ensure user needs are met. CMS is reaching out for assistance in identifying participants who would be willing to join focus groups and interviews. Those who are interested may be contacted over the next year to participate in feedback sessions. CMS is looking for: Health...
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Current Procedural Terminology (CPT ® ) has been revised to standardize coding placement under more appropriate headings in an effort to better categorize CPT ® procedures. New, revised or deleted CPT ® codes are listed below. Code revisions are noted in italics and new codes/additions are noted in bold . Revision Moderate Sedation symbol has been removed from 180 codes; these now have the revision mark in CPT 2017. New Codes Category III Code: 0421T Transurethral waterjet ablation of prostate Pathology and Laboratory/Chemistry: 84410 bioavailable, direct measurement (eg, differential precipitation) Rationale:...
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