ESWL Reimbursement Slashed By 22%

The 35-day government shutdown over President Trump’s border wall may have had a direct impact on many urologists beyond the many inconveniences and the cost to taxpayers that it caused—a reduction of 22% in the reimbursement rate for a popular procedure. Because of the shutdown, leaders representing urology were unable to meet with officials at the Centers for Medicare & Medicaid Services (CMS) to discuss their concerns regarding the agency’s Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) Payment System final rule for 2019.

The rule, which has the effect of slashing reimbursement to ASCs for extracorporeal shock wave lithotripsy (ESWL) by 22%, will make it difficult for many patients in rural communities to gain access to this procedure as they seek treatment for kidney stones, according to the major groups representing urologists. Deepak Kapoor, MD weighed in on the effects of this reimbursement decrease. To read Dr. Kapoor’s comments, click this article.

Exposure to CyberKnife Advertising is Associated with Over-Estimation of Objective Benefits Compared with other Prostate Cancer Treatments

There has been increased direct-to-consumer advertising for Cyberknife (CK), a brand of stereotactic radiotherapy for prostate cancer. Evidence comparing CyberKnife with other prostate cancer therapies is limited. Columbia University Medical Center physicians hypothesized that those viewing CyberKnife advertisements would have inaccurate impressions regarding its effectiveness and safety. In this study, they evaluated impressions of CyberKnife among laypersons exposed to actual advertisements versus factual information/controls. Respondents were more likely to consider CyberKnife superior to other prostate cancer treatments.

Columbia University Medical Center physicians concluded that advertisements regarding CyberKnife are misleading and impact laypersons’ impressions regarding effectiveness and safety. Direct-to-consumer advertising for cancer care is problematic, and relies on the advertiser and surrounding community to ensure accuracy and transparency. To learn more about the details of the study, read it here.

In NYC Subway, CyberKnife Prostate Cancer Ads Mislead

Survey Respondents Influenced by Claims

Direct-to-consumer (DTC) advertising about the radiotherapy (RT) known as CyberKnife (CK), which is currently omnipresent in the New York City transit system, creates “inaccurate impressions” about the treatment’s “comparative effectiveness and safety” in prostate cancer, according to new research.

That conclusion was made by investigators from Columbia University Medical Center after they created an online survey involving 400 men that used language lifted directly from an advertisement. The investigators compared the participants’ responses to the CyberKnife advertisement to responses to information about other prostate cancer treatments.

The results may surprise you. Read about the findings here.

Empire Blue Cross/Blue Shield reverses decision to drop LI providers

Last month, the insurer said it was removing Integrated Medical Professionals of Farmingdale, a urology and radiation oncology practice, and Port Jefferson Station-based New York Cancer & Blood Specialists, from its Medicare Advantage HMO and Dual Special Needs Plan networks.

Dr. Deepak Kapoor, Integrated Medical’s chairman and CEO, said “we met with senior staff [at Empire] and it wasn’t at all a difficult conversation. We offer high-quality, lower-cost, value-based care. We were hoping the adults would talk to each other, and that’s what happened. For more information about the BC/BS decision reversal, read the article here.

CMS gives radiation therapy providers a break — but bigger changes may be coming

CMS is letting radiation oncologists bill some E/Ms with superficial radiation therapy (SRT) that had previously been bundled. But those providers should look out: this may be a preliminary step before CMS puts in new regulations that may shake up their reimbursement.

CMS also noted in the fee schedule rule that it had been contemplating adding a new G-code to cover some of the services they had not previously allowed to be billed separately with 77401, including “associated E/M.” Deepak Kapoor, M.D., chairman and CEO of Integrated Medical Professionals (IMP) and past president and current health policy chairman of the Large Urology Group Physicians Association (LUGPA), wonders whether another shoe will soon drop at CMS.

To learn more about what Dr. Kapoor and others think will be changing in radiation oncology reimbursement, read the article here.

Lawmakers Introduce Bill To Exempt APMs From Stark Law Provisions

A bipartisan group of House lawmakers Wednesday (April 10) reintroduced legislation to give CMS the authority to exempt alternative pay models and those under development from some Stark, or physician self-referral, law provisions, shortly after HHS Deputy Secretary Eric Hargan assured attendees at the American Hospital Association that the department would issue rules as fast as it can easing the Stark and anti-kickback statutes’ restrictions on value-based pay.

Deepak A. Kapoor, MD said that last year’s bill had broad bipartisan, bicameral support, but the clock simply ran out. Read more about this important bill.

Empire Blue Cross/Blue Shield drops another provider from some plans

Empire Blue Cross/Blue Shield said about 7,000 patients of a Farmingdale-based urology and radiation oncology practice have been notified their doctors are being taken out of the network. Dr. Deepak Kapoor says “We have decades of doctor-patient relationships impacted,” and continued “Our hope is we can talk to the insurer and work it out like adults.” Read about how this BC/BS decision will impact patients.

NY Group Rethinks Physician Consolidation to Add Long-Term Value

A group practice in New York is centralizing business operations with their peers to keep practices independent in the face of rapid physician consolidation. Surviving as a small or independent practice in the current healthcare economy is hard. Providers are competing against large, integrated organizations that are just getting bigger. “There are opportunities to streamline and standardize services through some type of central business structure, whether that be an MSO, a statutory merger, IPA, or some other vertical integration,” suggested Deepak Kapoor, MD. Read more about what Dr. Kapoor attributes IMP’s growth in this article.

Helping A Loved One With Advanced Prostate Cancer

Over 174,000 men in the United States will be diagnosed with prostate cancer each year. When treated appropriately, prostate cancer has a high survival rate and may be slow to spread. But even with major advances in treatment options, there are times when the cancer progresses to an advanced stage. “Our goal is to not only extend survival but add quality years, and we are going to work together to make that happen. In the past – even five years ago – we did not have that message of hope,” says Dr. Deepak A. Kapoor. Read this important information about living with prostate cancer.

Health Insurers Now Cover Prostate Tests

A new law quietly went to effect last month that requires health insurers to cover the cost of routine prostate cancer screening. The new law places prostate-specific antigen screenings on the same level as mammograms. The intent is to encourage more men to take the test, which helps determine prostate cancer risk. New York is the only state in the country to pass this law.

“As far as physician practices go, we were in the lead,” said Deepak A. Kapoor, MD. Read Dr. Kapoor’s interview by clicking this link.

AUCNY President Promoted to Clinical Professor of Urology at Mount Sinai Hospital

Deepak A. Kapoor, MD, Chairman and Chief Executive Officer of Integrated Medical Professionals (IMP) and President of Advanced Urology Centers of New York (AUCNY), has been promoted to Clinical Professor of Urology at the Icahn School of Medicine at Mount Sinai Hospital. Established in 1852, Mount Sinai Hospital is one of the country’s largest and most highly regarded healthcare teaching hospitals, acclaimed universally for excellence in clinical care and research. Dr. Kapoor was featured in Newsday’s “People on the Move” column.

Organized urology has varied agenda for 2019

As the new Congress, with the House of Representatives now controlled by Democrats, opens up shop this month, physicians—urologists included—will be looking for action on several key initiatives important to their practices and patients. “We’re seeking to update and reform the law to accurately reflect the health care delivery system as it is today,” said Deepak A. Kapoor, MD, chairman of health policy at LUGPA. To learn about the changes, and impact of them, read the interview.

CMS Outpatient Rule Divides Opinion

The Centers for Medicare & Medicaid Services will level payments for outpatient visits regardless of site of service over a 2 year period. There are conflicting opinions about the impact. Dr. Kapoor weighs in during the interview with Urology Times.

Letter: IMRT ownership study methodology unsound

In a letter to the editor in Urology Times, Deepak A. Kapoor, MD addressed the conclusions of Borza et al on the issue of financial incentives in fee-for-service medicine impacting clinical decision-making (“IMRT ownership appears to influence PCa treatment,” October 2018, p6). To find out why Dr. Kapoor declares the study’s methodology to be unsound, click this link.

Histologic Changes in Prostate Cancer Detected Subsequent to the 2012 United States Preventive Services Task Force (USPSTF) Prostate Cancer Screening Recommendation

In 2012, the US Preventive Services Task Force, an independent panel of experts that makes recommendations to the American public, recommended against routine PSA screening for prostate cancer. Since then, there have been a number of studies showing a significant decrease in incidence of prostate cancer screening as well as the number of prostate cancers diagnosed in the United States. These new studies have discovered that there has been a significant increase in prostate cancer grade and volumes since the USPSTF recommended against prostate cancer screening. Read the research here.

LUGPA backs CMS plan for site-neutral pay for services

Changes in the Medicare fee schedule, including plans to pay essentially the same amount for services whether performed in a hospital provider-based department (PBD) or in individual physician offices, were hailed as “significant wins” in a Health Policy Forum at the 2018 LUGPA annual meeting in Chicago.

The discussion took place a day after the Centers for Medicare & Medicaid Services (CMS) released its final fee schedule rule for 2019. It covered a number of key LUGPA objectives that Deepak A. Kapoor, MD, outlined ahead of the meeting for Urology Times. Dr. Kapoor is LUGPA’s health policy chairman. Read about the new payment system here.

Congress Must Resist Hospitals’ Efforts Against Site-Neutral Payments

Recent efforts by the nation’s hospital industry illustrate the difficulty of controlling expenditures in the nation’s $700 billion Medicare program. Congress included in the Bipartisan Budget Act of 2015 (BBA), a clear, bipartisan message that, to the extent similar services can be safely provided in multiple settings, it is not prudent for Medicare to pay more in one setting compared to another. To read more, click here.

New Treatment Options Reduce Fear Of Advanced Prostate Cancer

Men with prostate cancer often survive 15 years or longer after learning they have the disease, but prostate cancer remains one of the five most common cancers and the second most frequent cause of cancer-related death among men. “This is an exciting time to be in the field of urology,” says Deepak A. Kapoor, MD. “We have a far more robust armamentarium of surgical and medical techniques. We can offer the possibility to extend survival far beyond the 18 to 24 months the patients could historically expect.”

Read more about the newer advanced prostate cancer treatment options that are offering hope, by clicking here.

Urologists Weigh Value-Based Options

“Just how value-based care will replace fee for service and what that will mean to urologists isn’t so clear,” says Deepak A. Kapoor, MD. Big health care—the system that existed before the Medicare Access and CHIP Reauthorization Act (MACRA)—is unsustainable, according to Dr. Kapoor.

To read more about value-based care, click here.

Gluten-Free Condoms Are Now Available, But Are They Really Necessary?

Organic condom manufacturers claim their condoms are gluten-free. But, um, since when do condoms have gluten to begin with?
If you were concerned that your condoms may contain gluten, Deepak A. Kapoor, MD sets the record straight. Read what he says here.