Presidential Matters April 2015

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April 2015

Dear Colleagues,

I am honored to begin my term as President of the Society of Gynecologic Oncology and thank you for the trust you have placed in me.

With a phenomenally successful 2015 Annual Meeting on Women’s Cancer behind us, SGO resumes its focus on one of the most pressing issues affecting us in our daily practice of gynecologic oncology.

During the Member Forum at the Annual Meeting, SGO referenced a reduction in RVUs, and therefore your reimbursement, for laparoscopic hysterectomies, CPT codes 58570, 58571, 58572, and 58573. These codes were identified by the Centers for Medicare and Medicaid Services (CMS) as part of their misvalued services screening program because more than 50 percent of the procedural volume is performed in the outpatient setting.

As a matter of process, individual procedures that are identified under these screens are referred to the Relative Value Scale Update Committee (RUC) of the American Medical Association for review. Medical societies that perform these procedures then conduct a survey regarding physician time and intensity/complexity for individual CPT codes. The results are presented at the RUC, voted upon and forwarded to CMS. CMS makes the decisions regarding the relative value units (RVUs) to assign. Under the current process these numbers are presented in the Final Medicare Physician Fee Schedule Rule on or around Nov. 1 and are interim for one year. The reduction in RVUs for these four laparoscopic hysterectomy codes for CY 2015 ranged from 12 – 22 percent. SGO provided comments on the CY2015 Final Medicare Physician Fee Schedule Rule opposing these interim values and asking for refinement prior to their finalization in the CY 2016 Medicare Physician Fee Schedule.

Because much of the data for the calculation of these RVUs is based on the results of surveys performed by medical societies for CPT codes, it is imperative that we as gynecologic oncologists take it upon ourselves to understand what the survey measures and how to answer the questions to most accurately communicate the time and expertise we bring to these cases. SGO partners with the American Congress of Obstetricians and Gynecologists (ACOG) on these efforts, but it is still our responsibility to work on those CPT codes our members perform.

The new, reduced RVUs are based on survey responses concerning the time spent performing the surgery (skin-to-skin time) for a typical patient, as well as the number of post-operative visits performed during a 90-day global period.

SGO’s reorganized Coding and Reimbursement Taskforce is researching ways to address this situation. Strategies include 1) educating members on how to complete all data collection efforts, including surveys that are used to collect data to validate or calculate RVUs, 2) urging members to educate gynecologic oncologists at their own institutions regarding the processes for setting our Medicare payments, 3) conducting our own survey of members to obtain more accurate data, 4) analyzing the possibilities for creating more appropriate bundled codes for the surgeries that SGO members perform, 5) creating new alternative payment models that place higher value on services performed by gynecologic oncologists, 6) collaborating with other medical societies, and 7) communicating accurate information to CMS through all available channels.

I am confident that the taskforce, chaired and co-chaired by Drs. Barbara Goff and Mark Shahin, respectively, will move quickly to address these issues. Dr. Shahin also serves as the SGO Liaison to ACOG’s coding committee. The recent repeal of the Sustainable Growth Rate, including the language rescinding the CMS Final Rule policy to eliminate the 10- and 90-day global surgical packages, was a huge victory, and bodes well for the future of quality care by focusing on patient outcomes rather than fee-for-service reimbursement. However, we are still a few years away from that. Therefore, we must take action now to ensure we have a system that can accurately measure patient outcomes as well as our efforts to achieve them. I cannot emphasize enough how important it is for you to stay informed and engaged on this issue. SGO now has more than 2,000 members; we must work together to ensure our voice is heard as health care reform advances at lightning pace. SGO has great minds intently focused on this issue and it is vital that we follow their leadership in order for our profession to continue to deliver the highest quality care to women with gynecologic cancers. If you are interested in doing more for your society in these areas, please contact me at robert.coleman@sgo.org.

Best Regards,

Robert L. Coleman, MD