What should the AUA’s legislative priorities be?
"What the AUA can do for those of us in the trenches, so to speak, is to lessen some of the regulatory burdens that have been put on us," says one urologist.
Dr. Piser“As a private practice urologist coming up on my 29th year of doing this, there have been a lot of changes. What the AUA can do for those of us in the trenches, so to speak, is to lessen some of the regulatory burdens that have been put on us, specifically the [Physician Quality Reporting System] and jumping through all these additional hoops.
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We’ve been forced into electronic medical records, which have increased our clerical time tremendously. Some people just kind of give up and do poor, cookie-cutter notes, and that goes against the grain of a lot of docs who take pride in taking care of patients-which means good documentation. But this adds things that are really unnecessary, so it takes a lot of unnecessary time. I personally have given up and have a scribe. That costs more money but makes my personal time more available.
The AUA needs to advocate strongly against repealing the in-office ancillary service exemption, especially ultrasonography. It’s also so much more expensive to send out cultures rather than doing our own. Study after study have shown we deliver care less expensively when it’s administered in our office as compared to the hospital or even the hospital-based urologists.
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If a patient in the office needs a catheter, Medicare pays me a minimal fee and doesn’t reimburse for the cost of the catheter. (We do it for existing patients because I won’t make them go sit in the ER for 4 hours when we’re here.) The AUA can do a lot to support the independent private practitioner that would be good for patient care, would be most cost effective to do, and really be the right thing to do for patients.”
Joel Piser, MD
Berkeley, CA
Dr. Broghammer“Continued access to PSA testing is something that needs to be looked at and advocated for by the AUA. So far, it’s still being covered by insurance, but we’ve seen kind of a blanket decrease in the primary care physicians who are doing the screenings, and I think we’re going to see cases of people presenting with late metastatic disease.
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The other two things that apply to all of medicine are access to medication, especially generics that we use but that frequently go on shortage because manufacturers stop producing it because there’s no oversight or regulation in terms of drugs. There’s less access and periods where some drugs aren’t available at all. The issue is, if we want to give guideline-directed care, we’re not able because the medication is not there. We need some sort of regulation.
Also see: Are you seeing a decline in PSA screening?
The other issue is the Affordable Care Act. Although I support the idea in principle of providing coverage, it hasn’t really accomplished that. There needs to be some kind of alternative solution.”
Joshua Broghammer, MD
Kansas City, KS
Dr. Weisner“I’ve been here for 21 years in a 15-man-group, with several of us in our 50s and very busy. We try to be politically active. One thing that really worries me is that we’re all about ‘quality’ work-and paying for quality is kind of a misnomer for me. How are you going to pay urologists to do quality work when much of what we do is episodic interventions for people with bladder cancer, kidney stones, prostate cancer? We do some primary care, but we don’t have a lot of preventive medicine to provide.
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I’m worried you’re already seeing it with fewer PSAs being done, with fewer people being referred for elevated PSAs. Unfortunately, people are getting diagnosed later with more aggressive prostate cancer. How do urologists fit into this integrated network or an accountable care organization when we’re such a small part of the health care dollar and we’re not on the front lines? But we’re important and necessary, and I would like for the AUA to confirm our seat at the table so we’re not excluded from any pay for performance.
I think the [U.S. Preventive Services Task Force] is a bunch of hooey. They should have had urologists’ input. They made a false decision that hurt urology and our patients.
Anything the AUA can do to tamp down meaningful use-some of it’s OK, but so much of it is not urology pertinent.
The other thing I hate is preauthorization for imaging and medications. We spend hours on the phone every day.
I love my job. Just the regulations drive me bonkers.”
Bradley Weisner, MD
Matthews, NC
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