Health Law & Policy

"The administrative burden associated with payer relations and benefit management contributes to rising costs and, in many cases, affects patient care," writes Ross E. Weber of the AACU.

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.

"The past month has been an active one for developments in Washington that impact health care, from proposed budget cuts to modernizing the Stark Law and boosting Graduate Medical Education funding," writes the AACU's Raymond Nicholas.

State and federal initiatives are starting to address regulatory hurdles.

Members of the urology community who participated in the Annual Urology Advocacy Summit in Washington early last month urged lawmakers to support initiatives to improve patient care, including in minority populations, increase support for urologic research, and ease regulatory burdens.

"In just the first few weeks of the new Congress, several bills have been introduced by legislators on both sides of the aisle addressing the issues of drug pricing and transparency," writes Heather Kazmark of the AACU.

With a long list of legislative priorities set for 2019, the AUA has established the AUA Political Action Committee to which members can contribute to help advance the association’s advocacy efforts in Washington.

Reversing a decision by the Department of Health and Human Services to impose a nearly 30% reduction in 340B reimbursement rates, the U.S. District Court for the District of Columbia has disappointed providers who believed that action was finally being taken to help control the cost of expensive physician-administered drugs.

"Surveying the landscape as leadership of the U.S. House of Representatives swaps parties and governorships creep toward a 50/50 partisan balance, several opportunities to affect positive change stand out," writes the AACU's Ross E. Weber.

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.

"To preserve a degree of competition within the industry, lawmakers and regulators have taken tentative steps to defend independent practice and patient-centered care, as well as ensure employed providers maintain fundamental rights," writes the AACU's Ross E. Weber.

​Significant Medicare regulatory changes finalized in November will end legal incentives that have enabled hospitals to leverage Medicare payment policy to generate profits allowing them to acquire physician practices and gain competitive advantages in the health care marketplace.

“Existing Stark and associated fraud and abuse laws are one of the principal barriers to the development of [alternative payment models] and the advancement of value-based care,” says Gary M. Kirsh, MD.

"CMS recently finalized laudable proposals for physician and ambulatory surgery center reimbursement in 2019 despite objections from powerful hospital groups and lawmakers," writes the AACU's Ross E. Weber.

The American Association of Clinical Urologists recently celebrated its 50th anniversary with a high-profile annual meeting in Washington, D.C.

Organizations representing urologists are urging Congress to enact protections from medical liability lawsuits for medical professionals who volunteer during emergencies, such as natural disasters or other large-scale crises.

Noted in many recent accounts of doctors running for Congress is the fact that, since January 2017, urologists have been fortunate to have one of their own serving in the U.S. House of Representatives-Florida's Neal Dunn, MD.

"[The MIPS program] provides the only mechanism for many specialists and subspecialists to engage in federally-sponsored quality improvement and demonstrate their commitment to deliver high-value care," says Parag Parekh, MD, of the Alliance of Specialty Medicine.

"If the rule changes proposed by Medicare for 2019 are passed, they may very well change the way you practice," write Ray Painter, MD, and Mark Painter.

It’s been a busy couple of months for health policy on Capitol Hill, as the AACU and UROPAC continue to make headway in their efforts to strengthen urology’s voice in Washington.

In an amicus brief, the American Medical Association warns of interference with medical judgments.

Choices include playing the MIPS game or qualifying as an advanced APM.

“I think the main thing is being able to empathize with your patients-simply because a lot of these patients become patients we end up having a pretty long relationship with," says one urologist.

A bill commonly known as “Right to Try,” or S.204, appears to be a step in the right direction for expanding access to treatment for terminally ill patients who have exhausted all other options.

"Although we commend the USPSTF for upgrading the recommendation for PSA- and digital rectal exam-based prostate cancer screening from a “D” to a “C” grade (JAMA 2018; 319:1901–13), we believe that not enough emphasis is placed on screening high-risk groups for prostate cancer," write Navin Shah, MD, and Vladimir Ioffe, MD.

The final recommendation on screening for prostate cancer issued May 8 by the U.S. Preventive Services Task Force, which gives a “C” grade for PSA testing in men 55-70 years of age, has been met with mixed reviews by prostate cancer-focused organizations, some of which continue to call for legislation to reform the task force itself.

"The topic of overlapping surgery remains a misunderstood and controversial issue," writes the AACU's Ross E. Weber.

Independence isn’t gone entirely in today’s urology practice environment, but it is different.

Forty-nine physician organizations across the medical spectrum, including urology, have urged CMS to reduce the period for reporting quality measures from a full year to a minimum of 90 days for 2018 under the Merit-based Incentive Payment System.

"No matter the most accurate interpretation of the current spate of retirements, the volume of vacancies promises to alter the political calculus in Washington," writes the AACU's Brian Henderson.