AMA urology delegates push back on USPSTF, ICD-10, more

The House of Delegates, the democratic policy-making body of the American Medical Association, meets twice a year to establish broad policy on health, medical, professional, and governance matters. More than 500 delegates and an equal number of alternate delegates attend, including three delegates representing organized urology.

As in previous years, several resolutions from this June’s meeting were of key interest to urologists.

Continued pushback against USPSTF

The AUA introduced a resolution that was adopted as policy by the House of Delegates to strike reference to the U.S. Preventive Services Task Force in the recent AMA Board of Trustees report, “Strategies to Strengthen the Medicare Program.” This reinforces our success 2 years ago when we successfully passed policy that positions the AMA in opposition to the methodology and conclusions of the USPSTF regarding its “D” rating of PSA testing and calls for greater involvement of expert input into USPSTF methodology going forward.

Fight against ICD-10

Under the unflagging determination and leadership of urologist Jeff Terry, MD, of Alabama, the fight against implementation of ICD-10 is reinvigorated. The passage of his resolution mandates the AMA to advocate that Congress ask the Comptroller General of the United States to conduct a study to evaluate the disruptive nature of the implementation of ICD-10 and what steps might be taken to mitigate it, with a report back to Congress by May 1, 2015. Also, the AMA is to advocate that Congress adopt a policy that Medicare would not be allowed to delay pay based on ICD-10 for the first 2 years of its implementation.

Affordable Care Act shortcomings

The AMA’s Council on Medical Service Report 9-“Improving the Affordable Care Act”-evaluates the current state of the ACA and its shortcomings and calls for elimination of the Independent Payment Advisory Board, repeal or significant modification of the Value-Based Payment Modifier program, and repeal of the sustainable growth rate (SGR) formula.

Medicare and Medicaid

Report of the Council on Medical Services on “Medicare Update Formulas Across Outpatient Sites of Service” addresses the disparate compensation for outpatient services in hospital outpatient departments (HOPD) versus ambulatory surgery centers (ASC) and physician offices. Each is subject to a different formula for payment updates, with the HOPD being the richest. Office compensation is the lowest, as it is tied to the SGR and a lesser formula as well.

The report highlights the increased cost to patients of the increasing presence of hospital ownership in outpatient surgery settings and physician office settings and calls for parity between HOPDs and ASCs as well as increased compensation to office practices for their professional fees.

Next: Graduate medical education

More on Health Policy

AUA pushes for USPSTF reform, coverage for PSA

Proposed EHR rule offers ‘breathing room’

AUA initiatives focus on lobbying, research efforts

Graduate medical education

Council on Medical Education report 5-“AMA Duty Hours Policy”-calls for evidence-based re-evaluation of the residency hour restrictions that are rotation/specialty specific so as to optimize patient safety but also restore competency-based learning opportunities.

The AMA will advocate for additional GME funding for resident training to address work force needs. There is high primary care emphasis but specific mention is made to underserved specialties.

These resolutions do not carry the authority of law, but they set a bar to which legislators may capitulate or springboard from. They also serve as the foundation for many health care institution rules and regulations. These resolutions inform the actions of the leadership of the AMA, including the elected officers, Board of Trustees, and executives. At significant expense, legal teams are dispatched and AMA lobbyists are mandated to pursue the goals explicitly stated in the resolutions.

Delegates are members of the AMA and represent national medical specialty organizations, state medical associations, professional interest medical associations, the five federal services, and several other AMA member sections and groups. The AACU maintains one delegate and the AUA has two. There are 17 urologists among the various associations.

We are few, but we are highly effective at promoting our interests and defending our positions. Our representation is proportional to the percentage of urologists who are AMA members and we lost a delegate last year, so resumption of AMA membership by urologists is critical to our ongoing “seat at the table.”

Next up: Coverage of penile prosthesis surgery

The interim meeting will be in Dallas in November, and the AUA will submit a resolution advocating for coverage for penile prosthesis surgery in the 12-state insurance exchanges that currently exclude coverage for it.

Stay tuned.UT

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