American Urological Association advocates interests in stimulus, health care bills

Key Points

Washington-The new government affairs team at AUA hardly had time to get settled in their offices before huge challenges on Capitol Hill involving four issues important to urologists moved quickly to the front burner.

The American Recovery and Reinvestment Act of 2009, signed by President Obama on Feb. 17, contains $19 billion to jump start efforts to computerize health records to cut costs and reduce medical errors and $1.1 billion for comparative medical research to develop the most effective uniform protocols. It provides financial incentives in the form of grants and loans to encourage doctors to adopt and use certified electronic health records, although the incentive payments would be gradually phased out.

"Many of our members are concerned about the cost of investing in electronic medical records systems and their effectiveness," said Priscilla Chatman, AUA director of government relations and advocacy. "Certainly, financial incentives would be welcomed by many."

The comparative research provision was somewhat controversial during the debate, and AUA worked to be cure the provision was properly structured.

Chatman was pleased with an amendment sponsored by Sen. Arlen Specter (R-PA), to ensure that protocols established under the "comparative effectiveness" policy would be the most "clinically" effective, not just the least expensive.

Meanwhile, the House-passed version of the SCHIP bill would have limited Medicare payment and referrals to hospitals owned by physicians to only those facilities that had physician owners or investors and that were eligible to receive Medicare reimbursement through a provider agreement as of Jan. 1, 2009.

The measure would have prevented any change in the percentage ownership by physicians, and any expansion of a hospital and its facilities without prior approval of the Secretary of Health and Human Services. It also required referring physician-owners or -investors to first disclose that information to the patient being referred.

"We are concerned that Congress is putting undue emphasis that financial gain is the prime motivator for physicians becoming involved in these ventures," AUA Executive Director Michael Sheppard wrote to key senators in January. "Physicians are motivated to form specialty hospitals because they recognize the potential to increase productivity and efficiency while also improving the quality of care and patient satisfaction."

Ultimately, the Senate excluded the restriction when it approved the SCHIP legislation.

Meanwhile, the Physician Payments Sunshine Act of 2009 would require drug, device, and biologics makers to report financial compensation and gifts to physicians to the Department of Health and Human Services and for those payments to be posted on a public, searchable web site no later than Sept. 30, 2011.

While MedPAC acknowledged that physician-industry relationships can lead to advances in medical technology and better patient care, they "may also create conflicts between physicians' obligation to do what is best for their patients and the commercial interests of drug and device manufacturers." It also associated physician-industry interactions with rapid prescribing of newer, more expensive drugs, decreased prescribing of generic drugs, and physician requests to add drugs to a hospital formulary.

A federal law requiring drug and device companies to publicly report financial ties to physicians "could encourage physicians to reflect on the propriety of those relationships, perhaps discouraging inappropriate arrangements," MedPAC said. It suggested that a public reporting system would help to expose physician-industry ties and explore potential conflicts of interest, noting that payers could examine physicians' practice patterns and industry and physician associations could use it to refine ethical standards.

Chatman said language from last year's bill to allow physicians to review the accuracy of information and make corrections before it was posted on the web site should be added to the current legislation.

Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.