AUA initiatives focus on lobbying, research efforts

In 2014, AUA members anticipate facing continued legislative challenges in a sea of health care reform. As a result, the AUA has increased its lobbying efforts, but needs the broad support of individual members to bring about change, says newly elected AUA President William W. Bohnert, MD. In this article, he discusses current AUA initiatives in advocacy, research, and education. Dr. Bohnert is in private practice at Arizona Urology Specialists in Phoenix. He was interviewed by Urology Times Editorial Consultant J. Brantley Thrasher, MD, professor and chair of urology at the University of Kansas Medical Center, Kansas City.

Many urologists have been concerned about certain recent legislative issues, including the sustainable growth rate (SGR), challenges from the U.S. Preventive Services Task Force, and challenges to the ancillary services that urologists provide. Give us an idea of what the AUA is doing to address some of those issues.  

With the SGR issue, we thought we had the opportunity of a lifetime to solve that problem earlier this year, but that all changed when Congress patched the SGR yet again. The AUA is continuing to work with its coalition partners and champions in Congress to move this issue forward. We’ve been told the House and Senate have postponed the issue until later this year, but we are hopeful we will get a resolution to the SGR this fall, even if it happens after the elections. The membership would definitely love to see the problem solved. You and I and several others have attended the Joint Advocacy Conference in Washington for many years, and all of the congressmen and senators we talk to tell us that the system is broken, but can’t be fixed because of the financial ramifications of doing so. It’s tough, but we’re doing all we can to advocate for urology.

In terms of the USPSTF, the AUA has been actively advocating for transparency and accountability for the USPSTF, and we have active legislation that we are working to advance on the Hill. Preservation of the in-office ancillary services exception remains a major priority for the AUA and, again, we are working with our partners and our friends on Capitol Hill to maintain our members’ right to provide those services to patients in the practice setting.

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The AUA has done a tremendous job beefing up our lobbying efforts, making sure we continue to contribute to UROPAC and pushing our membership to be involved there. Is there anything else that can be done to make sure that the members are supporting these efforts?

It would be a great thing if we could get every urologist in the country to write a check to UROPAC for whatever amount. Unfortunately, the percentage of urologists who are active in this movement is very low. There’s just not enough of us contributing on an average basis.

What would you like to accomplish as AUA president?

I personally think the AUA represents nearly all of the urologists here in the United States and many urologists internationally, but so many are just not involved. The AUA is a strong partner and ally to all of our members including our academic members, independent practitioners, and hospital-employed urologists. In addition, we support our VA urologists as well as all of our military members. While the field of urology has many facets, we can all continue to advance urology through the AUA.

If the AUA is to remain the viable and forward-thinking organization everyone has come to expect, we will need the expertise and  active involvement from those who know the medical and urologic community best. In a perfect world, every urologist and practitioner who touches urology from around the world would be a member of the AUA.

An alarming trend in urology is that, due to economic constraints, the independent practices are decreasing in number. More and more residents are being hired by hospitals, and while the employment model is fine, the AUA needs to ensure it supports those in the urologic community through this trend, and advance urology together under “one roof.” Our vision is to ensure that the hospital-employed urologists continue to attend AUA meetings and take AUA courses, and that involvement from urologists working for the VA and the military, as well as the independent practitioners, increases.

You mentioned international members, and I noticed that the AUA continues to be a sort of mother ship for many of the international urology organizations. Do you think you’ll continue to grow that effort, because many on the domestic side are concerned this may detract from the attention that we get in the U.S.?

I think it will continue to grow. As you well know, Dr. Gopal Badlani, the current AUA secretary, has taken this under his wing and has done a phenomenal job growing international participation. The AUA’s collaboration and cooperation with other international societies will help us work together to educate urologists around the world and also leads to important educational opportunities for our North American urologists to include international exchange programs, volunteer programs, and other teaching opportunities. The Global Philanthropic Committee also facilitates a partnership among the AUA, European Association of Urology, and the Société Internationale d’Urologie to improve education and patient care in third-world countries. Collaboration with urologists around the world will only improve the urological education experience for everyone, including our domestic members.

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Tell us about AUA University, which I hear so much about. Is that something that’s really going to help our membership?

Yes, I think AUA University will help the membership tremendously. All you have to do is enter your AUA ID and password, and you can complete courses at home, sign up for courses, review our guidelines, and check your transcripts. The AUA recognizes any time you are on the road or away from your practice, it’s a financial burden, especially for independent practitioners, the military, and our VA urologists, which is why we are making more of an effort to make things easily accessible. Being able to utilize AUA University anytime, anywhere is a true asset.

I’m hearing that AUA University offers a personalized approach that allows users to find, for example, where they are in the maintenance of certification process and find their CME credits all in one place. Is that true?

That is correct. The AUA University is a simple and intuitive online portal, which members can personalize according to where they are in their careers. It allows you to sign up for courses, purchase educational products, view webcasts, claim CME credits, view or print your transcripts, or see where you are in the MOC process all from your mobile device or computer.

What are the AUA’s current priorities in the area of research?

First, following the retirement of Dr. Leo Giambarresi, we have a new research director, Dr. Carolyn Best. She comes to us from the Department of Defense Prostate Cancer Research Program and we are excited to have her on board. With that said, Dr. Johannes Vieweg, AUA Research Chair, continues to make great strides in many areas with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other government research organizations. Our shared focus is to advocate for increased funding as it relates to urologic research.

The best way to maintain our charge for pioneering innovative research is to look for financial ways our research scholars and academic urologists can continue with their research and remain in research. With the demand on time and slowing of government funding for research, the AUA recognizes this is a priority and is actively working to mitigate these issues.

We’re obviously seeing a decrease across the board in research funds, but it sounds like the AUA has tried to beef up funding with a new 5:1 scholar match. Subspecialty societies are now involved, and hopefully those endowments can foster further research. Can you tell us a little more about this?

The AUA believes in the value of research and this is why they have been seeking ways to help fund grants while creating new funding opportunities. The sections are on board, and as you mentioned, so are the specialty societies. The AUA backs endowments and the research funds on a 5:1 match; however, this level of matching can’t be sustained on its own, which is why research is an AUA legislative priority. We will be on the Hill advocating for more research funding opportunities.

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I think the membership sometimes becomes a little confused about how supporting research helps them with their practice. Tell us how the AUA’s research efforts affect the care that we provide our patients.

The advantages of improved care through innovation are numerous. I used to do all sorts of ureterolithotomies and things like shock wave lithotripsy. Now, flexible ureteroscopy has come to the forefront, and robotic surgery, immunotherapy for renal cancer, and improved treatments for bladder cancer patients have all been developed through research. The members in the trenches have all benefited from innovative treatments in that they can provide the best quality care for their patients.

Another example is the treatments we now have for castrate-resistant prostate cancer, which open up a whole new practice opportunity for our urologists. The AUA has four or five training courses this year to help urologists throughout the United States expand their practice in this area.

Let’s switch gears and talk about the international landscape. You mentioned that Dr. Badlani has done a fantastic job of growing the international focus, but I understand we may need a little more help in that area. Are there areas on the international side that you see opening up?

During the AUA annual meeting in Orlando, I was at our international meeting and helping to plan for the future. One of the areas we are focused on, and making reasonable strides in, is supporting those urologists residing in countries with political unrest. We have remained in contact with many of these urologic communities and are committed to enhancing patient care around the world through the collaboration and exchange of knowledge and resources.

The Residency Review Committee has discussed the idea of an Accreditation Council for Graduate Medical Education International (ACGME-I) and American Board of Medical Specialties International (ABMS-I) or something similar on the international side. Does this open up an opportunity for us to offer more training courses in some of our international partnership countries?

Without question, it does. We just need to keep working at it and negotiating. I’ve been to Mexico, where several of the Arizona urologists travel and teach laparoscopic skills and courses twice a year. I know the European Association of Urology does a lot of that type of training in the Middle East and other areas. If we can collaborate on that, it will make it better for everyone.

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I know that Singapore has been one of the champions of that cause, and they have some very developed courses there.

Japan, China, and South Korea are some others. The international program is truly international.

Let’s switch topics and discuss the Urology Care Foundation, which I understand has a brand new board chaired by Dr. Richard Memo. What will the average member see as a change for the Urology Care Foundation, and where is it headed?

The new board will provide a strategy to raise more funds and be able to increase service to the practicing urologists’ patients with educational activities. The research scholar program will continue to grow, hopefully through the revenue generated from their new plans. The new board is an outstanding group of men who are working on this. It will take some time, but I think it will grow and provide us a basis to fund research and products for our patients who are looking to the AUA for advice about urologic care.

I understand that we also have a new publication that is going to be very relevant to the practicing urologist, addressing topics such as socioeconomic issues and health care policy. Can you give us an overview of that new publication?

Dr. Carl Olsson was selected as the editor of the new journal, Urology Practice. He was given a very tight timeline, and the first issue came out in May. Urology Practice will highlight health policy, business operations, and other practice-related topics designed to help the average practicing urologist. I think it will be a true asset, especially for urologists in the trenches.

The average practicing urologist is still very concerned about the urology work force, especially in rural America. We don’t have enough urologists to go around. What is the AUA doing to help?

The work force issue is a major concern, and as I mentioned, so many of our practicing urologists are getting ready, or are ready to retire. With all of the changes coming under health care reform, some will actually retire early. We have a very popular specialty that many students want to get into, and we simply don’t have the resident slots and funding needed to train these future urologists. This change needs to start in the health policy reform, funding for graduate medical education, and other ways that will ensure our patients have access to urologic care.

The AUA is also getting involved with training non-physician providers (NPPs), which I understand can be a sensitive issue to some. The AUA believes that NPPs should work under the supervision of the urologist, which will help improve our ability to see more patients.

Is the AUA sensitive to the issues you mentioned surrounding NPPs? Do they recognize the shortage of urologists but also recognize the implications of having too much unsupervised care by the NPPs?

Yes. The key is to have the NPPs trained “urologically” by qualified urologists and practitioners. Independent practitioners in the field can train their own NPPs to their style of practice, but I think the AUA can provide general educational activities in all sorts of different areas of urology on a global basis. For example, the AUA annual meeting has a lot more courses now for NPPs, and there are many more courses through the Office of Education.

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A beautiful tool that the AUA has always offered but not all members fully utilize is practice guidelines. Can you talk about the AUA’s guidelines?

From what I understand, and know of personally, our guidelines are very much used by our members. The guidelines page is actually the most visited area of our website and I am also told they are not only coveted by other specialties, but by the federal government as well.

AUA guidelines are developed using a rigorous, systematic review of published literature, which includes data extraction and analysis. This is all done in accordance with the Institute of Medicine’s standards for the development of trustworthy guidelines.

In addition, Dr. Deborah Lightner was recently named the new chair of the Practice Guidelines Committee, succeeding Dr. Stuart Wolf, and will work closely with AUA staff and members of various guideline committees to develop new guidance while revisiting existing ones to ensure they remain current.

I understand the AUA is in the process of developing databases and registries. How might those help the practicing urologist?

The AUA is developing the AUA Quality Registry, otherwise known as AQUA. This will be the only specialty-wide, urologic disease-focused registry in the United States and will be designed to measure and report health care quality and patient outcomes. For a practicing urologist, the AQUA Registry will, for the first time, enable them to review their practice patterns and outcomes in comparison with their peers. Starting in 2015, the AQUA Registry will provide urology practitioners with patient outcomes and health care quality metrics specific to prostate cancer using data gathered from physician and practice levels and patient reports.

Another initiative is the AUA census that was recently launched. The survey will provide comprehensive information about practice settings; experiences with EMR adoption and quality reporting; adherence to clinical guidelines; and provider demographics, education, and training.

Once these databases are developed, my understanding is that we’ll be able to look at quality initiatives that would help practicing physicians benchmark where they’re staying with their peers.

It will not only improve the urologist’s practice abilities, but also provide quality care for our patients. I think that is the number one mission of the AUA and all of our members. We all feel the most important part of our practice is the patient and the quality of care that we can provide for them.UT

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