AUA legislative priorities: One down, nine to go

Bob Gatty

Washington-Last Dec. 31, President Obama signed the 2014 National Defense Authorization Act, and it was a major victory for urology.

“Advocacy does work,” said James C. Ulchaker, MD, chairman of the AUA Legislative Affairs Committee.

The reason Dr. Ulchaker was so pleased with the president signing legislation to fund America’s defense activities is that the massive bill included the AUA’s proposal to establish a task force on urotrauma suffered by America’s troops, especially those in combat.

When the urotrauma language was included in the defense bill approved by the House of Representatives Dec. 12, urologist Mark Edney, MD, a veteran of Operation Iraqi Freedom and the AUA’s lead advocate on the issue, said the action was “a case study in what well-funded, AUA-led, coalition-based advocacy can be.”

The provision requires the Department of Defense to work with the Department of Veterans Affairs to develop and implement a comprehensive policy on improvements to the care, management, and transition of recovering members of the Armed Forces with urotrauma. Rep. Brett Guthrie (R-KY) and Sens. Ben Cardin (D-MD) and Roy Blunt (R-MO) championed the measure in Congress.

SGR repeal tops priority list

Now, the AUA has turned its attention to nine new legislative and regulatory priorities for 2014, based on the results of an online survey of members. Topping that list is the need to develop “viable strategies” for sustainable growth rate (SGR) repeal and promotion of value in health care.

In a new position statement, the AUA said urologists are pleased that each of the health committees’ proposals to address the SGR proposes repeal of the “flawed formula,” and said its elimination “is essential to ensuring a stable payment system that provides Medicare beneficiaries timely access to care.”

However, the AUA stressed that these key principles must be included:

• ensure that all physicians receive equitable reimbursement

• follow repeal by a minimum 5-year period of payment stability

• maintain a viable fee-for-service option

• incentivize meaningful, physician-led quality improvement, rather than penalize based on arbitrary indicators of performance

• limit unnecessary regulatory requirements

• include legal protections for physicians who satisfy quality improvement program requirements.

“We are a leader in terms of quality and we’ve got to make sure that reform supports good behavior, but it shouldn’t be punitive,” Dr. Ulchaker said. “Rather, it should be supportive and give credit for good behavior by physicians.”

There is also substantial concern how the cost of reform will be covered.

“You can’t just be taking from specialty medicine and giving it to primary care,” he stressed. “That would just exacerbate greater shortages in the future.”

Other AUA legislative and regulatory priorities include:

Access to appropriate PSA screening. “We support a man’s right to be tested for prostate cancer-and to have his insurance pay for it, if medically necessary-if, in fact, he decides to do so, following a detailed conversation with his physician about the benefits and harms of screening,” Dr. Ulchaker said.

Reform of the U.S. Preventive Service Task Force (USPSTF) recommendations process. The AUA is supporting H.R. 2143, the USPSTF Transparency and Accountability Act of 2013, which would include critical reforms that would improve accountability of the task force and ensure that Medicare or other payers cannot deny payment for a preventive service solely based on the task force grade.

Preservation and appropriate use of the in-office ancillary services exception to the Stark law. “The AUA feels that the preservation of these services, when appropriately used, can protect patient access and may actually decrease the overall cost to medicine,” Dr. Ulchaker said.

Oppose or defer implementation of ICD-10. On Oct. 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets, which increase the number of reporting codes from about 13,600 to about 69,000. Dr. Ulchaker said many practices are not ready for this transition.

Address work force shortages in all urologic practice environments, preserve access to timely and appropriate care, and advocate for increased graduate medical education funding and resources for urology positions. The AUA is supporting the Resident Physician Shortage Reduction Act, H.R. 1180/S.577, and the Training Tomorrow’s Doctors Today Act, H.R. 1201. “The number of urologists that we have continues to drop, yet as baby boomers continue to age, we will need more,” Dr. Ulchaker said.

Repeal of the Independent Payment Advisory Board (IPAB) or modification of the current law to provide for congressional oversight of their decisions, appointment of practicing physicians, and review by medical specialty societies. While Congress approved and President Obama signed funding legislation that slashes IPAB’s funding by $10 million, causing many to predict it will not be implemented, Dr. Ulchaker said that’s not good enough. The IPAB provision of the Affordable Care Act should be repealed, he said.

Promotion of medical liability reform. The AUA is supporting efforts at the state level, as well as in Congress, to provide necessary reform.

Promotion of urology/cancer research funding. “We need to make sure that American urology stays on the cutting edge and that it doesn’t get overlooked with funding,” said Dr. Ulchaker.UT

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