Summer heat doesn't cool critical issues in urology

This article is part of an ongoing series from the American Association of Clinical Urologists (AACU), based on a partnership between the AACU and Urology Times. Articles are designed to provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions about topics for future articles. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

The Supreme Court has ruled to uphold the Affordable Care Act (ACA), and reaction from lawmakers has been predictable. Democrats argue that the 5-4 decision is a strong validation of President Obama’s health care law while Republicans continue to push for full repeal. If you monitor health policy and its effect on urology, it could be easy to become complacent in the next few months. After all, the most significant health system issue of our time has been settled, at least until after Election Day, so why not take a break?

In spite of the record heat wave sweeping much of the nation, now is not the time to cool down. Issues actively being considered in Congress are some of the most vital to urology, including Medicare payment reform and reigning in two panels empowered by the ACA to ration care.

Physicians, politicians, and regulators have talked about reforming the Medicare sustainable growth rate (SGR) payment formula since it was enacted in 1997. But efforts to date have been just that: all talk. At the beginning of the year, Congress passed and the president signed the latest short-term “doc fix,” kicking the can down the road until Dec. 31, 2012, proving again that true reform would have to wait. Don’t hold your breath, but there is a small chance that Congress’ next action on the SGR might actually be substantial.

The Senate Finance Committee has held a series of Medicare payment roundtables over the last several months to inform their work on the issue this fall as the deadline looms. In three meetings thus far, the committee has heard testimony from former CMS administrators, private payers, and physicians. It’s too soon to tell, however, what a reform bill would look like because after Nov. 6 (Election Day), all of these decisions may be made by a lame duck House or Senate and signed by a lame duck president.

During recent testimony, former CMS Administrator Tom Scully, a George W. Bush appointee, warned that without removing the Relative Value Scale Update Committee (RUC) from the control of the AMA or limiting the AMA’s control of Current Procedural Terminology (CPT) codes, no real reform can be achieved on the SGR.

When physicians testified in mid-July, representatives of national organizations waivered on whether or not to expect a long-term fix to the immediate crisis. They pointed to pilot projects, however, that have demonstrated effectiveness in sharing risk/reward. Accountable Care Organizations (ACOs), they said, will play a key role as they are deployed for public and private programs.

If these roundtables are any indication of what lies ahead, physicians must stay vigilant. Any discussion of changes to Medicare will be wrapped in politics. That’s unavoidable, but real reforms that will impact physicians may be hidden in the minutiae of innocuous acronyms like the RUC, CPT, and ACO.

Speaking of acronyms, the IPAB-a.k.a. Independent Payment Advisory Board-is another alphabet soup receiving increased scrutiny following the high court’s decision. Famously labeled a "death panel," the IPAB’s Republican detractors have been joined by a chorus of Democrats calling for its demise. An IPAB repeal bill passed the House in March but was stalled in the Senate. It’s important to monitor the role this will play during election season. If President Obama wins re-election but Republicans take the Senate, they may be able to force his hand on IPAB repeal or other tweaks to the ACA.

The U.S. Preventive Services Task Force (USPSTF) has seen its fair share of controversy after giving PSA screening a D rating. The ACA mandates that such a recommendation would essentially forbid Medicare from paying for the test, putting men’s lives at risk. In June, Reps. Marsha Blackburn (R-TN) and John Barrow (D-GA) introduced HR 5988 to reform the task force by requiring input from the specialties that their decisions will impact.

HR 5998 calls for more transparency within the task force and requires involvement from other federal agencies. Organized urology has taken a forward position on this legislation. The AACU issued a joint letter with the AUA and LUGPA and then led a coalition of state societies and sections to make their voices heard, as well. In addition, their grassroots mobilization efforts are under way for individuals to take action.

Campaign sloganeering would have you believe Congress, presidential candidates, and voters are in one of two groups: those who are pro-Obamacare and those who favor repeal or "repeal and replace." The reality of the situation is far more complex than the ads that will bombard voters in the months ahead.

It’s a shame that SGR, IPAB, and the USPSTF don’t make for sexy campaign commercials because they will ultimately determine the future for urologists and their patients.

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