Urologists take aim at prior auth, work force at AACU conference

Based on a partnership with Urology Times, articles from theAmerican Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

Leaders of more than 30 organizations representing urologists and scores more attendees came away from the 2015 AACU state advocacy conference with a better understanding of the complicated socioeconomic issues facing the profession and a resolve to not stand idly by as public policies impacting their patients and practice are developed in Washington and state houses across the country.

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The event, now in its eighth year, brought together representatives of state, regional and subspecialty groups, many of which do not traditionally engage in political advocacy. After nearly every session, conference goers turned to one another to explain how the subject specifically affected them, or that the newfound insight would be of great value to colleagues back home.

St. Louis urologist Jeff Glaser, MD, declared, "The meeting content far exceeded my expectations. I learned a great deal of valuable information that will help me in my practice and to advocate for our specialty."

AACU State Society Network Chair Charles McWilliams, MD, of Oklahoma City, OK and President-elect Martin Dineen, MD, of Daytona Beach, FL designed a compact program that addressed urgent concerns, as well as emerging threats. Among these issues were the economic impact of the Affordable Care Act, physician employment and work force trends, the administrative burden of prior authorization requirements, and telemedicine.

Early in the meeting, health care attorney Mark Rust held the audience's attention by detailing the practical impact of the ACA on the practice of medicine. Rust, counsel of record on behalf of the American Medical Association and 50 state medical societies on matters before the U.S. Supreme Court, described the pressures that are driving individual engagement, as well as industry consolidation, in the post-ACA environment. He also widened attendees' understanding of narrow networks and retail medicine.

NEXT: Private practice vs. health system employment

Private practice vs. health system employment

In addition to changes in the insurance industry, the ACA precipitated a shift from independent private practice to health system employment. Two urologists with divergent experiences discussed the pros and cons of employment, as well as what to watch for before, during, and after a possible transition from one setting to another. Michael Fabrizio MD, CEO of Urology of Virginia in Virginia Beach, cited many reasons his practice joined a large regional health system in 2008, including: declining reimbursement, increasing administrative burdens, and cost concerns with electronic health records. Frustrated by a lack of autonomy and hospital administration, 3 years later Dr. Fabrizio and many of his colleagues re-established an independent practice. He generously explained the lessons he learned from this experience, including how to align and not be employed.

Also see - ACA, MACRA: What they mean for you, patients

Brian Jumper, MD, of Portland, ME, past president of the Maine Medical Association, explained how he and his former partners remain satisfied in a state where 80% of urologists are employed. He believes hospital employment can be successful when physicians are respected by the administration and both parties share a common culture and goals.

Prior authorization solutions

Unlike these workforce developments, the administrative burden of prior authorization was well-established before the advent of the ACA, according to AACU Past President Richard Pelman, MD, of Seattle and Medical Society of Virginia President William Reha, MD, MBA, of Woodbridge, VA. They said urologists can take certain actions today to mitigate time spent on payer relations in the future. Dr. Pelman announced the reinvigoration of an initiative he began during his presidency. Successful advocacy depends on data that back up the arguments made during visits with elected officials and their staffs, according to Dr. Pelman. To collect information on the impact of prior authorization in urology offices, he urged colleagues to track the amount of time medical assistants and other personnel spend on such requests using a worksheet (see Excel or PDF versions) derived from a resource previously distributed by his home state's medical society.

Related: States address payer interference with physicians' orders

Dr. Reha, meanwhile, described a previously reported legislative victory achieved in the Virginia General Assembly earlier this year. In short, the new law makes these requirements:

• Urgency. Requires a 24-hour turnaround on prior authorization requests for urgent medical needs.

• Timely response. Establishes a deadline of 2 business days for health plans to act on a non-urgent prescription prior authorization requests.

• Interoperability. Requires that health plans accept electronic prescription prior authorizations that can be transmitted by electronic medical record, e-prescribing, or health information exchange.

• Accountability. Health plans must provide a reason when denying a prior authorization request for a prescription.

• Stability. Requires health plans to honor an approved prior authorization from a patient’s previous health plan for at least 30 days when a patient switches plans.

• Transparency. Formularies, medications subject to prior authorization, prior authorization procedures, and all prior authorization forms must be located in one place on the health plan’s website. Providers will be given a tracking number when requested so they can track the status of their requests.

• Continues the conversation. Establishes a workgroup with physician and health plan representatives to discuss and bring data forward on mental health, chronic care management, and generic medications and improvements to the prior authorization process for those medications.

NEXT: Telemedicine and the future

Telemedicine and the future

Looking forward, AACU Western Section Representative Eugene Rhee, MD, MBA, and AUA Delegate to the AMA Aaron Spitz, MD, shared an eye-catching and media-rich presentation on the integration of telemedicine technology in the practice of urology. "Seeing" patients using a laptop or tablet is not science fiction. An important consideration, however, is whether those virtual visits can be reimbursed. Drs. Rhee and Spitz touched upon the Federation of State Medical Boards' national licensure initiative, as well as states' varied requirements on public and private payers. (Also see, Legal hurdles may stall telehealth’s role in work force crisis).

Read - The president, the Supreme Court, and ACA: A urologist’s view

Another prospective session addressed “Health Care in 2020.” Health care journalist and author Steve Jacob shared his vision based on more than 1,000 references and a year of in-depth research on the subject. He lamented a future in which a two-tiered health care system will be firmly entrenched and questioned how ill-defined "value" and "quality" measures will ultimately impact physician payment. Jacob referenced a survey that found 82% of physicians agreeing with the statement, "Physicians have little influence on the direction of health care and have little ability to affect change." He urged attendees to rebel against that prevailing notion on behalf of their patients and colleagues. Despite physicians' low opinion of their influence, Americans generally trust physicians the most when it comes to health care reform.

Along these lines, the presidents of the AACU, AUA, and LUGPA addressed how each organization plays a role in state and federal health care policies. For his part, AACU President Mark Stovsky, MD, MBA, asserted that physicians can accomplish great things when they come together for a common purpose. Look no further than the repeal of Medicare's sustainable growth rate formula earlier this year, which was approved just days after the 2015 Urology Joint Advocacy Conference. The 2016 event is scheduled for Feb. 28–March 1 in Washington. As stressed countless times during AACU state advocacy conference presentations, there is strength in numbers.

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How is your practice affected by prior authorizations?

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