Energized by recent legislative victories from Tallahassee to Olympia, urologists looked to the future as they gathered for the 6th Annual AACU State Society Network Advocacy Conference. Taking place just days after the October 1st launch of open enrollment for health insurance exchange plans, the event focused on the role of urologists and their professional associations in a transformed health care delivery system.
Technology will continue to be a driving force for the future practice of medicine, and attendees heard from experts who spoke
Nationally recognized policy experts and business consultants shared a fresh take on the nascent online insurance marketplaces and the evolution of health care delivery. Speakers described how the payfor-performance model is evolving and suggested that specialists must work together to establish “pay-for-value” metrics for these new reimbursement programs.
installed President Richard Pelman, MD, explained his desire
making. A dynamic trio of speakers explained how public, private, and academic entities can be partners in the technological innovation of medicine. Lisa Delp, director of Ohio-based Innovation Fund America, provided innumerable examples of how government has served as a catalyst, rather than an obstructionist in the development of health care technology. Urologic community advocacy, as always, featured prominently throughout the conference. The leaders of state and national urology societies shared recent successes and best practices to consider implementing nationwide. In addition, attendees were
establish societies in those jurisdictions without a state organization representing urologists. He insisted that the collective knowledge continued on page 3
Dear Colleagues,
the focus of this program are: strengthening expert witness standards in medical liability cases; medical practice freedom and fair contracting;
I want to thank the AACU Board of Directors and membership for prostate cancer testing mandates; and scope of practice. th
upcoming year. This is an important time to be engaged in health policy. The most implementation of Medicare has begun – with a rocky start – and members of Congress from both sides of aisle appear to be serious
capitol integrates the national legislative agenda for both organizations along with health policy presentations from Congressional elected and direct interactions with congressional members and staff. If
in the United States House of Representatives this summer seeking
visit experience.
potentially jeopardizing this important component to coordinated around the corner. States continue to be the most active players in health care with state legislatures debating and passing laws on Medicaid expansion, scope of practice, medical liability, telemedicine, third-party payor issues, and pharmaceuticals, among others. We have seen legislative successes in states like Florida, where active physician engagement led to the passage of a very important medical liability reform law this year which will, in part, require a testifying expert in a medical liability case to be from the same specialty as the defendant physician. In my home state of Washington, after a two-year campaign involving the hard work of Washington State
My goal as president is to continue to build upon our past successes and expand our membership throughout the country. There are a number of states with no urological society and the AACU would like to assist urologists in those states where it can in forming societies. Also, to improve our State Society Network, I would like to increase the number of State Society Network Representatives, the “boots on the ground,” in each of the states so that urologists have the opportunity the states. To succeed, it is vital that we have a robust and growing membership. I encourage each of you to engage your colleagues who may not be members of the AACU and urge them to join and be a part
We will thrive as individuals and as a specialty if we stick together and act prohibits the state from tying medical licensure to participation in a particular third-party payor system and bars insurers from changing only renew your membership but actively recruit your associates to join us. Thank you for your support of the AACU, and have a great new year! compulsory participation in third-payor programs during a
All of this demonstrates the importance of staying engaged and being a member of the AACU. The AACU is the only national organization
Richard S. Pelman, MD
widely held views on these and many other issues. The AACU team tracks and monitors the legislation coming out of Washington, D.C. important issues that affect your practice and your patients. As you heard there will soon be an improved and enhanced AACU website, allowing
continued from page 1
AACU Sentinel The Newsletter of the American Association of Clinical Urologists (AACU) Protecting the Political and Professional Interests of Urology since 1968
AACU OFFICERS
below. Information and advocacy tools surrounding these issues will this year.
President Richard S. Pelman, MD Bellevue, WA
AACU proactive advocacy campaigns: • Public Health–Prostate Cancer Screening & Awareness
President-Elect Mark D. Stovsky, MD, MBA, FACS Cleveland, OH
prostate cancer. Expanded scopes of practice for non-physician providers must maintain a physician as the leader in the provision of medical care.
State Society Network Chair Martin K. Dineen, MD Daytona Beach, FL
authorization forms for pharmaceuticals, procedures, and services.
Secretary/Treasurer Charles A. McWilliams, MD Oklahoma City, OK
Strengthen expert witness requirements to ensure witnesses
•
Past President Mark S. Austenfeld, MD Kansas City, MO
validity of their testimony. Work Force–Fair Contracting and Medical Practice Freedom third-party payers and health care providers and prohibit tying health care provider licensure to participation in a third-party payer program.
Health Policy Chair
Urology societies and individual urologists, empowered with model legislation, talking points, and coalition-building resources fashioned by the AACU, will achieve distinction within the medical community for their progressive push for pro-patient and pro-physician measures. Whether a state urology society already engages in socioeconomic affairs or it currently focuses solely on science, the AACU will encourage and reinforce proactive advocacy campaigns.
AACU Sentinel Staff Editor: Charles A. McWilliams, MD Managing Editor: Tristan Powell
Conference attendees, including the leaders of more than two dozen organizations representing urologists, exhibited tenacity and resolve during the AACU State Society Network Advocacy Conference that will sustain the entire urology community as the uncertain future is revealed.
physicians in grassroots activity, would be leveraged to support organizational development across the country.
Seattle, WA
with a new system governing updates and adjustments to Medicare payments. A major difference between the bills is how payment
activity surrounding the widely unpopular Ultimately, lawmakers were able to prevent
that would consolidate and replace the Physician Quality Reporting, for three months, under a provision of the and Democrats in the remaining days of
high-performing professionals. Both bills also provide for incentive bonuses to physicians who participate in APMs. Additionally, there
during the three-month time period. However, lawmakers did not
measurements are to be determined, and improvements to the accuracy of relative value unit computations and corresponding adjustments.
Still, in the midst of all this last minute deal-making, a more permanent solution was sparked earlier in the year when the
time frame. There still remains, however, the question of how to pay for repeal. One idea to help contain costs included in both bills is services. Ordered imaging services will need to meet AUC – which will be determined with input from physicians -- for reimbursement. While both bills limit the application of the AUC system to imaging services, the bills leave open the possibility that it may be expanded to other services.
Commerce and Ways and Means Committees released a statement
entitled the “Medicare Patient Access and Quality Improvement
the bill passed the full House Energy and Commerce Committee on Committee in conjunction with the House Ways and Means Committee released a draft proposal labeled a “discussion memo” on
development of the AUC found in the Senate Finance and House
a subsequent mark-up session by the Senate Finance Committee led that would foster division within the House of Medicine by increasing payments for primary care services at the expense of specialty services. in the House, the Ways and Means Committee voted on and medical community will be closely watching how this plays out in Washington, and given the stakes it will be important for all of us to a way that does not negatively impact access or patient care.
making. years. The Department of Defense must now, by law, consider urotrauma as a distinct entity with respect to care coordination and research instead of lumping it in with other injury patterns as it historically has done. This enormous victory for veterans and for organized urology is a case study in what grass roots advocacy can members, committed staff members of these organizations, our lobbyists at Hart Health Strategies, and our coalition Male Reproduction, American Society for Reproductive Medicine, Society for Male Reproduction and Urology and the long list of veteran advocacy organizations as well as industry partners. The pistons of the engine that drove this victory were the many different contacts and relationships that urologists have forged with members several of us have met with members and staffers, and have gone to fundraisers to get a few minutes of face time to highlight our urotrauma on Capitol Hill. Many have written letters and made phone calls, including many members of our urology coalition in Maryland which was integral in getting Senator Cardin to co-sponsor the amendment in the Senate.
State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky
Projected Session Dates
State
Projected Session Dates
Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota
State
Projected Session Dates
Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas No regular session in Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Subject to change. Most legislatures also establish deadlines for bill drafting, bill introduction, “cross-over”, etc.
SUNDAY, MARCH 9, 2014 11:45 a.m. – 12:00 p.m. Welcome Richard Pelman, MD President, AACU Pramod C. Sogani, MD, FACS, FRCS President, AUA 12:00 p.m. – 1:00 p.m. Keynote Address David Hawkings Senior Editor, Roll Call 1:00 p.m. – 1:15 p.m.
Break
1:15 p.m. – 2:15 p.m.
The State of Urology Address Richard Pelman, MD President, AACU David F. Penson, MD, MPH Chair, AUA Health Policy Council
4:00 p.m. – 4:45 p.m.
Keynote Address David Hoyt, MD, FACS Executive Director, American College of Surgeons
5:00 p.m. – 7:00 p.m.
Welcome Reception Room Congressional Room A/B
MONDAY, MARCH 10, 2014 7:00 a.m. – 8:00 a.m.
Breakfast
8:00 a.m. – 8:30 a.m.
UROPAC Update Arthur Tarantino, MD Chair, UROPAC Vice-Chair, UROPAC
8:30 a.m. – 9:30 a.m. President, LUGPA 2:15 p.m. – 2:45 p.m.
2014 Urology Joint Advocacy Priorities Overview: Presenting the “Asks”
Vice Chair, AUA Health Policy Council Panelists: Karen Fischer Professional Staff, Majority; Senate Finance Committee Dan Todd Health Policy Advisor, Minority; Senate Finance Committee Brett Baker Professional Staff, Majority, House Ways & Means Committee
Chair, AACU Health Policy Council Chair, AUA Legislative Affairs Committee 2:45 p.m. – 3:00 p.m.
Break
3:00 p.m. – 4:00 p.m.
Joint Advocacy Priority: Affordable Care Act Implementation Moderator: Mark Stovsky, MD AACU President-elect Panelists:
9:30 a.m. – 10:30 a.m.
Government Affairs and Policy Group, Johnson & Johnson; Former Special Assistant to the President for Healthcare and Economic Policy at the National Economic Council. Associate Professor, Department of Health Policy, School of Public Health & Health Services, George Washington University
A View from the Hill: Sustainable Growth Rate Moderator:
A View from K Street: Urology’s Policy Priorities Moderator: Eugene Rhee, MD, MBA Panelists: Principal, Hart Health Strategies President, The McManus Group Tracy Spicer Partner, Avenue Solutions
10:30 a.m. – 10:45 a.m. Break
10:45 a.m. – 11:45 a.m. Joint Advocacy Priority: Medical Liability Reform Moderator: Patrick McKenna, MD Panelist: Neil Dunn, MD Elizabeth Healy Director Government Relation, The Doctors Company
2:30 p.m. – 3:30 p.m.
AACU Russell Carson Memorial Lecture
3:30 p.m. – 3:45 p.m.
Break
3:45 p.m. – 4:45 p.m.
How Congress Really Works
11:45 a.m. – 12:00 p.m. Break
4:45 p.m.
General Session Adjourned
12:00 p.m. – 1:00 p.m. UROPAC Luncheon Room Regency B
5:00 p.m. – 6:00 p.m.
UROPAC Reception Room Congressional A
12:30 p.m. – 1:15 p.m. UROPAC Keynote Address Michael Barone Respected political historian; Senior writer, U.S. News & World Report
TUESDAY, MARCH 11, 2014 8:00 a.m. – 8:30 a.m.
Breakfast & Last Minute Logistics Room Columbia A/B
1:15 p.m. – 1:30 p.m.
Break
9:00 a.m. – 11:30 a.m.
Senate Meetings
1:30 p.m. – 2:30 p.m.
Grassroots Campaign Development: Men’s Health Moderators:
11:30 a.m. – 12:30 p.m. Luncheon on Capitol Hill Room 106
Panelists:
1:00 p.m. – 4:30 p.m.
House Hill Meetings
5:00 p.m.
Conference Concludes
Specialist on the Congress, Congressional Research Service
VP Government Affairs, ZERO Pete Anthony SVP, Advocacy and Engagement, CQ Roll Call Brandon Legnard Director Strategic Initiatives, Mens Health Network
Michael Barone is Senior Political Analyst for the Washington Examiner and a Resident Fellow at the American Enterprise Institute. He is a contributor to Fox News Channel and coauthor of The Almanac of American Politics. He grew up in Detroit and Birmingham, Michigan. He was graduated from Harvard and was an editor of the Harvard Crimson and the Yale Law Journal.
Washington Post. with U.S. News & World Report Editor at Reader’s Digest.
Shaping of America from Roosevelt to Reagan The New Americans: How the Melting Pot Can Work Again (Regnery, Hard America, Soft America: Competition vs.Coddling and the Competition for the Nation’s Future Our First Revolution: The Remarkable British Upheaval That Inspired America’s Founding Fathers Shaping Our Nation: How Surges of Migration Transformed America and Its Politics (Crown Over the years he has written for many other publications in the United States and several other countries, including the Economist, the Times Literary Supplement and the Daily Telegraph and the Sunday Times of London. His column is syndicated by Creators Syndicate. Mr. Barone received the Bradley Prize from the Lynde and Harry Bradley The American Spectator
Mr. Barone is the principal co-author of The Almanac of American Politics, nd
edition, The Almanac of American Politics 2014, Our Country: The
countries and has reported on recent elections in Britain, Italy, Russia and Mexico.
such a grace period. Although the insurer is responsible to make st
th
day without notifying the treating provider of such a status. If the patient comes current with his premiums during that time, payment will ultimately be made. However, if the patient fails to pay his premiums, th
insurer will not pay (even though they said the patient was covered by
The Interim meeting of the AMA House of Delegates convened at the Hotel, National Harbor, Maryland just outside of Washington, D.C. this week. As usual, there was considerable discussion of a range of topics including public health issues like regulation of electronic cigarettes and immunizations; status of education; scope of practice; internal AMA administrative and organizational issues; and pharmaceutical issues like medication shortages, off label medication use and control of compounded pharmacies; however, most of the discussion centered on addressing the myriad issues raised by the Affordable Care Act (including multiple calls to repeal many of its formula.
these patients are economically disadvantaged, the chances of collecting more than three months after care was delivered from the patient who has lost coverage is between slim and none. The AMA is calling for transparency and fairness: the insurance company must notify the provider when the patient enters this grace period and how far into the doctor to collect a deposit if the patient is within the grace period and makes the insurer responsible for payment if the provider is not directs AMA lobbyists to advocate for correction of current ACA law.
no repeal and no further delays. This transition will cost physicians and create a potential delay in payments lasting up to six months, subject providers to increased audits and denials while providing no
There was a call for federal legislation to shorten the waiting interval between signing informed consent and performing permanent inappropriate and illegitimate work by the RAC contractors,
change in coding and documentation involving entirely new codes and an explosion in the number of codes used creates a granularity of detail far beyond any needed for clinical care or even most research. The House of Delegates called again for maximal efforts to prevent
payment of costs generated by successful appeals when the RAC to defend against RAC audits. A resolution supported continued provided to physicians for EHR software. Similarly, the House
PLEASE CONTACT YOUR CONGRESSMAN AND SENATORS TODAY TO REQUEST THAT THEY COSPONSOR AND SUPPORT THIS LEGISLATION.
Meaningful Use phase two and three without eliminating the bonus paid for successful compliance. A position paper combining current AMA policies regarding the Affordable Care Act included a phrase that could be taken to support conclusions made by the USPSTF despite vigorous urology caucus testimony against. It will be necessary to introduce another resolution next year to change this
integrated multi-specialty group practice among a range of choices that are appropriate in a pluralistic model that allows healthcare different types of healthcare.
rule that determines inpatient status versus outpatient observation. There was yet another call to abolish the IPAB (see below for more The AMA has called on the private insurance industry to establish a fairer retro-authorization process and eliminate automatic prepayment audits for arbitrary reasons lacking demonstrated indications. Fees are being cut universally; adding unfair costs and hurdles to collecting for honest charges should not continue. The delegates approved a number of resolutions regarding the Affordable Care Act such as a resolution against making insurance exchange participation mandatory, a resolution requiring real time linked to guarantee payment. Current law allows patients who are insurance is cancelled. However, the insurance company is not required to tell the treating physician that the patient has entered
repeal on Saturday was followed by vigorous discussion and debate over related resolutions for the rest of the meeting. The Congressional not been solved. The Senate Finance and House Ways and Means some bonuses based on quality performance. The negatives attached has and will continue to increase the costs of providing medical care. The myriad of current quality reporting programs will be streamlined and combined into one score that will impact payments no matter how many of us feel that current metrics do not accurately measure quality or properly attribute costs. Although the draft does not promise that fees are immune from future IPAB cuts, the freeze is unlikely that the IPAB will make cuts even if such a panel is created. The
overall goal is to freeze FFS fees while allowing some bonus payments for value based performance. The “freeze” applies to global Medicare payments allowing continued redistribution among physicians which still threatens to cut specialty payments in favor of primary care. The freeze will still create a debt to be paid under current Congressional rules but this money has now been earmarked to come
calculations on past interest no longer accruing on deferred cuts. The bill does not address tort reform or otherwise include limits on unfunded mandates that continuously increase overhead (meaningful alternative payment models (accepting risk in return for potential This is not a good deal and AMA members voiced considerable displeasure and frustration. However, leadership repeatedly emphasized that the alternative to accepting this painful compromise
have escaped this control and enjoyed cost of living increases that are asked to suffer so much. By the time this is read, much of this negotiation will have played out, voices will be raised and few endure further freezes, Congress should mitigate the impact by PLEASE CONTACT YOUR CONGRESSMAN AND SENATORS TODAY TO DEMAND THAT ICD-10 BE AVERTED. This is a timely issue. If we delay in pressing the message, it will be too late. Let them know how further lost income and dramatic increases in overhead will impact your ability to deliver care to your patients. The loudest argument is Washington regards access to care. If I cannot afford to remain in practice, it is my patients who suffer. I hope to have better news with my next update (hope springs other matters.
more harmful, continued moderate cuts to reimbursement annually for several years leading to even lower rates. Recognize that
Federal PAC that speaks for all of Urology, has been totally restructured. I am honored and excited to be the new Kirsh, MD has done a phenomenal job as UROPAC Chair, and I would like to personally thank him for all his hard PAC restructuring has included the following: New Articles of Organization Totally rebuilt website – www.UROPAC.org Revised Standard Operating Procedures Budgeting and Financial Responsibilities Strategic Fundraising Initiative to be Launched Our New Board of Directors is as follows:
There have been dramatic administrative changes as well. UROPAC started working with Aristotle, a Washington, D.C. based PAC consulting, roots efforts of UROPAC. Our website has been totally redesigned and contains features such as a Politico newsfeed, political resources for members, and a convenient way to contribute to UROPAC. UROPAC now has infrastructure to be an even stronger voice in Washington, D.C.
continued challenges to be faced with the Affordable Care Act implementation, among many other issues. For more information on UROPAC, please visit the new website at www.UROPAC.org. I thank you for your support.
Arthur Tarantino, MD
Call
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If you have an article or item of interest that you would like to be considered for publication in the AACU Sentinel, please submit to: Tristan Powell Email: tristan@wjweiser.com