March 2011
The essential resource for your practice
Volume XXI, Number 3

Meet A Member of Congress

Starting this month, the Health Policy Brief will include a new column, “Meet a Member of Congress,” which will introduce you to our nation’s lawmakers, who each day debate legislation that affects your family, your practice and your patients.@blurbend

Our inaugural column features Joe Pitts, a Republican Member of Congress who represents the 16th Congressional district of Pennsylvania. Before becoming a Member of Congress, Chairman Pitts was an officer in the Air Force, a teacher and a small business owner, giving him a wide array of experiences, which he brings to Congress. First elected in 1996, he has served on the House Budget Committee, the International Relations Committee (now known as the Foreign Affairs Committee), the Small Business Committee, the House Armed Services Committee, the Transportation and Infrastructure Committee, and the powerful Energy and Commerce Committee. As a member of the Budget Committee, Chairman Pitts co-wrote the only four balanced budgets enacted into law since the Lyndon Johnson Administration. Each of those budgets, negotiated with President Clinton, actually paid off some of the government’s debt.

Chairman Pitts is an advocate for fiscal responsibility, refusing to request earmarks and voting against Democratic and Republican legislation if he feels it is irresponsibly expensive. He is an advocate for truly bipartisan health reform, working with New York Democrat Nydia Velazquez, chairwoman of the Small Business Committee, to introduce the Small Business CHOICE Act, which would make it easier for small businesses to offer health insurance to their employees.

Because of his service, his hard work and his commitment to the issues, he was appointed the chair of the Health Subcommittee of the powerful Energy and Commerce Committee for 112th Congress. Though he is rather busy right now in setting up the agenda for his Committee, Chairman Pitts graciously sat down with us for a few minutes to tell us a little about his plans for the Committee in the next year.

Q: What do you see as the biggest items on your Committee’s horizon for the next year?

Pitts: Our number one priority is repealing the Affordable Care Act and proposing legislation that reforms healthcare with free-market measures. We will also tackle medical malpractice reform and a permanent fix to the Sustainable Growth Rate formula. The Subcommittee also needs to reauthorize the Medical Device User Fee Modernization Act (MDUFMA) and the Prescription Drug User Fee Act (PDUFA).

Q: If you could wave a magic wand and anything could happen, what would you like to see pass (both through the Committee and the whole House)?

Pitts: Repeal of the Affordable Care Act.

[Editor’s note: On January 19, 2011, the House passed H.R. 2, to the legislation to repeal the Affordable Care Act (ACA). The vote was 245-189 in favor of repeal.]

Q: What do you think is likely to pass?

Pitts: Certainly the reauthorization bills, but we should also be able to pass targeted repeal legislation and free-market healthcare reforms.

Q: What do you think the Senate will do with these issues?

Pitts: I think that we will work together to send reauthorization bills to the President. I hope that we can work together on further healthcare reforms and perhaps a permanent Sustainable Growth Rate fix. We need to stop kicking the can down the road.

Q: Physicians have had a rough time over the last two years. Many are feeling discouraged. What would you like to tell them to keep them hopeful about their futures and the future of healthcare in America?

Pitts: One of my heroes, Winston Churchill, once said that “Americans will always do the right thing…after they’ve exhausted all the alternatives.” I think the same could be said of Congress. The American people want us to get this right, and I think that we will. The Affordable Care Act was a bad start, but if doctors and the American people stay engaged, we can undo the damage and pass real reform.

Q: As physicians, community members and voters, what can physicians do to “make a difference” and why should they continue to be active and involved?

Pitts: The biggest way they can make a difference is by communicating with their Members of Congress. Most Members of Congress are not doctors, and don’t understand the struggles that health professionals go through. But what we do in Congress has a huge impact on your work. We need to make decisions that are based on what is best for doctors and patients.

Q: Is there anything else you would like to say to our members (urologists – who are surgeons, office practitioners, pediatricians, geriatricians, researchers and cancer care specialists)?

Pitts: I know many provider groups are especially concerned with certain aspects of the Affordable Care Act, such as the Independent Payment Advisory Board (IPAB). I support the repeal of IPAB, as it leaves crucial medical decisions in the hands of an unaccountable commission.

Many thanks to Chairman Pitts for taking time to share with us some of his vision for the Healthcare Committee over the next year. We look forward to working with him and all Members of Congress as this session moves forward.

Table of Contents

  

Coding Corner:

Bladder Scan Confusion

AUA Releases New Clinical Guideline on BPH, Outlines Diagnostic Workup Protocol

On February 3, 2011, the AUA released a new clinical Guideline on the Treatment of Benign Prostatic Hyperplasia (BPH), which updates current guidance on diagnosing and treating this common condition in men that can lead to lower urinary tract symptoms (LUTS) and impact the quality of life for patients. The AUA first released its own original guidance on BPH in 2003. The full guideline is available online and is expected to be published in an upcoming issue of The Journal of Urology®. A special Webinar about this guideline is also available on the AUA's YouTube Channel. Click here to view the presentation.@blurbend

The update to the guideline, finalized in late 2010, includes a detailed diagnostic algorithm to guide a physician in diagnosing and treating LUTS secondary to BPH, as well as in-depth information on its basic management and the management of complicated cases. Physicians treating men with suspected cases of LUTS should obtain a relevant medical history, assess symptoms using the AUA Symptom Index and conduct a full physical examination (including a digital rectal exam). Laboratory tests should include a prostate-specific antigen (PSA) test and a urinalysis to exclude infection or other causes for LUTS. Frequency and volume charts may also be useful in providing a diagnosis.

The 2003 update provided key information on the use of pharmacologic therapies to treat BPH (in addition to surgical therapies available); the 2010 edition contains added recommendations for the use of anti-cholinergic drugs and the use of laser therapies. Additionally, the index patient age has been lowered to 45 from 50 in order to better guide physicians in treating younger men who may be experiencing lower urinary symptoms.

The guideline also includes cautionary statements about intraoperative floppy iris syndrome (IFIS) in cataract patients taking alpha-blockers to treat BPH. The AUA cautions physicians to question patients about any planned cataract surgery prior to their starting an alpha-blocker regimen (men planning cataract surgery should avoiding initiating alpha-blockers until after their surgery has been completed). Those men already taking the drugs should inform their ophthalmologists of their alpha-blocker regimen prior to surgery.

“The increasing life expectancy and growth of our elderly population will increase the number of men who suffer from LUTS. This will place increased demands for treatment services, and necessitate the incorporation of evidence-based medicine in that treatment,” said Kevin T. McVary, MD, chair of the panel that developed the guideline. “This document provides much-needed guidance to doctors who are already treating LUTS, as well as those who will be in the future.”

For The Record

EHR Incentive Sources Extend Beyond CMS

Although the most talked about source of financial assistance to help practices purchase electronic health records (EHRs) is the Medicare/Medicaid Meaningful Use incentive, there are other sources of funds that every urology practice should investigate@blurbend as they move toward acquisition of new or upgraded EHR systems.

According to an article in the November 2010 issue of Managed Care Magazine, a number of the managed care plans are stepping up to the plate with additional payment incentives for those providers who use EHR systems. Examples include Highmark Blue Cross and Blue Shield in Pennsylvania, Wellpoint, UnitedHealthcare and Aetna. These incentives will not last forever, but are designed to be kick-starters to supplement what Medicare is doing. Additionally, the Connecticut Medical Association is issuing $100,000 grants to primary care physicians who purchase EHR systems in an effort to increase momentum toward establishing patient-centered medical homes. Finally, all urology practices should keep in mind that the Stark and anti-kickback exemptions that allow other healthcare providers (such as your local hospital or reference lab) to contribute toward the purchase price of EHR systems and maintenance are still in effect.

Approved Testing and Certifying Bodies (ATCB) for Meaningful Use Expand

The Office of the National Coordinator for Health Information Technology (ONCHIT) recently issued an announcement of two more Approved Testing and Certifying Bodies (ATCBs) that have been approved to test and certify electronic medical record systems as qualified for Meaningful Use. These ATCBs include ICSA Labs in Mechanicsburg, PA, and SLI Global Solutions in Denver, CO. This addition increases the total number of ONC-ATCBs to five. These testing facilities accept applications from EHR vendors and if the software submitted passes a rigorous set of tests of the Meaningful Use criteria issued by ONC, the software is added to the list of certified systems, one of which a provider must use in order to receive the government subsidies over the next five years. Click here for a complete list of ATCBs or to view the current list of certified products.

MGMA Releases Survey Showing EHR Users Are More Profitable

At its 2010 Annual Conference held in New Orleans in October, the Medical Group Management Association (MGMA) unveiled the results of its newest survey, titled Electronic Health Records Impacts on Revenue, Costs and Staffing: 2010 Report Based on 2009 Data. MGMA CEO William Jessee, MD, explained that, although multi-specialty practices using EHR had higher expenses, they also had higher revenue resulting in approximately $50,000 more profit per physician per year. The survey report can be ordered on the MGMA Web site.

E-mail pracman@AUAnet.org for more information.

AUA Sets 2011 Legislative Priorities

The AUA Legislative Affairs Committee and the Health Policy Council recently approved the legislative priorities for 2011. The AUA will work closely with our partner coalitions (such as the American College of Surgeons [ACS], the Alliance of Specialty Medicine [the Alliance], and the American Medical Association [AMA]) on issues of importance to organized medicine in order to exert greater collective pressure on Capitol Hill. These issues include replacing the Sustainable Growth Rate (SGR), repealing the Independent Payment Advisory Board (IPAB), enacting comprehensive medical liability reform, and preserving the in-office ancillary exception to the Stark Law.@blurbend

In addition, the AUA will focus on issues of particular concern to urology. These include reintroducing and working toward the passage of the AUA-drafted prostate cancer bill (the Prostate Research, Outreach, Screening, Testing, Access and Treatment Effectiveness Act) and the AUA-drafted urotrauma bill, and ensuring that ultrasound is not categorized with other advanced imaging services (such as computerized tomography[CT] and positron emission tomography [PET] scans) as Congress looks at further cuts to reimbursement.

AUA General Healthcare Legislative Priorities

Sustainable Growth Rate (SGR) Formula: the Medicare physician payment cuts necessitated by the SGR remain a concern for the AUA. The AUA has worked with and signed onto letters with a multitude of coalitions and other stakeholders, including the ACS, the Alliance and the AMA, calling for a repeal of the SGR. Congress, however, has continued to prolong addressing this critical issue.

Independent Payment Advisory Board (IPAB): the AUA remains concerned about the Affordable Care Act (ACA)-established IPAB and believes that it is an inappropriate delegation of Congress’ oversight responsibilities to an unelected, unaccountable body. Without proper Congressional oversight, and without the ability to have practicing physicians on this Board, the recommendations of the IPAB could further reduce Medicare beneficiaries’ access to high quality healthcare.

Imaging and Other In-Office Ancillaries: the AUA will continue to work with groups, such as the Coalition for Patient Centered Imaging, to preserve the in-office ancillary exception to the Stark Law. We believe that attempts by other groups (e.g., radiology, pathology, radiation oncology) to remove this critical exception are misguided. The AUA continues to strongly advocate that the integration of in-office services, particularly ultrasound, into clinical care improves quality and safety; reduces complications; and saves Medicare money by enhancing access to minimally invasive procedures.

Access to Specialty Care: the AUA supports Congressional efforts to maintain appropriate access to specialty care while there is a national shift in healthcare delivery toward greater preventive care. The AUA urges Congress to ensure that efforts aimed at increasing access to primary care are not addressed in a budget neutral fashion, and to ensure that specialists will be allowed proper access to new payment models being tested (such as medical homes and accountable care organizations) so that access to specialty care does not suffer as a result of a greater focus on preventive medicine.

Medical Liability Reform: while the AUA supports testing alternatives to the current tort system, such as health courts, medical tribunals, and early disclosure and compensation offers, this is not enough. We need comprehensive medical liability reform to truly address this problem, as was recently suggested by the National Commission on Fiscal Responsibility and Reform. The AUA urges Congress to pass federal legislation that 1) includes reasonable limits on non-economic damages (similar to laws in California or Texas), and 2) protects physicians who follow established evidence-based practice guidelines and/or volunteer services in a disaster or local/national emergency situation. Congress is responding to this request. Recently, the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (H.R. 5) was introduced by Representative Phil Gingrey (R-GA). The bill, which the AUA supports, aims to improve patient access to healthcare services and provide improved medical care by reducing the excessive burden the liability system places on the healthcare delivery system. Click here to read the bill.

Quality and Physician Quality Reporting System (PQRS): the AUA has been an active supporter of the national quality agenda, supplying representatives to the National Quality Forum (NQF), AQA (formerly the Ambulatory Quality Alliance), the Surgical Quality Alliance (SQA) and the AMA Physician Consortium for Performance Improvement (PCPI), among others, developing measures for prostate cancer and other major urologic conditions. We have also taken numerous steps to educate our members about the importance of reporting on quality measures. While we continue to encourage our members to participate in the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System, or PQRS (formerly known as the Physician Quality Reporting Initiative, or PQRI); we oppose mandatory penalties established in the ACA for those who do not successfully participate in PQRS. Furthermore, we oppose any reporting of PQRS participation results on the “Physician Compare Web site.” The AUA urges Congress to repeal the penalties and push for better infrastructure, including the inclusion of more relevant quality urology measures within PQRS and timely access to feedback reports within PQRS.

Physician Feedback Reporting Program: Value-Based Purchasing: under Section 3003 of the ACA, beginning in 2012, the U.S. Department of Health and Human Services (HHS) Secretary is directed to use CMS claims data to provide physicians with confidential reports that measure the costs of the resources involved (e.g., labs, diagnostic tests) in furnishing care to Medicare beneficiaries and comparing both a physician’s pattern of resource use and his/her score on quality measures relevant to the condition under review to those of other physicians. Further, CMS is mandated under the ACA to devise a publicly-available episode grouper, attribution methodology, risk adjustment methodology, and budget neutral payment adjuster by 2013, which will then be used to differentially reward those physicians, who, in comparison to their peers in the same geographic market treating the same condition, cost less and score higher on quality measures. This introduction into the Medicare program of a value-based purchasing model for physicians is scheduled to be rolled out nationwide by 2017. The AUA is very concerned that the complexities involved to accurately and fairly implement such a program cannot be done in time to meet this ambitious deadline. We will work with our coalition groups to ensure CMS is provided sufficient time to fully develop and test this program before it is implemented nationally.

Payment Models: the AUA firmly believes that innovative payment models such as the patient-centered medical home and accountable care organizations must ensure participation and leadership by specialists. For example, with patients who have diseases and conditions such as prostate cancer and incontinence, urologists are the appropriate physicians to serve as a patient-centered medical home, if the patient so chooses. Therefore, we urge Congress and federal agencies to ensure that specialists are part of any new initiatives that may be developed.

AUA Urology-Specific Priorities

Urotrauma: the AUA will continue to build on the success of the AUA-led urotrauma bill (H.R. 5106) that was introduced in the 111th Congress by Representative Zack Space (D-OH-18) and Representative Carol Shea-Porter (D-NH-1) and co-sponsored by Representatives Chris Lee (R-NY-26) and Mike Ross (D-AR-4). We are very pleased that some language from the bill was inserted into the House report, Report 111-491, of the National Defense Authorization Act (NDAA) of 2010, H.R. 5136. This is the annual bill that funds the nation’s military operations; having report language included in this Act is thus a major victory. A modified version of the NDAA, which did not officially contain any report language, was approved. However, the House Armed Services Committee was very clear that it fully expects the U.S. Department of Defense (DoD) to comply with House Report 111-491, which contains our language. In anticipation of this, the AUA will convene a urotrauma expert task force to make recommendations to the DoD. The mandate contained within the original NDAA report that requires that the DoD issue urotrauma recommendations within a year.

Prostate Cancer: the AUA will continue to build on the success of the AUA-led PROSTATE Act (Prostate Research, Outreach, Screening, Testing, Access and Treatment Effectiveness Act of 2010). This legislation calls for the establishment of a federal interagency task force to align and more efficiently coordinate current prostate cancer programs across the federal government. The task force will be convened by the U.S. Department of Veterans Affairs, with participation from the DoD, and HHS. The legislation establishes four-year pilot projects for telehealth services for rural and underserved populations, as well as a grant program to address the widespread disparities in the timely diagnosis and treatment of this disease.

The legislation was introduced in the 111th Congress in both chambers of Congress, giving the bill much prized bipartisan support. In the Senate, S. 3755 was introduced by both Senator John Tester (D-MT) and Senator George Voinovich (R-OH) and co-sponsored by Senator Daniel Inouye (D-HI). Chairman of the House Oversight and Government Reform Committee Edolphus Towns (D-NY-10) introduced the bill in the House (H.R. 6389). The AUA will work closely with its Legislative Affairs Committee, Health Policy Council, and advocacy groups and other stakeholders as we seek to re-introduce both pieces of legislation and gather even more support and momentum in the 112th Congress.

Ultrasound: the AUA has a distinct interest in ensuring that ultrasound services are not included with other advanced imaging services (e.g., CT, PET scans) as Congress and federal agencies continue to scrutinize advanced diagnostic imaging. Some CMS and private insurance policies are already grouping these services together. The AUA will work with states to monitor Medicaid activity and private insurer activity on this issue, as well as explore the common uses of ultrasound in various Current Procedural Terminology codes.

For more information, e-mail GovernmentRelations@AUAnet.org.