June 2011
The essential resource for your practice
Volume XXI, Number 6

Meet a Member of Congress: Senator Orrin Hatch (R-UT)

Now in his sixth term, Senator Orrin Hatch is Utah’s senior senator and also the Ranking Republican on the Senate Committee on Finance@blurbend, the committee responsible for overseeing 60 percent of the federal budget, including Medicare, Medicaid and Social Security, as well as all tax policy and international trade agreements.

Senator Hatch is also a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, the Senate Select Committee on Intelligence, and the Joint Committee on Taxation. In addition, he has the honor of serving on the Board of Directors for the Holocaust Memorial Museum in Washington, DC.

Recently, when we asked Senator Hatch to speak to our AUA membership, he was delighted to summarize what he is doing in the Senate this year about the Affordable Care Act (ACA).

align=The Wrong Tonic at the Wrong Time
Healthcare Law Should Be Repealed

By: U.S. Senator Orrin Hatch (R-UT)
Ranking Member of the Senate Finance Committee

It has been a little more than a year since the enactment of the budget-busting $2.6 trillion health law and, regrettably, the Obama Administration’s overhaul of the nation’s healthcare system has failed to lower costs, create new jobs, protect Medicare for seniors and preserve the patient-doctor relationship for Americans. For this reason, I will be working with a bipartisan group of senators to dismantle the pillars holding up the Affordable Care Act (ACA) step-by-step, and repeal its most onerous and costly provisions. In fact, as the Ranking Member of the Senate Finance Committee, I have already introduced a series of bills to achieve this goal.

First, I have introduced legislation to repeal the unconstitutional, individual mandate. I’ve also introduced a bill to eliminate the job-crushing employer mandate imposed by the ACA. During these tough economic times, with record-high levels of unemployment, American employers and workers need certainty. The new regulations and penalties under the ACA would force layoffs, and incentivize employers to drop health insurance. A full repeal of the employer mandate will prevent millions of individuals from losing the coverage they want to keep, prevent higher premiums and retain good-paying jobs.

This Congress, I have also introduced legislation to repeal the $20 billion tax on medical device manufacturers. Device manufactures employ nearly half a million people in the United States and their employees earn 40 percent more than the average American. Keeping these important jobs and maintaining an environment that promotes and supports innovation is key to economic recovery. Repealing the tax will allow for economic growth and allow the United States to continue to be the largest exporter of medical device goods. I will also soon introduce a bill to provide states with the flexibility under the Medicaid program. States are facing a collective budget shortfalls of $175 billion and it is critical that we ease the burden of these Washington dictated mandates that have forced states to cut law enforcement and education programs to meet the law’s requirements.

Many in the Senate are deeply concerned that the health overhaul law above all else failed to address the long-term costs of healthcare. In fact, healthcare costs are anticipated to increase by $311 billion over the 10-year budget window. In addition, the majority failed to keep their promise to permanently fix the Sustainable Growth Rate (SGR). Temporary delays of SGR enacted by Congress cause real uncertainty for physicians and threaten patient access to care. By the Obama Administration’s own estimates, the 10-year cost of a doc fix, simply with a 0 percent update, stands at an astonishing $370 billion. At the end of this year alone, physicians will face approximately a 30 percent cut in their payments, seriously threatening access for millions of seniors. Physicians, including urologists, provide essential services to our seniors through the Medicare program. Their time should be spent focusing on their patients, not worrying about whether or not they will make payroll that month because of the uncertainty in Washington.

It’s abundantly clear that this new law raises taxes, increases already out-of-control health costs, puts bureaucrats between patients and doctors—all while putting our already fragile entitlements on an even worse fiscal footing. Our nation cannot continue on its current course. It’s past time we start down the road of real reform and act to address the number one concern of the American people: skyrocketing healthcare costs.

Table of Contents


Coding Corner:

CMS Issues New Temporary Code for Provenge®

AUA, AACU Celebrate Another Successful Urology Joint Advocacy Conference

The 2011 Urology Joint Advocacy Conference (JAC) kicked off with a great start in Washington, DC, with nearly 180 urologists in attendance. After an opening luncheon and welcome from then AUA President Datta G. Wagle, MD, and American Association of Clinical Urologists (AACU) President B. Thomas Brown, MD, MBA, attendees heard from keynote speaker Richard A. “Buz” Cooper, MD, who addressed the declining physician workforce and how it impacts healthcare reform. According to Dr. Cooper, physician growth will not occur at a rate strong enough to meet the projected patient demand under the new law. His speech was a rallying call to attendees to get involved and share their experiences with lawmakers.@blurbend

Dr. Brown and AUA Health Policy Chair Steven M. Schlossberg, MD, MBA, then shared with attendees the key issues to be presented during JAC advocacy efforts that week: protecting patient access to quality urologic care by preserving the in-office ancillary exception; physician payment and replacing the flawed Sustainable Growth Rate (SGR); eliminating the Independent Payment Advisory Board (IPAB); the Prostate Research, Outreach, Screening, Testing, Access and Treatment Effectiveness (PROSTATE) Act of 2011; and the urotrauma bill. These “asks” were the primary issues brought to the attention of lawmakers.

The first two days of the agenda were packed with stimulating presentations by DC policymakers, Members of Congress, urologists and fellow physicians. Some of the highlights were:

  • Vicki Hart of Hart Health Strategies put our “asks” into the context of the Affordable Care Act (ACA) and the 112th Congress. As the law will not be fully implemented until 2019, there is still time to work with lawmakers to address some of the fundamental issues that negatively impact physicians and patient access to care. AUA Government Relations & Advocacy Federal Manager Karen Lencoski, JD, MBA, shared information about the House and Senate committees that have jurisdiction over healthcare issues and which can play an important role in helping further urology’s agenda on the Hill.
  • During a seven-member state panel discussion, attendees were cautioned to be vigilant in their advocacy efforts, as urologists from around the country shared their state-level experiences. Panelists included Mark Edney, MD, from Peninsula Urology Associates in Southern Maryland. Dr. Edney, as president of Maryland Urologists for Patient Access and Care, was on the front lines as Maryland specialists defended the in-office ancillary exception from judicial and legislative restrictions. Keeping your radar up is critical, according to Howard Rubin, a lobbyist advocating on behalf of Maryland physicians who have been fighting against the state's self-referral restrictions. When issues (like self-referral) are defeated at the national level, they can crop up at the state level, he said. More importantly, copycat legislation can appear in states across the nation and, as Rubin pointed out, legislation moves more swiftly and at lesser cost than a federal effort. It is extremely important to be prepared to respond, and to develop and nurture political relationships, not only with lawmakers and key decision-makers, but also with like-minded groups.
  • Various Congressional speakers shared their unique insights throughout the three days of the JAC:
    • The afternoon lecture, “Healthcare and Medicare Reform in the 112th Congress,” was delivered by Representative Chuck Fleischmann (R-TN-3). New to Congress, Representative Fleischmann presented data on government spending and why he believes healthcare reform under the ACA will not work.
    • Freshman Congressman and professional football great, Representative Jon Runyan (R-NJ-3) shared his perspectives on healthcare. He noted that one year after the passage of the ACA, few Americans are happier with the healthcare system. Additionally, he pledged his support for the AUA’s two pieces of legislation—the PROSTATE Act and the urotrauma bill.
    • The Russell Carson Memorial Lecture, sponsored by the AACU, featured Representative Michael C. Burgess, MD (R-TX-26). As a physician and a Member of Congress, he opined that the expectations embedded within the ACA  are too onerous for physicians. One of the first issues that still must be addressed is the SGR, and he and other members of the House Energy and Commerce Committee are committed to reforming it.
    • As a small business owner, newly elected Representative Kristi Noem (R-SD-At Large) empathized with physicians. Numerous ACA requirements are making it difficult for many doctors to maintain their practices. As a representative from a rural state, she also noted that recruiting and keeping physicians in these states is increasingly difficult. Congress is aware of these concerns and plans to address them.
  • Attendees heard from American Medical Association (AMA) Trustee Steven Stack, MD, an emergency physician, who gave a spirited discussion addressing the pitfalls of early adoption of electronic medical records (EMRs), urging the urologists in attendance to let the market settle, work out the bugs of implementation and take the time to adopt EMR systems carefully and properly. Dr. Stack explained the government incentive programs for adoption and that while doctors are eligible only for a single incentive in the two separate government EMR programs (for either e-prescribing or Meaningful Use), penalties are not limited to a single program. Incentives and penalties aside, Stack pointed out, Health Information Technology (HIT) is the way of the future, and though it would be foolish to adopt HIT only to get the incentives, it is equally as unwise not to adopt at all, unless, of course, one plans to retire before the ultimate deadlines for adoption.
  • An energetic panel of Congressional staffers representing the offices of Representative Tim Murphy, Representative Michael Burgess and Senator Jay Rockefeller engaged in a spirited debate over the merits of the IPAB, a controversial provision of the ACA; its elimination was one of the “asks” that urologists took to the Hill. “IPAB is the death knell for private practice,” one attendee told the panel, cautioning the staffers to think about the IPAB’s unintended consequences that could, ultimately, drive up healthcare costs instead of helping to bring them down.
  • Accountable Care Organizations (ACOs) were a popular topic of discussion as Robert Berenson, MD, and Paul Brower, MD, presented their perspectives. Dr. Berenson, a senior fellow at the Urban Institute and vice-chair of the Medicare Payment Advisory Commission (MedPAC), emphasized potential problems with ACOs and advised physicians to carefully consider whether or not to participate. Dr. Brower, a urologist who practices in Orange County, CA, reported on his experiences in creating a collaborative effort among practices in his region that ultimately served as the foundation of an ACO-like organization. Though there were challenges to building the group, there have also been many benefits; ultimately, this group collaboration was tapped by Dartmouth-Brookings (a team of scholars from Dartmouth University and the Brookings Institution tasked with developing and implementing policy reforms that reduce the growth in healthcare costs and improve the quality of care) as one of the five pilot ACOs in the country.
  • The annual UROPAC luncheon featured Gail Wilensky, PhD, former administrator of the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) under President George H. W. Bush and currently a senior fellow at Project HOPE, an international health foundation. She noted that during all the debate and deliberation about the ACA, “healthcare reform became health insurance reform.” The legislation actually offers very limited delivery system reforms. Cost savings have been highly touted, but “payment reductions do not equal payment reform,” Dr. Wilensky declared. In order to achieve true reform, the physician payment system must be redesigned and there must be evidence-based liability reform.
  • A Congressional staff panel engaged in a lively debate on the SGR. While all agreed that it needed to be fixed, the challenge is finding the funding to do so. This led to a discussion about the budget and how Medicare spending is unsustainable. Again, all agreed on this point but differed on how to reign in this spending. Democratic staff members emphasized the innovation measures in the ACA, such as ACOs and various other payment models. The Republican staffers said that the ACA was an expansion of entitlements that will hurt physicians by increasing the number of patients they need to see (due to Medicaid expansion) while cutting their pay. During the question and answer period, other cost-saving tactics, such as increasing patient cost sharing, were mentioned but were not supported by staff members.
  • The release of the National Urology Research Agenda (NURA) coincided with the JAC and its publication was championed by Johannes Vieweg, MD, AUA Foundation Research Council Chair. The NURA provides the first comprehensive roadmap for urology research by identifying key areas that need to be addressed in order for urology to progress. Dr. Vieweg promoted increased funding for urologic research within federal agencies and the need to strengthen urology research advocacy efforts overall.
  • A reception was held in the shadow of the U.S. Capitol at the popular Charlie Palmer’s Restaurant. Even though both the House of Representatives and Senate were out of session on Monday, several Members of Congress with longstanding ties to the AUA made a point to return to Washington early to attend the JAC reception. Joining AUA members at the lively reception were:
    • Representative Paul C. Broun, MD (R-GA), one of the sponsors of H.R. 2159, the PROSTATE Act
    • Representative Andy Harris, MD (R-MD-1), who recently visited the practice of Peninsula Urology Associates in Salisbury, MD
    • Representative Joe Pitts (R-PA-16), Chair of the House Energy and Commerce Committee’s Subcommittee on Health
    • Senator Jon Tester (D-MT), sponsor of the S. 3775 and S. 1190, the PROSTATE Act, in 2010 and 2011, respectively

On the final day, JAC attendees headed to Capitol Hill to meet with their elected officials. In nearly 200 meetings, urologists advocated for our four “asks.” During lunch in a majestic Senate conference room, Representative Mike Pompeo (R-KS-4), a member of the House Energy and Commerce Committee, which oversees healthcare, spoke with attendees, emphasizing his hopes to see the high cost of healthcare addressed in the 2012 budget.

The AUA will continue advance urology’s four “asks” and monitor other topics of importance to our members. Additionally, there are year-round advocacy opportunities for AUA members. Look for updates and ways to get involved in UroSTAT!, NetNews, the Health Policy Brief and other AUA communications.

The 2012 JAC is scheduled for March 4-6, 2012, and we urge you to attend. Look for more information in December 2011. If you have questions about the JAC, please e-mail GovernmentRelations@AUAnet.org.

For The Record

MGMA Publishes Medical Practice Survey on Electronic Health Records

In April 2011, the Medical Group Management Association (MGMA) published a report titled, Electronic Health Records: Status, Needs and Lessons – 2011 Report Based on 2010 Data.@blurbend According to the MGMA, the study was conducted “to explore the barriers to electronic health records (EHR) adoption and the experiences of healthcare organizations that have progressed through the implementation process and optimized use of their EHRs.”

Supported by a grant from PNC Bank, the study collected data in the fall of 2010 and responses were submitted by more than 4,500 healthcare organizations. Although there were a variety of organizations that responded, almost 60 percent were independent medical practices. Other respondents included hospitals, faculty practice plans, consultants and practice management companies. Among the survey respondents, 52.3 percent stated they used electronic record keeping and 35.8 percent reported paper records. Among those using EHRs, 46.3 percent said that they have completed implementation and are working toward optimizing usage, while slightly over 16 percent indicated they feel they have optimized EHR usage. One interesting result showed that slightly over 8 percent were considering replacing their current EHR system.

Although the study points out that it is not representative of the health profession at large, the data highlights user satisfaction, integration of EHRs and practice management systems, and the intent of respondents to participate in the Meaningful Use Incentive Program (80 percent). Although data was included about practice specialty usage, urology was not among those listed.

Medicare’s Proposed Rule on Accountable Care Organizations Emphasizes EHR Usage

On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) published the proposed rule for the Medicare Shared Savings Program, otherwise known as Accountable Care Organizations (ACOs).

In the overview and introduction to this rule, CMS stated that “the collection of information should minimize the burden on providers to the extent possible. As part of that effort, we will continuously seek to align our measures with the adoption of Meaningful Use standards with health information technology (HIT).” Many of the proposed rule’s required measures are taken directly from the EHR Meaningful Use Incentive Program. The rule goes on to say that ACOs should embrace specific goals. Among the listed goals, the rule states an ACO “will draw upon the best, most advanced models of care, using modern technologies, including telehealth and electronic health records, and other tools to continually reinvent care in the modern age.” It further specifies that over half of the primary care providers in a Medicare approved ACO must be “meaningful EHR users” by the second year of the three-year contractual period.

Please e-mail pracman@AUAnet.org for more information.

Perspectives on the Urology Joint Advocacy Conference: Eugene Rhee, MD, MBA

Following the 2011 Urology Joint Advocacy Conference (JAC), Dr. Rhee, a member of the 2010-2011 AUA Leadership Class, shared the following testimonial about his experience in Washington, DC.

I am sitting on the plane flying from Capitol Hill back to San Diego, California, reflecting on the last four days I have spent at the 2011 Urology Joint Advocacy Conference, in Washington, DC, with other urologists from around the country along with AUA staffers, AUA lobbyists, legislators and their aides.@blurbend

This JAC meeting is urology's sixth consecutive joint gathering and the largest ever convened. I’m frankly proud to be associated with an organization that recognizes the importance of organized political advocacy. I met urologists ranging in scope from solo practice in Indiana to huge group practices in Atlanta, GA. I met private practice doctors, university professors, HMO doctors, physician administrators and even residents.

The winds over the political landscape have shifted and the fight on Capitol Hill over healthcare reform is well underway. Other medical specialty societies have quickly organized and mobilized. The common thread that compelled us all to join together and fly from all over the United States, away from our loved ones and from our jobs, was a need to have our collective urology voices heard within the legislative halls of the newly elected 112th Congress. I can think of no other time where I experienced such a broad cross section of urologists, all determined to make a difference, united in stance to assure our voice is heard.

I got together with my 2010-2011 AUA Leadership class one morning and saw grand possibilities and promise for our organization. As we all gathered for a group photograph, I sensed an invigorated body of people who are hungry to find our individual and collective paths to best contribute to the AUA during a challenging time as a physician. We caught up with one another and exchanged pleasantries. As the day passed, the political agenda started to take shape and by the end of the day, during breaks, many conversations were being had across state lines and across practice patterns, exchanging challenges and successes within our respective practices. It became clearer as to what we were all doing in this hotel beyond a reunion. We heard from the Maryland delegation who fought a long hard battle to protect urology interests and explained the lessons learned from this experience. We heard from a Trustee of the AMA, who discussed Health Information Technologies and what we can expect in the near future. We heard from Congressional leaders from the newly elected 112th Congress who advocate on our behalf, fighting to maintain urology interests. We heard from UROPAC, which now has achieved a major milestone in the political landscape, raising $1 million for the 2010-2011 election cycle and formulating a plan of action as to how this money is being wisely slated. $50K has been raised since January 1, 2011, for the current election cycle.

As the days and nights passed, I grew to understand how critically important it is for the AUA Leadership Class to grasp what the AUA has organized: an opportunity to consistently influence and ensure our future as urologists. As I joined Chris Porter, Daniel Lin, Aaron Milbank and Bill Bohnert (our mentor) at dinner, we all sat with AUA leadership, staffers, and the class itself. I realized, then, that many of us will move on and continue to aspire to become political heavyweights in either local, state, and/or national levels. Our last day of the JAC, we all headed out with our state delegations, and whether they were just one or 10 delegates, the point of the visit to the Hill is to really bend the ear of the front line of legislation. One acutely realizes that there is really no one else who will care to protect urology. The day we descended on to the Hill, radiation oncologists, by chance, were present as well. One urologist in the California delegation was awaiting a meeting, and within earshot could hear the radiation oncologist explaining the turf battle, spinning urology as the opportunist. The urologist met next and elegantly and proficiently explained how this misguided perception hurts the quality and efficiency that urology delivers in this arena. This is influence.

Here are the four points of the urology agenda that the AUA and AACU forcefully advocated, with much emphasis on a goal to find a permanent solution to a broken reimbursement system.

  1. repeal the Independent Payment Advisory Board (IPAB) by supporting the bipartisan House Bill 452
  2. protection of in-office ancillary services
  3. support of the PROSTATE Act 2011
  4. create a national commission on urotrauma

As I sit in my airplane seat, I found three things that will make a difference as a personal commitment to my profession and specialty of urology as a result of the JAC meeting.

  1. Continue to donate to UROPAC—it’s absolutely imperative that the level of giving is over the $1 million mark as a measure of substantive staying power within political arena.
  2. Be actively involved in the state urology organization, AACU and the AUA—it’s another way to either be involved or stay informed as to the onslaught of urology threats that affect the state and nation.
  3. Be politically involved! Write to Congressmen, call them and let them know my concerns.

There are a few of us and a lot of them. Only a firm and diligent organized effort over a period of time, with more than a few devotees who take up the cause will ensure the health of our specialty. I’m proud to be a member of the 2010-2011 AUA Leadership Class.