October 2011
The essential resource for your practice
Volume XXI, Number 10

Meet a Member of Congress: Congressman Edolphus “Ed” Towns (D-NY-10)

Congressman Edolphus “Ed” Towns began his political career when he left his position as an administrator at Beth Israel Hospital to become Brooklyn’s first African American Deputy Borough President in 1978.@blurbend He was elected to Congress in 1982 and began a long and distinguished career in the U.S. House of Representatives. In the previous Congress, he served as chairman of the powerful Committee on Oversight and Government Reform (OGR); he relinquished his opportunity to be its ranking member in order to return to his influential seat on the Energy and Commerce Committee, a seat he has held since 1989. As a member of Energy and Commerce, he serves on the Health Subcommittee, which plays an integral role in the healthcare debate still raging in Congress, especially as Congress looks to reign in overall healthcare spending.

Congressman Towns has been actively engaged in several Congressional caucuses, including: the Congressional Black Caucus, which he chaired in 1991; the Congressional Caribbean Caucus; the Congressional Urban Caucus; the Congressional Mental Health Caucus; and the Congressional Labor and Working Families Caucus. He is currently serving as chair of the Congressional Social Work Caucus, a Congressional member organization he founded in the 111th Congress. The purpose of this group is to create a platform on the Hill for the more than 600,000 social workers throughout the United States who positively impact the lives of the elderly, the disadvantaged, children, veterans and/or other individuals in need of guidance and direction in their lives.

He has been recognized by numerous organizations during his storied political career. In 2010, the AUA and AUA Foundation thanked Representative Towns for sponsoring the Prostate Outreach, Screening, Testing, Access, and Treatment Effectiveness (PROSTATE) Act by presenting him with the 2nd Annual Prostate Cancer Awareness Award.

Q: First, on behalf of the AUA, I would like to thank you for championing the Prostate Outreach, Screening, Testing, Access, and Treatment Effectiveness (PROSTATE) Act of 2011, H.R. 2159. What was it about this bill that piqued your interest?

Towns: Prostate cancer is one of the leading causes of death among men, and there are significant racial and ethnic disparities that demand attention. While there are currently significant resources focused on prostate cancer programs, there needs to be coordination across the federal agencies that are receiving these funds. This coordination would serve to improve accountability and actively encourage the translation of research into practice. Additionally, this coordination would serve to identify and implement best practices in order to foster an integrated and monolithic focus on effective prevention, diagnosis and treatment of this disease. The PROSTATE Act is a step in the right direction to coordinate the important work that is being done in the battle to end prostate cancer.

Q: Was it important that this bill be a bi-partisan effort?

Towns: This is an extremely important issue. This is not a Democratic issue or a Republican issue. This is a men’s issue. In this current political climate, I believe that there needs to be an example of unity and cooperation in the House.

Q: Why is prostate cancer such an important issue to you?

Towns: This is such an important issue to me because I, just as many other Americans, have had friends and family members affected by this horrible disease.

Q: With all of the information available about prostate cancer and the need to be tested, especially for African American men, why is the message still not getting out? And what can we do to change this?

Towns: Though there is a copious amount of information about prostate cancer and the need to be tested, the mortality rate for this disease is still far too high—especially in the African American, rural and certain veteran populations ... We need to do all that we can to ensure that men, particularly those who have a higher risk of developing the disease, are screened and treated at the earliest possible stages.

Q: In parting, is there one thing you would like to say to our members?

Towns: Let’s work together to ensure that we can pass this important piece of legislation. Please call or write to your Members of Congress and ask that they contact my office to sign on as co-sponsors to this bill.

Click here to view the list of sponsors and contact your Senators.

Click here to view the list of sponsors and contact your Representative.

Table of Contents

  

Coding Corner:

ABNs and Modifiers

UROPAC: Building on Success and a Renewed Energy for the Future

Steven M. Schlossberg, MD, MBA, AUA Health Policy Chair

In the 2009-2010 election cycle, UROPAC raised more than $1 million, making it the 10th largest physician specialty political action committee (PAC). Our 2011-2012 goal is to build on this success and focus our efforts to become even more successful moving forward.@blurbend

What is UROPAC? It is the only PAC dedicated exclusively to advancing the public policy interests of urology. As a voluntary, non-partisan PAC, UROPAC organizes urologists, residents and students who share an interest in electing and retaining pro-urology candidates in Congress. UROPAC is co-sponsored by the AUA and the American Association of Clinical Urologists (AACU).

In the 2009-2010 election cycle, UROPAC:

  • Advocated actively for the maintenance of the in-office ancillary exception (IOAE) by thwarting an attempt to remove advanced diagnostic imaging from the in-office ancillary exception to the Stark Law that some lawmakers were trying to include in the Affordable Care Act (ACA).
  • Ensured that ultrasound was not categorized as advanced imaging and thus, was not included in the ACA’s increased utilization rate of 75 percent, and successfully fought back against adoption of MedPAC’s originally proposed utilization rate of 90 percent.
  • Lobbied for the introduction of the newly-crafted Prostate Outreach, Screening, Testing, Access, and Treatment Effectiveness (PROSTATE) Act last year in the 111th Congress, which will help establish urology as a leader in prostate cancer. UROPAC assisted staff to obtain firm commitments from Members of Congress to reintroduce in the new 112th Congress.
  • Aided with the introduction in both the 111th and 112th Congresses of a bill to create a National Commission on Urotrauma to conduct a study on urotrauma and make recommendations on how to better treat and prevent such injuries. A portion of this language was included in the House report language on the National Defense Authorization Act and will be addressed by the Department of Defense in 2011.
  • Helped garner champions in both the House and the Senate that we can call upon when new threats emerge.

The fight for healthcare reform continues. As the 112th Congress and the Administration begin implementation of provisions in the ACA, UROPAC, the only PAC dedicated to promoting and protecting the interests of urologic patients and urology, will need to ensure that the interests of the profession and its ability to provide high quality care to patients are protected.

We will advocate strongly for revisions to some of the more troubling provisions included in the ACA, such as the Independent Payment Advisory Board (IPAB), and address some of the significant issues that were missing from the bill, such as the Sustainable Growth Rate (SGR) and medical liability reform.

UROPAC has adopted a revised giving strategy that we hope will allow us to focus our efforts more effectively. We will devote 70 percent of UROPAC federal funds to a slate that targets key leadership and committees with healthcare jurisdiction to develop champions on our issues. The remaining 30 percent of UROPAC federal funds will be reserved for contributions to other Members and candidates on an “as requested” basis.

Gary M. Kirsh, MD, Chair, UROPAC
Lawrence W. Jones, MD, Vice Chair, UROPAC

The UROPAC executive committee, composed of leaders from both the AUA and the AACU, has identified the top legislative concerns facing urology today and divided them into three categories:

  • Priorities where urology is the lead
  • Core priorities of organized medicine where urology works with coalition partners
  • Areas that require monitoring

Urology as lead:

  • Protection of the in‐office ancillary exception (IOAE) to the Stark Physician Self‐Referral Law
  • Promotion of the PROSTATE Act
  • Promotion of the bill to create a Commission on Urotrauma
  • Regulatory issues specific to urology (e.g., practice expense, restrictions on ultrasound)

Urology working with coalition partners:

  • Permanent fix to the SGR
  • Repeal/modification of the IPAB
  • General regulatory issues, such as the elimination of consultation codes and the Relative Value Scale Update Committee (RUC)
  • Quality measure development and implementation
  • Medical liability reform

Urology will continue to monitor:

  • Health information technology/Meaningful Use
  • New payment systems (e.g., accountable care organizations [ACOs], bundling, value-based purchasing)

The UROPAC leadership is committed to advocating for our profession at both the federal and state level. We will work with all Members of Congress to ensure that our interests and those of our patients are protected. Moving forward in this new Congressional cycle, UROPAC will pay close attention to these issues and support those Members of Congress that support them.

It is critical that those who have supported UROPAC continue to do so and others begin to do so. Our presence in Washington advocating for our patients and specialty has never be more important than in this time of dwindling resources and rapid change. In Washington, although achieving the $1 million status is noticed, losing it may be even more noticeable. We encourage you to visit the UROPAC* Web site (www.UROPAC.org) to understand how you can support these efforts. Please feel free to contact any of us at GovernmentRelations@AUAnet.org with questions or comments.

*UROPAC is a separate segregated fund co-sponsored by the American Association of Clinical Urologists, Inc. and the American Urological Association, Inc. UROPAC will not solicit contributions from foreign nationals or individuals who are not members of AUA or AACU. Contributions from foreign nationals and individuals who are not members of AUA or AACU are prohibited.

For The Record

Scanning Old Records into Your New EHR System
Recent discussions on the AUA Practice Managers’ Network Q&A Forum about scanning records into a new electronic health record (EHR) system pointed out that urologists who are starting the conversion to EHRs can learn lessons from their more experienced peers.@blurbend One of the common transition challenges is how to access the patient records created prior to “going live.” Most practices scan copies of past office notes, radiology reports, clinical lab results, etc.

In order to be as efficient as possible when accessing this historical data during future visits, it is essential to arrange these scanned images in a consistent and organized fashion so that all providers know exactly where to look to find the data they need. Some practices made the mistake of simply taking paperwork out of the patient’s chart and scanning it all into an “old chart” file. However, even in paper charts, the documents stored were often subdivided into different categories; without subdividing the scanned information, finding a necessary bit of information became extremely time-consuming.

Most urology managers who have survived the transition recommend that the providers and managers discuss the transition of old records and develop a protocol before the first document is scanned. One manager on the Q&A Forum shared some good advice:

I don't know if you can name your own tabs (we can do this in our system), but we named tabs ‘old chart lab reports,’ ‘old chart path reports,’ etc. This helped us differentiate them from any reports done after starting on EHR. Any paper documents received from outside sources that were scanned in after going live were just labeled ‘labs,’ ‘paths,’ etc. Our doctors also decided exactly what they wanted scanned from each chart—otherwise it would have been too much to try to scan every sheet from every chart.”

Another suggestion included working with the providers to identify specific documents from each paper chart they felt should be scanned. This review took place during the first patient visit following the “go-live” date and the designated documents were then scanned into the proper sub-division in the electronic chart. From that point on, that individual patient’s paper record was rarely ever requested again.

AMA Provides Online HIT Education
For those urologists who have seen some of their colleagues collect the first installment of the Medicare incentive bonuses for use of EHR and are thinking that the time is finally here to take the leap, there is some free education available on the American Medical Association’s (AMA) Web site. Click here to access.

This online training is composed of the following six short video modules:

  • Overview of Health Information Technology
  • Practice Needs Assessment
  • EHR Selection Considerations
  • Implementation Planning and Preparation
  • Implementation
  • Post Implementation

The education was launched in April 2011 and will continue until 2014. By completing all six modules and taking the post-test, urologists can also earn 1.5 hours of AMA PRA Category I Credits™.

Medicare Continues to Work to Align EHR Direct Reporting for All Incentive Categories
In the 2012 Medicare Physician Fee Schedule proposed rule, it is clear that Medicare will continue to let providers report on various programs by using their EHR system. Among the programs offering financial incentives for participation are the Physician Quality Reporting System (PQRS), the Electronic Prescribing (ERx) program, and quality measure reporting under the Meaningful Use (MU) program.

For 2012, the Centers for Medicare & Medicaid Services (CMS) has proposed that providers can report PQRS measures either directly from their EHR or by contracting with a “qualified EHR data submission vendor.” To direct report, one must use one of the vendors qualified for the 2012 PQRS noted on CMS’ list. These are not to be confused with EHR systems that are certified for MU. CMS explains in the proposed rule, “We are currently exploring ways to further align these two programs' reporting requirements for future years so that Certified EHR Technology may be used to satisfy both the Medicare EHR Incentive Program and the Physician Quality Reporting System without any additional testing. For 2012, we propose to modify the current list of EHR vendors qualified under the Physician Quality Reporting System to indicate which of the qualified vendors' products have also received a certification for the purposes of the EHR Incentive Programs.”

Alternatively, CMS proposes that a provider using an EHR that is not qualified for direct reporting of PQRS may decide to contract with a vendor within the framework of a Health Insurance Portability and Accountability Act (HIPAA) Business Associate contract to “provide for the EHR data submission vendor's receipt of beneficiary-specific data from the eligible professional and the EHR data submission vendor's disclosure of the beneficiary-specific data on behalf of the eligible professional to CMS.” The proposed addition of EHR data submission vendors will require prospective vendors to self-nominate their systems and submit test files to CMS to prove their format and data transmission processes are accurate. If this proposal is approved in the Medicare Physician Fee Schedule final rule in November 2011, it remains to be seen how many vendors will apply for this reporting arrangement and to what extent this will expand opportunities for providers using EHRs to report for PQRS in 2012 and 2013.

CMS is also proposing to allow those EHR vendors who are certified under the MU program to be considered qualified submitters of electronic prescriptions for the ERx incentive, as well. The intent is to reduce the investment in multiple technologies to meet requirements in the different programs. In addition, the reporting of the measure that defines successful electronic prescribing will also be reportable through qualified EHR vendors.

Click here for a list of the vendors currently qualified for reporting PQRS directly from a qualified EHR and/or reporting ERx directly from a qualified EHR. We expect if the data submission vendor concept is approved in the final rule, another list will be published on the CMS Web site in the future.

For more information, please e-mail pracman@AUAnet.org.

PROSTATE Act Gains Momentum

On September 15, 2011, the Congressional Tri-Caucus (Congressional Black Caucus, Congressional Hispanic Caucus and Congressional Asian Pacific American Caucus) introduced H.R. 2954, the Health Equity and Accountability Act of 2011. This is a comprehensive bill on minority health. The AUA is excited to announce that the PROSTATE Act, in its entirety, was inserted into this bill as Section 702. Click here to read the bill.

The AUA will closely monitor this legislation. Look for updates in the Health Policy Brief, as well as other AUA publications.@blurbend