December 11, 2013
For the past year, the AUA has been working through its health policy committees to advocate for your legislative priorities to repeal the sustainable growth rate (SGR). Our recent efforts have focused on communications with the House Ways and Means and the Senate Finance Committees who are marking up draft legislation this week. The legislation originated as a discussion draft that the two committees provided to the medical stakeholders on October 31. The committees then provided an updated draft on December 11 that incorporated some changes based on comments provided by the AUA and other medical groups.
While the proposal includes many positive elements we support, it calls for a 10-year freeze to Medicare physician payments. Further, it would financially reward physicians for hitting specific quality targets, but finance those payments by cutting other physicians' pay. For these reasons, the AUA was unable to fully support the joint effort of the Senate Finance and the House Ways and Means Committees in its current form. In addition, the AUA joined the American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Ophthalmology, American Association of Neurological Surgeons, Congress of Neurological Surgeons, American College of Osteopathic Surgeons, American Osteopathic Academy of Orthopedics, American Society of Cataract & Refractive Surgery, American Society of Metabolic and Bariatric Surgeons, American Society of Plastic Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), The American Society of Breast Surgeons, The Society of Thoracic Surgeons, and Society for Vascular Surgery in signing an American College of Surgeons (ACS) authored letter to the Senate Finance and the House Ways and Means Committees stating this position and requesting they postpone the scheduled committee markups of the proposal. This partnership ensures that Congress understands that surgery is speaking with one voice and increases the chances that we will be heard.
Given the importance of the issue to our members and the need to respond to the committees in a time-sensitive manner, our decision to send these letters went through a comprehensive review process that included input throughout the year from the chairs and vice chairs of the AUA Health Policy Council; the Legislative Affairs, Coding & Reimbursement and Quality Improvement and Patient Safety committees; as well as the AUA Relative Value Update Committee (RUC) members and advisors and their alternates, and Data Committee chair. Our legislative priorities were reviewed and weighed against the sections of the bills that AUA either had no position on or did not support.
Although we feel the strengths of the bill overall make it favorable for physicians and supports the elimination of the SGR formula, we believe the repeal of the SGR with a 10-year freeze is an unsustainable business model. Both the AUA and ACS comment letters to Congress stated that the freeze does not keep pace with the cost of providing care or provide physicians the ability to invest in the infrastructure necessary to transition to the new system. Both letters also maintain that physicians should be eligible to receive annual inflationary updates.
Since issuance of the letters, the Chairman of the House Ways and Means committee, Rep. Dave Camp (R-MI-4), has submitted an amendment to the draft that would allow for a 0.5 percent increase for the first three years, and then maintain reimbursement levels until 2023. This shows a commitment by the Chairman to work with medicine to resolve this and other issues. The AUA and others are considering a letter to the Committee on Ways and Means stating appreciation for the good faith effort taken to addresses some of our concerns and movement toward providing more stability for surgeons and the surgical patient.
As we go forward, the AUA will continue to work with our colleagues and legislators to protect our ability to provide the highest quality urological care possible and will continue to advocate on behalf of you and your patients.
Read the November 12, 2013 AUA letter here.
November 19, 2013
On November 12, the AUA submitted detailed comments to the Senate Finance and House Ways & Means committees in response to their bicameral, bipartisan discussion draft of a proposal to permanently repeal the sustainable growth rate (SGR) formula and reform the Medicare physician payment system. The proposal would freeze existing fee schedule rates for the next 10 years and create two payment tracks for physicians and other health care providers currently paid under the physician fee schedule: 1) value-based performance (VBP) program; and 2) alternative payment model (APM). The draft, which was released on October 30, does not include any potential offsets for the $139 billion cost to repeal the SGR, nor does it include other Medicare extenders that may be part of the final package.
The AUA's comments reiterated our position on several of the proposed policy changes impacting quality and valuation of physician services. The AUA has long advocated for repeal of the SGR; however, a 10-year freeze is a serious concern, given that fee schedule payments already have trailed inflation for nearly a decade. Extending current payment levels for 10 more years would result in a nearly 45 percent cumulative gap between the actual cost to treat Medicare patients, rising practice expense and the cost of inflation.
Under the VBP, physicians would continue to be paid under the physician fee schedule, but penalties and payment incentives under existing quality, resource use and electronic health record programs would be combined. Starting in 2017, fee schedule payments would be adjusted based on a single, budget-neutral incentive payment program centered on quality, resource use, clinical practice improvement activities, and EHR meaningful use. The payment pool for the VBP would be 8 percent of total estimated spending for eligible professionals. In 2018, the payment pool would increase to 9 percent and to 10 percent in 2019. On the contrary, providers that participate in APMs would be exempt from the VBP program and eligible for a 5 percent annual bonus from 2016 to 2021. The APMs involve two-sided financial risk with various revenue percentage thresholds that providers must earn to qualify for the bonus. The proposal also encourages testing of APMs for specialty providers and those that align with private and state-based payer initiatives.
The AUA supports testing of APM for specialists and welcomes the proposal to align Medicare payment initiatives with private payer initiatives. Physicians are already so overburdened with reporting requirements; reducing time spent collecting data is critically important in ensuring widespread participation in the VBP program.
In addition, the proposal would set a one percent target for misvalued services over a three-year period. If the target is not met, fee schedule payments would be reduced by the difference between the target and the amount of misvalued services identified that year. Selected physicians would be required to submit data. Participation for data submission would be compensated; however, physicians that refuse to comply would face a 10 percent payment reduction. The proposal also calls for a study of the AMA/Specialty Society Relative Value Scale Update Committee (RUC) process for making recommendations on valuation of physician services and would adjust surgical procedures by 20 percent over a two year period if the number and type of post-op visits are found to be misaligned.
The AUA comments reiterated support of the RUC as the most effective process to establish valuation of physician services, and adamantly opposed establishment of the proposed 1 percent expenditure target for identifying misvalued services, the 10 percent penalty for not providing information, and the 20 percent reduction phase-in for surgical procedures.
With the federal debt deal in place through the early part of next year, the AUA has been working closely with the American College of Surgeons through the Surgical Coalition on a congressional sign-on letter to repeal the SGR. The bipartisan effort was led by Representatives Bill Flores (R-TX) and Dan Maffei (D-NY). The AUA played an active role in securing signatures for this sign-on letter, which now has more than 200 supporters.
"We should not pass up this chance to repeal the SGR...and enact a permanent solution," the letter urges. "This year represents a great opportunity to repeal the flawed SGR formula, reform health care delivery to drive quality and efficiency, and set Medicare on a more stable and predictable course for current and future generations of patients and physicians." The AUA will continue to monitor progress on this critical issue and advocate for repeal and replacement of the SGR with members of Congress.
November 19, 2013
The Medicaid and Children's Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) met on November 14-15, 2013. The MACPAC, established in the CHIP Reauthorization Act of 2009 and later expanded and funded through the Affordable Care Act (ACA), is tasked with reviewing state and federal Medicaid and CHIP access and payment policies and making recommendations to Congress, the Secretary of Health and Human Services (HHS), and the states on a wide range of issues affecting Medicaid and CHIP populations, including health care reform.
AUA staff attended the meeting and is closely monitoring the MACPAC's policy decisions and recommendations to determine if expansion of the Medicaid program will impact patient access to health care services and reimbursement for physician services.
Starting January 1, 2014, many states will expand Medicaid to previously ineligible non-elderly adults. At the same time, the Market place (formerly referred to as state health insurance Exchanges) will become operational. The Commission discussed ACA policy implications on Medicaid enrollment [churning and Transitional Medical Assistance (TMA)].
Churning, the transition from one health plan or system to another, interrupts continuity of coverage and care, and makes programs more complicated and costly to administer. While churning already occurs in the Medicaid and CHIP programs, the ACA's Medicaid expansion and subsidized coverage through state Exchanges is estimated to expand its scope. To limit the number of beneficiaries liable to churn from Medicaid to a state Exchange due to household income changes throughout the year, the Commission agreed to reiterate its March 2013 recommendation to Congress to extend existing Medicaid policy for children that allows for 12-months of continuous eligibility to adults.
The transitional medical assistance (TMA) program, created to help families that had been on Medicaid but whose circumstances changed, provides funding for states to keep families on Medicaid for at least six months and up to 12 months. The MACPAC restated its recommendation to Congress for permanent funding of the TMA program and allow states that implement expansion to the adult group to opt out of TMA to reduce the harmful effect of churning and administrative burden across programs.
The Commission will meet again next month to discuss other policy implications of the ACA. The AUA will continue to monitor and report on the Commission's activities as states ramp up implementation of the ACA.
November 6, 2013
The American Urological Association (AUA) has released a new version of its Guidelines-At-A-Glance app; one specifically targeted to primary care providers. Much like the Guidelines-At-A-Glance for urologists, this new version contains essential information from many AUA guidelines and best practice statements, but summarized and formatted explicitly for primary care clinicians. "This app is simple to access, easy to navigate and very useful to the busy clinician," said Dr. Stuart Wolf, AUA Practice Guidelines Committee Chair. "It accurately and succinctly presents the AUA practice guidelines in a way that really helps the practicing physician provide optimal patient care."
The development of the summaries was coordinated mainly by primary care clinicians, and reviewed by the original panel chairs. The evidence-based documents from which the summaries are derived were developed by multidisciplinary panels of leading physicians and other health experts, and underwent extensive peer review prior to publication. The content of these guidelines and best practice statements is reviewed every one to three years, depending on the topic, to ensure timeliness and accuracy.
November 4, 2013
The AUA Office of Research is now accepting nominations for young investigators to attend the first AUA Early Career Investigators Workshop of 2014. The deadline for nomination packages has been extended through Friday, November, 15, 2013. The workshop, a "Urology Research Toolbox for Success," will be held January 10-12, 2014, at the AUA Headquarters in Linthicum, Maryland. The goal of this workshop is to motivate and support young scientists and urologists by providing an outstanding mentoring/career development/scientific program presented by leaders in the field. The meeting agenda is designed to provide information necessary to foster career success and to provide attendees with a solid foundation for successful grant writing. A maximum of 20 attendees will be selected to attend this meeting.
Nominations must be received no later than Friday, November 15, 2013. Learn more!
October 30, 2013
It is no surprise as a result of the government shutdown; the Centers for Medicare & Medicaid Services (CMS) have encountered a delay in promulgating the final rule for the Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems.
The final rules are typically released around November 1 for January 1 implementation; however, the lapse in federal appropriations caused staff shortages, which limited the agency's ability to publish the regulations as scheduled. As a result, CMS recently announced the final rules will now be issued on or before November 27. Despite the delay, the rules will likely take effect on January 1, 2014, allowing Medicare contractors and participating providers approximately one month to make necessary changes in coding and billing systems.
Delay of the final rules is not expected to affect recent legislative efforts to repeal and replace the sustainable growth rate (SGR) formula with a permanent solution before the end of the year. Lawmakers are closer now to replacing the SGR than ever before, in part because of the lower price to repeal the formula. With congressional budget negotiations underway, the prospect for SGR repeal this year is possible, as part of a larger Medicare entitlement reform. Without a permanent legislative solution by December 31, physicians will face a 24.4 percent across-the-board cut in payment rates on January 1, unless Congress acts to avert it with another temporary patch.
AUA will notify members of final publication and analyses of the rules as soon as they are released. In the meantime, practices should prepare for the likelihood of having to notify their Medicare patients scheduled for December about a possible delay in claims processing, which may result in the patient's share of the bill arriving later than usual.
October 23, 2013
The American Urological Association (AUA) is committed to ensuring the delivery of appropriate, high-quality healthcare to men with prostate cancer and welcomes the opportunity to discuss these issues in a constructive manner. Unfortunately, given its inherent biases and flawed methodologies, Dr. Mitchell's article does not contribute to the discourse. Specifically, there are serious concerns about the author's selection of control groups that may not be representative of general practice trends. Prior studies using the SEER database (the data source considered most reflective of the United States as it includes roughly 25 percent of the U.S. population affected with cancer) have shown significant declines in the use of brachytherapy in the United States during the same time period, yet Dr. Mitchell's control groups fail to show any decline in brachytherapy usei. As the methods used to select the control groups are poorly described, one cannot help but wonder whether Dr. Mitchell chose the control groups to arrive at results that were acceptable to the study's sponsors.
Limitations of the current study aside, the AUA supports initiatives that benefit patients by providing coordinated, continuous care and management of urologic disease, including IMRT. Earlier this year, the AUA Board of Directors adopted a set of guiding principles for in-office ancillary services to help guide its members. We believe that provision of ancillary services, such as IMRT, should be transparent and in the patient's best interest, with all treatment advice or referrals based on objective, medically acceptable and supported recommendations. Patients should be reassured that their urologic care will not be disrupted or penalized if they seek an alternate physician supplier or provider of IMRT.
In its June 2011 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended against limiting the Stark law exception for ancillary services, citing potential "unintended consequences, such as inhibiting the development of organizations that integrate and coordinate care within a physician practice." The General Accountability Office (GAO) recently issued a series of reports on self-referral and flatly rejected the recommendation to limit the Stark exception.
As a leading advocate for the specialty of urology, the AUA is committed to advancing research that will improve quality of care for patients with urologic disease. The AUA is developing a quality registry, AQUA, that is designed to provide data to help identify trends in the diagnosis and treatment of prostate cancer and eventual outcomes related to treatment options. The registry will be launched in 2014.
i Mahmood, U.; Pugh, T.; Frank, S.; et al. "Declining use of brachytherapy for the treatment of prostate cancer." Brachytherapy. In press (http://dx.doi.org/10.1016/j.brachy.2013.08.005).
October 23, 2013
As part of its ongoing commitment to improving the quality of care for patients with urologic disease, the AUA today announced it is developing the AUA Quality (AQUA) Registry. This is the first national level urologic registry on healthcare quality and patient outcomes and is designed to provide data to help identify trends in the diagnosis and treatment of prostate cancer and eventual outcomes related to treatment options. The registry will be launched in 2014.
October 17, 2013
Today, the federal government officially reopened for business after President Obama signed a bipartisan short-term measure that funds government operations through January 15. The measure also postpones the debt ceiling decision until February 7. One question that the AUA and other leading medical groups are asking following this government shutdown is, "Is repeal of the sustainable growth rate (SGR) formula still possible in time to prevent payment cuts in January?"
According to some political pundits around Capitol Hill, the issue of SGR repeal may be in a precarious position as Congress rebounds after the 16 days of shutdown. Many are pessimistic that activity will take place in time to prevent the 24.4 percent cut scheduled to take place starting January 1. Some, however, believe that even if reform doesn't occur prior to January 1, it is still possible that physicians could see relief in the coming year.
Billy Wynne, a partner at DC-based Thorn Run Partners told Inside Health Policy that it is more likely that legislation to replace the SGR would move with budget legislation as opposed to a stand-alone bill. "There are 11 business days from Jan. 1-15, so I think [the Centers for Medicare & Medicaid Services] could get away with holding claims until a new fix is passed," he said. Congress also has the option of passing an SGR "patch," as it has done in recent years. Congress' failure to fix an SGR patch before December 31 could result in CMS holding claims. When this occurred in 2010, CMS was forced to hold claims while insurers updated their systems. Later that same year, when Congress worked to pass a mid-year patch, CMS again delayed claims payment for nearly two weeks to allow carriers time to update systems with the new rates.
2013 has been a significant year for advancing SGR reform which, for the first time, has strong bipartisan support that could be a rallying point for lawmakers. The House Energy and Commerce Committee unanimously passed a repeal and replace SGR bill earlier this year and it awaits further action. In earlier talks, House Ways & Means Health Subcommittee Chair Kevin Brady (R-TX) said that combining government funding and debt ceiling measures could present an opportunity to attach legislation regarding the SGR. While the notion was, ultimately, rejected, he said, "If we can come together on a debt ceiling solution, it's not too much for us to permanently fix and replace the SGR." Also of note, the agreement to re-open the government and avoid default included acceptance of a budget resolution (H. Con. Res. 25) that includes language to "permanently reform or replace the Medicare SGR formula." While this language is only advisory, it articulates the desire to address the faulty SGR formula. The conferees have been named and are required to file a conference report by December 13, 2013 which will require further congressional action.
Polsinelli Shughard Senior Policy Advisor Julius Hobson told reporter John Wilkerson that the short-term measure passed by Congress could present another viable opportunity for SGR legislation, pointing out that there are multiple proposals for Medicare reform that could be considered during this process.
"We've been fighting for SGR reform for nearly a decade. 2013 has been a strong year for progress on this issue and we've never had this level of bipartisan support or a solution so closely within our grasp," said AUA Legislative Affairs Committee Chair Jim Ulchaker, MD. "The AUA and the rest of the medical community is going to do everything we can not to let lawmakers take away this opportunity to fix this system."
The AUA will continue to monitor budget discussions and will keep members informed. If you have any questions, please contact us by emailing GovernmentRelations@AUAnet.org.
September 9, 2013
On September 5, the AUA joined other major medical organizations in supporting the American Medical Association's (AMA) comments to the Centers for Medicare & Medicaid Services (CMS) regarding the potential release of Medicare physician data. The comments, while supporting the appropriate use of claims data to "inform and improve" the nation's healthcare system, also call for the agency to partner with physicians to develop policies regarding the sharing of such data. "Our goal," the letter states, "is to promote efforts focused on improving the quality of patient care while safeguarding against potential abuses that could negatively impact healthcare outcomes or diminish the privacy of Medicare physicians and patients."
September 5, 2013
United Healthcare changed its Maximum Frequency per Day reimbursement policy to limit the number of units CPT code 88305 Level IV - Surgical pathology, gross and microscopic examination may be reimbursed. In this policy, United Healthcare specifically states that they will limit reimbursement of 88305 to 6 units. After receiving inquiries on the Practice Management Listserv regarding the limited reimbursement of prostate biopsy specimen examinations, the AUA's Reimbursement and Regulation (R&R) Department immediately contacted the Chief Medical Director of United Healthcare. According to the CMD, as long as documentation supports separately identified specimens, Modifier 59 can be used to report additional billed units. The R&R team noted that not all United Healthcare affiliates are limiting reimbursement to 6 units. Research the appropriate policy by the United Healthcare affiliate in your area to ensure accurate coding, billing and reimbursement. For further questions or concerns regarding this issue, please contact the Reimbursement and Regulation Department at R&R@AUAnet.org.
September 5, 2013
On August 29, 2013, the AUA, together with several medical specialty societies signed on to an American Medical Association (AMA) letter to the Centers of Medicare & Medicaid Services (CMS) urging the agency to withdraw its 2014 Medicare Physician Fee Schedule (PFS) proposal to cap payment rates for 211 physician services at outpatient prospective payment system (OPPS) or ambulatory surgery center (ASC) rates. If adopted, the proposal would reduce payment for some urology services performed in the office setting by 50 percent or more. Payment cuts this steep could potentially drive services out of physician offices altogether.
In a separate comment letter to CMS, the AUA also called for the proposal to be withdrawn, as the underlying premise of the proposal is irreparably flawed. Specifically, CMS ignored fundamental differences in Medicare payment methodologies between the statutorily-required resource-based relative value scale (RBRVS) that is the basis for the PFS, and the ambulatory payment classifications (APCs) used for OPPS and ASC rates. Further analysis of the proposal found for several of the urology codes subject to the proposed cap, the direct expenses alone (i.e., clinical labor, supplies, and equipment) exceeded CMS' proposed payment rate. Read more about the AUA's comments.
CMS is expected to release the PFS final rule on or about November 1, 2013, with an effective date of January 1, 2014. In the interim, the AUA will continue to work with the AMA and CMS to develop a sensible resolution for facility and non-facility payment inequities.
September 4, 2013
On September 3, 2013 the AUA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the Medicare Physician Fee Schedule for calendar year 2014.
August 29, 2013
The AUA is providing members and other interested parties the opportunity to review and provide comments on the AUA's Urotrauma draft guideline. The final guideline will be completed in the near future after the peer review process is completed. All reviewers must disclose their current industry relationships on the AUA website in order to comply with the AUA's conflict of interest policy, and sign a non-disclosure agreement before being provided a copy of the guideline to review. Information about the draft must be kept confidential until after publication of the guideline on the AUA website.
Interested reviewers should send an email with their name, address and email address to guidelines@AUAnet.org. AUA members should include their AUA ID#s. Non-members will receive an AUA ID# so they can disclose their industry relationships on the AUA website and submit a signed copy of the non-disclosure agreement.
August 26, 2013
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Helpful tips as well as downloadable resources are available through the webinar replay. Don't miss out on the opportunity to be a part of the #Conversation!
August 13, 2013
The deadline for the 2014 Research Scholars Program has been extended. Applicants do not need to submit a Letter of Intent. The EXTENDED deadline for submitting applications for the 2014 Urology Care Foundation Research Scholars Program is 5 p.m. LOCAL time (based on the location of the Applicant) on Monday, September 2, 2013.
The oldest and most prolific funding program of the Urology Care Foundation, the Research Scholars Program has supported more than 525 MDs and PhDs in 1- or 2-year research fellowships. Many remain in academic urology today, continuing to build upon the base of experience and knowledge gained during their research fellowships. One- and two-year awards are available for eligible MD and PhD researchers interested in pursuing careers in urologic research. Recipients receive $40,000 annually and the sponsoring institution provides matching funds.
There are currently at least 12 awards available for 2014 fellowships. Among those we have specifically targeted funding for three areas: neurourology, prostate cancer, and kidney cancer. The Allergan Foundation has provided funding for two, two-year awards for research in neurotoxins or areas associated with neurourology. The Robert J. Krane, MD Research Scholar Fund provides support for a one-year award for research on erectile dysfunction, prostate cancer or male incontinence. The Kidney Cancer Association provides support for a one-year fellowship in areas related to kidney cancer.
August 1, 2013
On August 1, the Government Accountability Office (GAO) released a new report on the relationship between ownership and the use of intensity-modulated radiation therapy (IMRT). In its report, the GAO recommends that Congress should consider directing the Secretary of Health and Human Services (HHS), whose agency oversees the Centers for Medicare & Medicaid Services (CMS), to require providers to disclose their financial interests in IMRT to their patients.
The GAO also recommends that CMS identify and monitor self-referral of IMRT services. HHS disagreed with the GAO's recommendation. Given the magnitude of the GAO's findings, the GAO maintains CMS should identify and monitor self-referral of IMRT services.
The AUA, the Large Urology Group Practice Association and the American Association of Clinical Urologists have issued a joint response to the report. Learn more.
August 1, 2013
On July 31, the House Energy & Commerce Committee voted 51 to 0 in favor of H.R. 2810, the Medicare Patient Access and Quality Improvement Act of 2013. The bill, authored by Rep. Michael Burgess, MD, replaces the sustainable growth rate (SGR) formula with a 0.5 percent payment increase for physicians from 2014 through 2018. Additionally, the legislation supports fee-for-service (FFS) but calls for the formation of new payment models and quality reporting. The bill will now move to the floor for a full vote by the House of Representatives. H.R. 2810 is just one of multiple bipartisan proposals for SGR reform currently being vetted by key Congressional committees. The House Ways and Means and Senate Finance committees have also been working to develop similar bills.
The AUA, along with other physician groups and the Alliance of Specialty Medicine, has been actively engaged with lawmakers in the development of these pieces of legislation, providing feedback and comments to key leaders. The AUA is largely in support of H.R. 2810 as passed on July 31, although there are elements of it that we do not like and are working to have removed. Specifically, the bill contains a penalty for those who either do not meet certain quality measures within Fee-for-Service Medicare or chose not to participate in the FFS quality reporting program. The AUA will continue to work with lawmakers as the bill moves forward.
Lawmakers are enthusiastic on progress to develop a replacement for the much maligned SGR, and to develop a permanent "doc fix."
"For years, repealing and replacing SGR has been a top priority for lawmakers and stakeholders. Yet no meaningful progress has ever been made - until now," Committee Chair Fred Upton (R-MI-06) said in his opening statement. "We have been deliberate in ensuring the medical community finally has a voice in this process."
As Congress moves into its August recess, AUA members are urged to contact their lawmakers to discuss the importance of SGR reform/repeal and how it affects their constituents. For more information on how to meet with your lawmakers, contact the AUA at GovernmentRelations@AUAnet.org.
August 1, 2013
The American Urological Association (AUA) is now accepting applications for the 2014-2015 Gallagher Health Policy Scholar program. Since 2007, the AUA has offered urologists a unique opportunity to explore policy issues that impact urology through the one-year Gallagher Health Policy Scholar program. Applicants must be AUA member urologists who have demonstrated a commitment to or have a keen interest in the field of health policy and who are dedicated to advancing urology's health policy agenda. Scholars will spend up to 30 days away from their practice for intensive training on a wide range of health policy issues. Training includes mentoring from seasoned physician volunteers, participation in key meetings and conferences, and study of selected didactic articles. A stipend of $15,000 and reimbursement for travel and other expenses will be provided over the course of the year-long program.
Previous Gallagher Scholars are now among some of the AUA's top health policy leaders, and attribute participation in this program as a key step in making the transition into leadership roles. "You really need to know this information to plan for the future of both your practice and urology in general," says David Penson, MD, MPH, current AUA Health Policy Council Chair and 2007-2008 Gallagher Health Policy Scholar.
Apply today! All applications and required materials must be received by Friday, October 18, 2013. Gallagher Health Policy Scholar program applicants will be notified of the 2014-2015 Gallagher Health Policy Scholar selection by December 6, 2013. For more information, email csaunders@AUAnet.org.
August 1, 2013
The Centers for Medicare & Medicaid Services announced its release of new mobile applications to help providers and industry representatives track financial relationships. The release of the app comes less than a month before industry will begin collecting and reporting payments and other transfers of value to providers. Reporting will begin in August 2013. Not sure what you need to know about the National Physician Payment Transparency Program? Learn more from the AUA.
July 26, 2013
The Urology Care Foundation is now accepting applications for the 2014 Research Scholars Program. The oldest and most prolific funding program of the Urology Care Foundation, the Research Scholars program has supported more than 525 MDs and PhDs in 1- or 2-year research fellowships. Many remain in academic urology today, continuing to build upon the base of experience and knowledge gained during their research fellowships. One- and two-year awards are available for eligible MD and PhD researchers interested in pursuing careers in urologic research. Recipients receive $40,000 annually and the sponsoring institution provides matching funds.
There are currently at least 12 awards available for 2014 fellowships, including funding specifically in the area of neurourology. The Allergan Foundation has provided funding for two, two-year awards for research in neurotoxins or areas associated with neurourology. Additionally, the Robert J. Krane, MD Research Scholar Fund will provide support for a one-year scholarship for an investigator working in the fields of erectile dysfunction, prostate cancer or male incontinence, and we anticipate at least one additional one-year award available specifically in the area of prostate cancer research.
July 23, 2013
On July 22, the Alliance of Specialty Medicine, of which the AUA is a member, submitted feedback on a new Committee print on the sustainable growth rate (SGR) formula released on July 18. While the print includes multiple key elements of import to the Alliance and to specialty physicians, our comment letter brings to the Committee's attention two problematic provisions: one related to mis-valued codes and the other to care coordination and medical homes. The Alliance and the AUA will continue to work with lawmakers to address our concerns and to advocate on specialists' behalf.
July 19, 2013
On Friday, July 19, the House Ways and Means Committee introduced bipartisan proposals for Medicare reform. This draft legislation, which comes after several hearings on Capitol Hill by the Ways and Means Health Subcommittee, outlines three key policies to modernize cost-sharing, including:
The committee is encouraging the public to submit comments on these proposals. The AUA is actively reviewing the legislation and will advocate on behalf of its members and the patients they treat. Additional information will be available in future issues of the AUA Health Policy Brief.
June 27, 2013
Medicare cost-savings through elimination of the in-office ancillary exception (IOAE) has been a topic of conversation on Capitol Hill in recent weeks. Protecting a physician's relationship with their patients is at the top of the AUA legislative agenda, and the association is actively working with lawmakers to protect a physician's right to personally provide these services to patients.
Most recently, on June 24, the AUA joined physician members of Congress, the GOP Doctors Caucus and other specialty groups in urging members of Congress to preserve the exception.
The AUA is actively monitoring these ongoing threats to the IOAE and will continue to keep our members posted on developments.
June 21, 2013
The American Medical Association voted Tuesday to support Genitourinary Treatment and Research for active duty members of the armed forces and veterans.
The nation's leading physician's organization took the vote after hearing testimony from urology caucus members on the issue.
"We were successful in securing the support of the AMA House of Delegates this week," said Dr. Jeffrey Kaufman, an American Urological Association Board member and member of the urology caucus. "It takes a coalition to translate policy into action and the coordinated effort by urologists in the AMA House of Delegates is vital to protecting and furthering our interests."
Tuesday's vote adds pressure on Congress to pass legislation that would ensure that our servicemen and women receive the best possible surgical and mental health care. Currently, genitourinary organ injuries (urotrauma) account for up to 10 percent of battlefield injuries.
The resolution was drafted and co-sponsored by the AUA, the American Association of Clinical Urologists, and the American Congress of Obstetricians and Gynecologists. The American Psychological Association, military urologists and medical students rose to support passage during the meeting.
June 19, 2013
Medicare payment differences across sites of care, competitively determined plan contributions (CPC), payment bundling for post-acute care services and refinements to Medicare hospital admissions reduction program and a review of the Centers for Medicare & Medicaid Services' estimate of 2014 for physician and professional services are key topics of the Medicare Payment Advisory Commission (MedPAC) June 2013 report to Congress. The report, entitled "Medicare and the Health Care Delivery System" was released on June 14.
The report focuses on a variety of payment system issues within the Medicare program and reaffirms the Commission's support of sustainable growth rate (SGR) repeal. The report also includes three chapters mandated by Congress in the Middle Class Tax Relief and Job Creation Act of 2012: a chapter on Medicare ambulance add-on payments, a chapter on geographic adjustment of fee schedule payments for the work effort of physicians and other health professionals; and a chapter on Medicare payment for outpatient therapy services. The AUA is currently reviewing the report and more detailed coverage will be available in an upcoming issue of the Health Policy Brief.
Established by the Balanced Budget Act of 1997, MedPAC is an independent agency charged with advising Congress about issues affecting the Medicare program, including payments to participating health plans and providers in the fee-for-service program, and analyzing access to and quality of care.
June 14, 2013
As a result of recent AUA activity on Capitol Hill around the issue of urotrauma, a new amendment was added to the 2014 National Defense Authorization Act (NDAA), which passed the House of Representatives on June 14. Rep. Brett Guthrie (R-KY-2), the lead sponsor for H.R. 984, the AUA-led urotrauma bill, introduced the amendment at the request of House Armed Services Committee Chair Buck McKeon (R-CA-25). The amendment spotlights urotrauma and calls for the Secretary of Defense and the Secretary of Veterans Affairs to jointly develop and implement by January 1, 2014 a comprehensive policy on improvements to the care, management and transition of recovering service members with urotrauma.
Veteran's Affairs Health Subcommittee chair Representative Michael Burgess, MD, commended the AUA and Dr. Mark Edney for his work on behalf of injured servicemen and women and for bringing this issue to the attention of Congress.
The NDAA will now move to the Senate for review by its Armed Services Committee. The AUA will continue to keep you updated on this important initiative.
June 10, 2013
In a response to lawmakers seeking to clarify how sequestration will affect payments for the delivery of oncology drugs, the Centers for Medicare & Medicaid Services (CMS) has stated that Part B drugs will not be exempted from sequestration cuts. The statement was made in in a letter responding to lawmakers requesting clarification on how sequestration would affect these services.
"We do not believe that we have the authority under the Budget Control Act of 2011 to exempt Medicare payment for Part B drugs," the letter read.
Under Medicare, pre-sequester reimbursement for injectable oncology drugs was paid at 106 percent of the average sales price (ASP), with the extra 6 percent covering the costs to administer the drugs. Under sequestration, Medicare applied a 2 percent reduction in the overall reimbursement (both the drug itself and cost to administer), resulting in a reimbursement of 104.4 percent of the ASP. These reductions in payment went into effect on April 1.
June 10, 2013
The Urology Care Foundation is now accepting applications for the 2014 Research Scholars Program. The oldest and most prolific funding program of the Urology Care Foundation, the Research Scholars program has supported more than 525 MDs and PhDs in 1- or 2-year research fellowships. Many remain in academic urology today, continuing to build upon the base of experience and knowledge gained during their research fellowships. One- and two-year awards are available for eligible MD and PhD researchers interested in pursuing careers in urologic research. Recipients receive $40,000 annually and the sponsoring institution provides matching funds. The deadline for application submission is Friday, August 9th, 2013.
June 10, 2013
Recently the Food and Drug Administration (FDA) issued and then expanded an alert to healthcare providers concerning a lack of sterility assurance of all sterile drug products made and distributed by NuVision Pharmacy of Dallas, TX. This compounding pharmacy produces an array of products including several used for treatment of urologic conditions.
June 4, 2013
On May 23, Reps. Marsha Blackburn (R-TN-7) and John Barrow (D-GA-12), joined by Lee Terry (R-NE-2) and Donna Christensen (D-VI), reintroduced the USPSTF Transparency and Accountability Act (HR2143). The AUA spearheaded the bill's introduction in response to the downgrading of PSA testing to a "D." The bill would strike language added by the Affordable Care Act that directly ties Medicare coverage of a particular preventive service to the grade given by the US Preventative Services Task Force. The bill also would require the USPSTF to include "practicing specialists that treat the specific disease under review," when evaluating the grading of a preventative service. This would expand upon the USPSTF's transparency efforts of allowing the public to comment on draft Research Plans, Evidence Reports, or Recommendation Statements
June 4, 2013
The House Energy and Commerce Subcommittee on Health will hold a hearing on June 5th to review the Committee's draft proposal on Sustainable Growth Rate repeal (SGR). The AUA has worked closely with the committee providing written comments outlining AUA's position and concerns regarding the repeal and replacement of the SGR. AUA's comments include supporting a five-year transition period to any new payment model and harmonizing quality reporting systems such as Physician Quality Reporting System, Electronic Health Records, and Value-Based Payment Modifiers to lessen the burden on physicians. Repeal and replacement of the SGR is a key legislative priority for the AUA and its members, and we will continue to work with the Committee and our coalition members on repeal.
May 22, 2013
On May 21, AUA member urologist Dr. Mark T. Edney testified before the House of Representatives Veterans Affairs Subcommittee on Health about H.R. 984, a bill to establish a task force on urotrauma to focus attention on the treatment of these injuries for servicepersons and veterans.
Additionally, the AUA will co-sponsor a new urotrauma resolution that will be presented to the American Medical Association (AMA) House of Delegates at its June meeting. The resolution supports the AUA's legislative priority to advance urotrauma legislation and resources for veterans and active duty service members. The resolution is also being co-sponsored by the American Association of Clinical Urologists, the American Congress of Obstetricians and Gynecologists and the American Psychological Association.
May 14, 2013
The U.S. House of Representatives Veterans Affairs Subcommittee on Health will hold a special hearing on the AUA-led urotrauma legislation on May 21 in Washington. AUA Legislative Affairs Committee member Dr. Mark Edney, a urologist, veteran of Operation Iraqi Freedom and the AUA's lead advocate on this issue, will deliver both written and oral statements on behalf of the AUA at the hearing.
May 13, 2013
Webcasts from the 2013 AUA Annual Meeting in San Diego are now available online for viewing. Also available are segments from this year's AUA-TV program, which aired daily in select meeting hotels and in the San Diego Convention Center throughout the meeting.
May 6, 2013
On Friday, May 3, the AUA released a new clinical guideline on the Early Detection of Prostate Cancer. The new guideline has been in development for nearly two years and was peer reviewed by more than 50 AUA members prior to being approved by the AUA's Board of Directors. While much of the media coverage concerning the guidelines has been accurate, some outlets have mistakenly stated that the AUA has changed its position and is now recommending against prostate cancer screening in all men at risk for this common disease. In fact, this is not at all what the guidelines state. Compared to our 2009 best practice policy document, the guidelines do narrow the age range in which informed decision making around PSA screening should be offered to men at average risk for prostate cancer, but they do not make a blanket statement against screening, as some have implied. Importantly, the guidelines only apply to men at average risk. The guidelines do not apply to symptomatic men or those at high risk for disease (men with a family history or of African-American race), who are encouraged to discuss their individual case with their doctor, regardless of their age.
Acknowledging this, there are some changes that have been made to the guidelines in response to recent new studies on screening. Specifically, in men age 40-54 at average risk for the disease, the guidelines recommend that screening, as a routine practice, should not be encouraged. Simply put, the evidence for the benefit for screening in this age range was limited while the quality and strength of the evidence regarding the harms of screening was high. This does not mean that we are recommending AGAINST screening; It simply means that there is insufficient evidence to support routine screening in this population at this time.
The other key change is in men over age 70 or those with less than a 10-year life expectancy in whom routine screening is not recommended. However, the guidelines acknowledge that some men over age 70 in excellent health may benefit from screening. In this setting, the guidelines suggest that a discussion of the unique risks and benefits of screening in older men occur.
The highest quality evidence for benefit (defined as lower prostate cancer mortality) of screening was found in men ages 55 to 69, and this evidence demonstrated that one man per 1,000 screened at two- to four-year intervals will avert a prostate cancer death over a decade. However, over a lifetime, this benefit could be much greater.
In men age 55-69, the guidelines still strongly recommends shared decision-making and screening based on a man's values and preferences. The only difference here is that the guidelines now recommend biennial screening to reduce the potential harms of screening.
Additionally, it should be noted that the AUA remains in disagreement with the U.S. Preventive Services Task Force in recommendation against prostate cancer screening in all men, regardless of age or risk, without even considering a discussion of the risks and benefits of screening. The AUA continues to support a man's right to be tested for prostate cancer -- and to have his insurance pay for it, if medically necessary.
The AUA is in the process of preparing supplemental materials that urologists can share with primary care providers in their communities, and will be working with major patient advocacy groups to ensure that patient education materials are available. More information about these tools will be available in late May; the toolkit will be available on AUAnet.org.
May 5, 2013
The number of urologists is projected to decrease by nearly 30 percent through the year 2025, while the rapidly aging population and influx of uninsured patients is projected to dramatically increase demand, according to a new study from researchers at the University of North Carolina, Chapel Hill, presented during the 2013 AUA Annual Meeting in San Diego. Dr. Raj Pruthi shared findings today at the meeting and held a special event for attending media.
May 5, 2013
The incidence of testicular cancer has increased among American males over 15 years of age for more than 20 years and while overall incidence is still highest among Caucasian males, the greatest increase was observed in the Hispanic community, according to a new study presented during the 2013 AUA Annual Meeting in San Diego.
May 5, 2013
In a new audio podcast from UroToday.com, Guideline Panel Chair H. Ballentine Carter discusses the AUA's new Guideline on the Early Detection of Prostate Cancer. Dr. Carter will present the new guideline to Annual Meeting attendees during a special Plenary II session on Monday, May 6 at 11:30 a.m. and a course at 12 p.m. PDT.
AUA Releases New Guideline on Early Detection of Prostate Cancer
May 3, 2013
On May 3, the AUA released a new clinical Guideline on the Early Detection of Prostate Cancer, outlining new recommendations on screening. The guideline, which does not address detection of prostate cancer in symptomatic men, recommends that men ages 55 to 69 who are considering prostate cancer screening talk with their doctors about the benefits and harms of testing and proceed based on their personal values and preferences. The AUA recognizes that there is a significant amount of research being conducted in the area of prostate cancer detection, including the development of new biomarkers, and that these studies could lead to changes in future recommendations. Read the press release to learn more about today's announcement; the full guideline is available here.
May 3, 2013
It was a great day for research at the AUA2013 meeting, with two exciting programs. The first, the Urologic Oncology Research Symposium on Pathways to Therapy, featured exciting speakers and engaging discussion that provided insight and progress updates across a wide range of oncologic disease pathways and fostered an intense and highly comprehensive discussion. The second, the Basic Science Symposium, addressed inflammation and fibrosis as underlying factors in benign urological disorders. A joint effort between the AUA, the Society for Basic Urologic Research and the National Institute of Diabetes and Digestive and Kidney Diseases the event fostered a rigorous and in-depth discussion of basic and translational aspects of inflammation and fibrosis, assembling leading urology researchers, clinical urologists and junior investigators.
May 3, 2013
The AUA's new guideline on Early Detection of Prostate Cancer made national news upon its release on May 3, including a number of articles in major outlets and distributions, including the New York Times, Reuters, Medscape and U.S. News and World Report. Additionally, the Prostate Conditions Education Council issued a statement "applauding" the new guideline.
Day 1: 10th Annual Urology Practice Management Conference
May 3, 2013
The first day of the 10th annual Urology Practice Management Conference was a huge success! This years' conference is more innovative than ever and allows attendees to expand their knowledge on quality practice management education, while exchanging ideas with peers regarding the latest urology management hot topics. There are nearly 200 attendees learning from 20 faculty members who are sharing their expertise in the field. Also, attendees are receiving bonus luncheon presentations with special thanks to sponsors Janssen and Dendreon. There is still time to register for the final day of the conference. Stop by the Marriott Marquis Hotel and Marina at the registration booth outside Marriott Hall for more information or visit www.aua2013.org/pmc.
April 19, 2013
On May 5 and 6, the American Urological Association (AUA) will co-host two U.S. Food and Drug Administration (FDA) public workshops to address research in the areas of bladder and prostate cancer. The events are free and open to the public. The first event, "Clinical Trial Design Issues: Drug and Device Development for Localized Prostate Cancer" will be held on May 5, from 8 a.m. to 5 p.m. and will feature key leaders in the field of prostate cancer, including physicians, advocates and industry representatives from a variety of specialties, including urology, radiation oncology, medical oncology, biostatistics and experts in clinical trial methodology. The second, "Clinical Trial Design Issues: Development of New Therapies for Non-Muscle Invasive Bladder Cancer" will take place on May 6 from 1 p.m. to 5 p.m. Both events will be held at the Manchester Grand Hyatt Hotel in San Diego.
April 23, 2013
On May 1, 2013, certain Medicare Part B claims (for imaging, lab, durable medical equipment or home health services) will be denied if the referring/ordering physician does not appear in the Medicare Provider Enrollment Chain Ownership System (PECOS). These edits have been in place since 2010 but have not been enforced through claims denials until this year. However, warning notices have been issued for claims that are at risk since 2010 so providers should not be surprised. Claims based on referrals to specialists are not affected, so the volume of claims affected from AUA members should be very small.
The rule that takes effect on May 1 results in denials only in the following situations:
April 17, 2013
The U.S. Food and Drug Admnistration (FDA) has released new updates for certain male enhancement supplements, citing hidden drug ingredients – including phosphodiesterase inhibitors. AUA members are urged to caution patients about the use of these supplements.
March 26, 2013
The AUA has released a new White Paper on Biopsy Sampling, Labeling and Specimen Processing to provide clinical guidance to practitioners performing prostate biopsies. This white paper is the result of more than a year's work led by Dr. Samir S. Taneja, MD. A complementary review article has been accepted for publication in The Journal of Urology® and will appear in an upcoming issue. Additionally, Dr. Steven Schlossberg will lead a panel discussion during the May 5 Plenary session at the AUA Annual Meeting in San Diego. The discussion will begin at 10:50 a.m. and will feature Dr. Taneja as well as Drs. David G. Bostwick and Samson W. Fine.