April 2011
The essential resource for your practice
Volume XXI, Number 4

Heard on the Hill: Learn More about Congressional Hearings

As the 112th Congress gets underway, we are pleased to announce that the Health Policy Brief will now feature a section devoted to summarizing Congressional hearings dealing with health policy of importance to urology.@blurbend As the AUA expands the role of its Washington, DC, legislative office, the Government Relations & Advocacy (GR&A) team will now regularly attend hearings and routinely provide you with updates. A GR&A presence at hearings will increase urology’s presence on Capitol Hill while providing you with inside information on Congress’ work—ensuring that we protect urology’s interest before any bill becomes law.

House of Representatives Committee on the Judiciary
Hearing on Medical Liability Reform - Cutting Costs, Spurring Investment, Creating Jobs
January 20, 2011

This hearing featured testimony from: Stu Weinstein, MD, a pediatric orthopedic surgeon from Iowa and past chair of Doctors for Medical Liability Reform, who spoke on behalf of the Health Coalition on Liability and Access; Ardis Hoven, MD, chair of the American Medical Association Board of Trustees; and Joanne Doroshow, executive director of the Center for Justice Democracy.

This hearing highlighted the burden on the healthcare system caused by “defensive medicine,” which adds expense without improving the quality of patient care. Both Drs. Weinstein and Hoven testified on behalf of physicians, calling for the need for comprehensive medical liability reform including caps on non-economic damages. Ms. Doroshow testified to the contrary, citing reports that show that the cost of malpractice insurance has been going down in recent years, and that states that have significant tort reform laws, such as California and Texas, do not have significantly lower costs of malpractice insurance than those without it. This hearing was held prior to and set the stage for the introduction of H.R. 5, the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011, a medical liability reform bill introduced by Representative Phil Gingrey, MD (R-GA).

For more information and to view testimony from this hearing, click here (link removed).

House of Representatives Committee on Ways and Means
Hearing on the Health Care Law’s Impact on Jobs, Employers, and the Economy
January 26, 2011

The hearing featured two panels of witnesses. Austan Goolsbee, PhD, chairman of the Council of Economic Advisors, composed the first panel, and the second panel consisted of small business owners. Prominent topics of the hearing included repealing the 1099 provision, repealing the medical device tax and working to implement some kind of medical liability reform.  

For more information about the hearing and to view testimony, click here (link removed).

Senate Committee on the Judiciary
Hearing on the Constitutionality of the Affordable Care Act
February 2, 2011

Amidst the many policy debates over the Affordable Care Act, the Senate Committee on the Judiciary invited a panel of constitutional law experts to speak to the constitutionality of the law. The crux of the argument rests on whether or not the individual mandate to purchase health insurance falls under Congress’ power to regulate interstate commerce. On the one side, as argued by Oregon Attorney General John Kroger, Harvard Law professor Charles Fried, and Duke School of Law professor Walter Dellinger, health insurance is clearly interstate commerce; thus, the individual mandate is the means by which Congress has chosen to regulate that market. On the other hand, as argued by Georgetown Law School Professor of Legal Theory Randy Barnett and Michael Carvin, partner at Jones Day, the individual mandate exceeds the power of Congress to regulate interstate commerce because there is really no precedent for Congress mandating individuals, who are not currently part of a market, to enter into a contractual obligation to participate within that market. Rather, they argue that the Supreme Court has only dealt with cases where Congress regulates what the experts called “activity”—businesses or individuals that are already participating in commerce. In this case, Congress is regulating “inactivity” where individuals are not and do not even want to participate in the market.

Already, two district court rulings in Virginia and Florida have declared the law unconstitutional, but many courts have refused to even hear the case. While it is not guaranteed, the final decision on this issue will likely rest with the Supreme Court.

For more information including testimony and a Webcast of the hearing, click here (link removed).

If you have questions about these or any other hears or if you are interested in attending any Washington, DC, legislative events, e-mail GovernmentRelations@AUAnet.org.

Table of Contents


Coding Corner:

How Should My Office Bill J3490, Unclassified drug?

Looking Back at Another Record-Breaking JAC and Looking Forward to “Afternoon on the Hill”

For the third consecutive year, attendance at the Annual Urology Joint Advocacy Conference (JAC), held from March 27-29, 2011, in Washington, DC, broke previous records. The Ritz-Carlton, Washington, DC, was filled to capacity by more than 180 urologists. The increasingly popular event, co-hosted by the AUA and the American Association of Clinical Urologists (AACU), is the only such advocacy conference that focuses on protecting the needs of urology.

A host of nationally recognized healthcare policy leaders, Members of Congress, fellow urologists and other policy analysts briefed attendees on topics such as workforce issues, health information technology and meaningful use, the Independent Payment Advisory Board (IPAB), and accountable care organizations (ACOs).@blurbend

Richard “Buz” Cooper, MD, a professor of medicine and senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania delivered the Keynote Address.

Gail Wilensky, PhD, former administrator of the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) under President George H. W. Bush, now an economist and senior fellow at Project HOPE, an international health foundation, also addressed attendees.

On Monday, March 28, 2011, numerous Representatives and Senators attended the Capitol Hill reception at Charlie Palmer’s, a well-known spot for the powerful legislators, allowing urologists a chance to meet and mingle with their elected officials. These Members of Congress applauded urology’s advocacy work and urged attendees to fight for their profession and voice the changes urology would like Congress to approve.

On Tuesday, March 29, 2011, urologists participated in more than 250 Congressional meetings, advocating for several key issues. One prominent focus was the repeal of the IPAB, which our coalition partner, the American College of Surgeons (ACS), did not take on during their Hill visits that same day. Urologists also lobbied for the continuation of the in-office ancillary exception (IOAE) and a permanent fix to the Sustainable Growth Rate (SGR). Also highlighted was urology’s PROSTATE Act (a prostate cancer bill that addresses disparities, access, research, outreach and education) and urotrauma legislation (a bill that creates a government-sponsored technical commission to investigate and advise the Department of Defense on research and action needed to advance this growing area within urology). The two bills were originally introduced in the last Congressional session and, thanks to the advocacy work of our members and AUA professional staff, are now poised to be reintroduced with more co-sponsors and a broader base of support. Click here to view urology’s summary statements on these and other significant issues.

As we celebrate yet another successful JAC, we look forward to continuing our advocacy work on Capitol Hill during the AUA2011 Annual Meeting at the “Afternoon on the Hill.” On Wednesday, May 18, 2011, hundreds of AUA members will take advantage of the unique opportunity of being in Washington, DC, by visiting their Senators and their staff in order to bring urology’s message to Capitol Hill. If you missed your chance to attend the JAC, this is your opportunity to make your voice heard and join many of your colleagues at this important advocacy event. Space is limited, so be sure to register for this event when you complete your Annual Meeting registration. The registration deadline is April 18.

Additionally, we formed a separate research “Strike Force” of senior urologist researchers who will promote the AUA Foundation's National Urology Research Agenda (NURA) on Capitol Hill during "Afternoon on the Hill."

For more information about “Afternoon on the Hill, click here (link removed).

If you have any questions, staff at the UROPAC Booth at Annual Meeting will be there to help or you can e-mail GovernmentRelations@AUAnet.org.

Please look for additional information and photos from the Joint Advocacy Conference in the upcoming issues of the Health Policy Brief.

For The Record

Frequently asked questions (FAQs) are periodically placed on the Office of the National Coordinator for Health Information Technology (ONC) Web site to expand public understanding of the Meaningful Use (MU) of electronic health record (EHR) rules and how they will be enforced. A recently posted response concerning the determination of “possession” of certified EHR technology has left many industry experts confused and concerned.@blurbend

An article by James B. Wieland and Joshua J. Freemire of the Ober|Kaler law firm in Washington, DC, explains the details of this FAQ and highlights the source of the confusion*. The ONC guidance seems to counter the widespread understanding that the MU rules allow eligible providers to acquire EHR technology in a modular fashion in order to qualify for the MU incentive payments. In other words, providers can invest in technology only as needed to comply with annual requirements. However, the ONC’s answer to the question posed appears to say that only “complete EHR” software tested and approved by an approved testing and certification body would qualify for the payments.

The AUA will continue to monitor this situation and will keep you apprised through our many publications.

Practice Management Develops Meaningful Use (MU) Educational Tools for Urology Practices

The AUA Practice Management Department is planning a number of educational experiences this year to assist urologists and practice managers in understanding how to collect the Medicare MU bonuses payable beginning around May 2011. The following projects are under way and should all be ready by the AUA2011 Annual Meeting:

  • New on the agenda for the Urology Practice Management Conference is “Looking under the Hood of Meaningful Use of EHR.” Several popular EHR vendors (certified for MU) have been invited to demonstrate data entry (required to meet MU measures) and how their systems report the results. The objective of this course is to show prospective users what information will be at their fingertips when they get ready to attest to the Centers for Medicare & Medicaid Services (CMS) that they have met all the Stage 1 MU requirements for 2011 or 2012. See the ad below for more details on the entire Practice Management Conference. To register, go to www.AUA2011.org and select Practice Management Conference.
  • All 2011 Practice Managers’ Network (PMN) subscribers will be invited to a series of conference call discussions (supported by WebEx online materials) about the various aspects of MU. Topics include certified systems, the provider registration and attestation process for MU, and forums about what measures in MU make the most sense for urology. To subscribe to the PMN and become eligible for these free calls, go to the AUA’s PMN Web page on AUAnet.org.

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

*Reprinted with permission from Ober|Kaler (www.ober.com)
Authors James B. Wieland and Joshua J. Freemire are lawyers in the Health Law Group of Baltimore-based law firm Ober|Kaler. Mr. Wieland and Mr. Freemire focus their legal practices on health care information and technology issues. They may be reached at jbwieland@ober.com and jjfreemire@ober.com.

Meet a Member of Congress: Congressman Mike McIntyre (D-NC-7)

Mike McIntyre was first elected to represent North Carolina's 7th Congressional District in the U.S. House of Representatives in 1996. He is now serving in his 8th term and was named a Democratic Senior Whip in the House.

Representative McIntyre, a member of the Blue Dog Coalition, has taken a common-sense approach to forging a bipartisan consensus on public policy. From this vantage point, he has played a key role in finding practical solutions to complex problems.@blurbend

align=Representative McIntyre is a member of the House Armed Services Committee, which promotes and protects our nation’s servicemen and women, veterans and military retirees. In 2008, he was named National Legislator of the Year by the National Association of Veterans County Service Officers for his work on behalf of our nation’s veterans. Additionally, he is the author of the Veterans Outreach Improvement Act, supported by the National Association of County Veterans Service Officers, the American Legion, the Veterans of Foreign Wars, the Paralyzed Veterans of America, the Military Officers Association of America, the National Organization of Veterans’ Advocates and the Iraq and Afghanistan Veterans of America.

Representative McIntyre also serves on the Steering Committee of the Rural Health Care Coalition. In 2002, he was the only Member of the House to be chosen for a Legislative Award in recognition of his leadership and "ongoing commitment to policies improving healthcare" by the National Rural Health Association. He has also been a leader on law enforcement issues, an avid defender of our senior citizens, and a strong advocate for improved healthcare and education. We recently sat down with him to discuss his positions on healthcare reform and how physicians can get involved in enacting change.

Q: First, of all, thank you for your history of supporting physicians and the healthcare community as a whole. Last year, you voted against the Affordable Care Act, and this year you voted for its repeal. These were not the popular positions of your party. What led you to make these tough decisions?

As you know, I voted against the healthcare bill last year because it did not address the long-term problem of access and reimbursement for our hospitals, especially rural hospitals. It hurts small businesses and it costs too much money at a time when we have an exploding federal deficit. All of these problems are as acute today as they were last year.

A true healthcare reform bill would ensure that our senior citizens and rural citizens get the same access to healthcare as others, reduce the skyrocketing cost of healthcare and health insurance for middle class families, not hurt small businesses and not keep spending money we do not have. The healthcare law fails on all of these counts, and I voted for legislation to repeal it on January 19, 2011.

I hope that the leaders of this Congress, Democrats and Republicans alike, will join me in reaching across the aisle to pass a common-sense healthcare reform that achieves these objectives and, in so doing, helps to improve the health and well being of America's families.

Q: While it is unlikely that the Senate will repeal the entire Affordable Care Act and send it to the President, are there any provisions that you think might be repealed, such as the 1099 provision, or the Independent Payment Advisory Board?

Yes, there are provisions that are currently being looked at for potential repeal. In fact, the House recently passed legislation to repeal the 1099 provision. I supported it. I also understand the concerns physicians have with the Independent Payment Advisory Board and will keep them in mind should a bill be considered to repeal that provision.

Q: Physicians have had a rough time over the last two years. Many are feeling discouraged, especially in light of the current trend to cut government spending including entitlement programs. What might make them hopeful about their futures and the future of healthcare in America?

While these issues do exist, many of us in Congress are committed to ensuring that the Sustainable Growth Rate is repealed to encourage a better Medicare reimbursement system. For far too long, physicians have been at the whim of Congress to pass short-term extensions that impede their practice and ultimately impact patients. A real solution is needed.

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

Given that the healthcare reform bill will unlikely be repealed this Congress, it is essential that physicians weigh in and provide information about the issues impacting their industry, including various provisions in the healthcare reform law. Whether it is issues like access to healthcare, workforce shortages or Medicare and Medicaid reimbursements, physicians can and should be advocates for their profession and measures impacting them at the federal level.

I work with a Medical and Health Affairs Advisory Committee that is comprised of physicians, surgeons, hospital administrators and others in health-related fields of service, including a urologist! We meet and discuss issues of concern to the medical community.

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

As a member of the Rural Health Care Coalition and the Cancer Caucus, I am committed to working on behalf of the dedicated physicians who help keep our country healthy. I have recently added my name to [the AUA’s] urotrauma legislation that establishes a National Commission on Urotrauma. And, I have co-sponsored [the AUA’s] PROSTATE Act, which establishes a federal interagency task force, composed of agencies from  the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Defense and led by the U.S. Department of Veterans Affairs, which will develop a strategy to improve the research portfolio, eliminate duplication between agencies, identify best practices, expand collaboration, increase patient and medical community participation, and develop a coordinated message related to screening and treatment for prostate cancer.

The AUA would again like thank Congressman McIntyre for his continued dedication to preserving our doctors’ ability to continue to provide high quality healthcare to their patients, and for his support on both or our bills. We look forward to working with him and all Members of Congress as this session moves forward.