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Our Priority: Reduce Regulatory Burdens

Why the Issue Matters

MACRA implementation, prior authorizations, step-therapy and other issues can limit patient access to care, interfere with the physician-patient relationship, or cause physician burnout.

The administrative and regulatory burdens federal programs place on physician and their practices are cumbersome to accessing care. The increasing amount of administrative responsibility – often leading to physician burnout – has forced physicians to retire early and further increases unnecessary costs not only to practices and the Medicare program but also negatively impacts patient care. Unnecessary administrative tasks undercut the patient-physician relationship. Moreover, for every hour of face-to-face time with patients, physicians spend nearly two additional hours on administrative tasks throughout the day. The increase in administrative tasks is unsustainable, diverts time and focus away from patient care, and leads to additional stress and burnout among physicians.

The AUA is working to address this priority by focusing on four key areas: the Medicare Access and CHIP Reauthorization Act (MACRA), prior authorization, step therapy and physician burnout.

Learn more about each area of focus.

Part of MACRA is the need to improve the Quality Payment Program (QPP) and reduce the burden of participation, as well as minimize the number of clinicians subject to negative payment adjustments. Nevertheless, specialty physicians like urologists continue to face unique challenges as they attempt to engage.

The viability of the Merit-based Incentive Payment System (MIPS) program is critical, as it is the only track that specialty physicians can engage in the QPP. Most existing Advanced Alternative Payment Models (AAPMs), including Medicare Accountable Care Organizations (ACOs), focus on primary care services and make specialty physician engagement a challenge.

Prior authorization is a burdensome process that requires physicians to obtain pre-approval for medical treatments or tests before rendering care to their patients. The process for obtaining approval is lengthy and typically requires physicians or their staff to spend the equivalent of two or more days each week negotiating with insurance companies — time that would better be spent taking care of patients. Patients experience significant barriers to medically necessary care due to prior authorization requirements for items and services that are eventually routinely approved.

Step therapy requires patients to try and fail first to have a desired clinical outcome on a lower cost medication before they can access the medication prescribed by their health care provider. This practice jeopardizes the health of patients and the physician-patient relationship. A 2018 article in the Food and Drug Law Journal discusses that such policy has been shown not to save money in the long run due to patient complications. Appealing step therapy protocols can be very timely and burdensome for physicians and patients and can take months to resolve — all while the disease is progressing.

Doctors spend so much energy worrying about the health of their patients, often times their own issues go unresolved. Consequently, physician incidences of medical burnout are increasing at an alarming rate. And, given the shortage of physicians already including urologists, physician burnout is more acutely felt.

Career fatigue is more common among doctors than any other U.S. worker. A recent study by the Archives of Internal Medicine found that out of 7,000 participating physicians more than 41% reported at least one symptom of burnout. Additionally, the country is facing overall shortage of physicians in part due to physician burnout. While the number of specialty medicine physicians, such as urologists, is decreasing and the average age is increasing, 53.8% of urology residents have more than $150,000 in student loan debt, and for 26.8% of them, the figure is $250,000 or more.

More on physician burnout can be found within the 2019 National Academy of Medicine Report. The report reflects on the findings of the 2016 AUA Census, which reported burnout rates for urologists as being high, with more than one-third of urologists experiencing symptoms.

Fast Facts


What the AUA is Doing

Medicare Access and CHIP Reauthorization Act (MACRA)
The AUA has urged Congress to extend positive physician payment updates to the conversion factor, the Merit-based Incentive Payment System (MIPS) exceptional performance bonus and AAPMs incentive payments.

MACRA emphasizes the use of qualified clinical data registries (QCDRs), a significant health IT tool that is especially important for specialists looking to deepen their understanding of quality and performance for relevant episodes of care.

The AUA, via Centers for Medicare & Medicaid Services (CMS), continuously request the following:

  • Make MIPS Value Pathway (MVP) participation voluntary and to incentivize physicians to opt-in to MVPs. Physicians should have the choice to opt-in to participate in an applicable MVP, if available, or remain in traditional MIPS;
  • Hold physicians harmless from a penalty for the first two years of participation in a new MVP;
  • Consider the expenses to adopt and administer an MVP for physicians in small practices who have been reporting via claims, as well as physicians in health systems and group practices that have been reporting via the CMS web interface;
  • Immediately provide more QPP and claims data to help stakeholders identify MVP opportunities and reduce the costs of developing and proposing them to CMS;
  • Provide more details in the upcoming QPP proposed rule about how qualified QCDRs and QCDR measures can be included in MVPs;
  • Measures that should be included in MVPs are those that have been developed by physician-led organizations, such as specialty societies, to ensure they are meaningful to a physician’s practice and patients and measure things a physician can control; and
  • Eliminate the need for physicians to report in four separate performance categories.

Coalition Activity:
The AUA is a member of the Alliance of Specialty Medicine, which is a coalition of national medical societies representing more than 100,000 specialty physicians in the United States. This non-partisan group is dedicated to the development of sound federal health care policy that fosters patient access to the highest quality specialty care.

Prior Authorization

Active Legislation:
The Improving Seniors’ Timely Access to Care Act (H.R. 3173) would streamline prior authorization in the Medicare Advantage (MA) program. H.R. 3107 was introduced by Representatives Suzan DelBene (D-WA-01), Mike Kelly (R-PA-16), Roger Marshall, MD (R-KS-01), and Ami Bera, MD (D-CA-07).

Coalition Activity
The AUA is a member of the Regulatory Relief Coalition, which is a group of national physician specialty organizations advocating for regulatory burden reductions in the Medicare program so that physicians can spend more time treating patients.

Step Therapy

Active Legislation
The Safe Step Act (H.R. 2163/S. 464), introduced by Reps. Raul Ruiz, MD (D-CA-36) and Brad Wenstrup (R-OH-02) and Sens. Lisa Murkowski (R-AK), Maggie Hassan (D-NH), Cindy Hyde-Smith (R-MS), Jacky Rosen (D-NV), Kevin Cramer (R-ND), and Angus King (I-ME),would ensure patients with private insurance have reasonable protections against harmful step therapy practices. The Safe Step Act would not ban step therapy, but it would give doctors a transparent and standardized process to appeal step therapy requirements for patients needing a particular treatment, putting common-sense parameters and reasonable timelines around the practice.

Physician Burnout

The AUA issued a public statement from 2019 President John H. Lynch, MD, applauding the National Academy of Medicine for developing a report on burnout and bringing additional attention to this important issue.

Learn more about AUA activites: