The AUA and other organizations have been urging Congress to create transparency and accountability within the USPSTF while adding input and feedback from patients and specialists involved in treating the conditions for which it is developing recommendations.
Bob GattyOne of the top remaining federal issues for urologists as Congress heads into full campaign mode is the effort to reform a federal entity that can virtually dictate whether various procedures are covered by federal health programs and, ultimately, by private insurers.
That entity is the U.S. Preventive Services Task Force (USPSTF), which in May 2012 recommended against PSA-based screening for prostate cancer. It was a decision that drew the ire of the AUA and other organizations within the specialty and prompted an all-out blitz on Congress to reform the way the USPSTF does business.
The AUA and other organizations, since the instant of that recommendation, have been urging Congress to create transparency and accountability within the USPSTF while adding input and feedback from patients and specialists involved in treating the conditions for which it is developing recommendations.
Since that USPSTF ruling, Rep. Marsha Blackburn (R-TN) introduced the USPSTF Transparency and Accountability Act, which is strongly supported by the AUA and other urology groups. Co-sponsored in 2015 by Rep. Bobby Rush (D-IL), the bill includes a requirement that a “balanced representation of primary and specialty care providers” and other stakeholders in the health care community are involved in the development and review of USPSTF recommendations.
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The Blackburn-Rush bill would require the USPSTF to:
• publish a draft research plan (including analytic frameworks, key questions, and a literature search strategy, plus methodologic guidelines for the project) to guide the systematic evidence review process
• consider findings and research by federal agencies and departments
• make the evidence review available for public comment
• coordinate activity with other federal government departments
• consult with “external subject matter experts,” including provider and patient representatives.
Now, of course, time has just about run out on the current Congress and new legislation will need to be introduced and fought for when the new Congress convenes in January-unless, by some miracle, supporters manage to get it passed during an expected lame-duck session following the election.
With this in mind, USPSTF reform advocates are continuing their efforts on behalf of the reform legislation, working every conceivable angle and taking advantage of every opportunity.
On July 12-13, nine AUA urologists joined members of the Alliance of Specialty Medicine at the annual Capitol Hill Advocacy Conference in Washington. Representing the AUA were Chris Gonzalez, MD, MBA; Jim Ulchaker, MD; Tom Rechtschaffen, MD; Jason Jameson, MD; Tim Averch, MD; Cary J. Stimson, MD, JD; Jim Dupree, MD, MPH; Kevin Koo, MD, MPH, MPhil; and Joshua Langston, MD.
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Members of both houses of Congress attended the 2-day session, which covered such topics as the proposed rule for the 2017 Medicare Physician Fee Schedule, physician payment reform, quality reporting, meaningful use, and an analysis of the federal elections.
During the session, the AUA urologists visited Capitol Hill to advance sound health care policy and protecting patient access to care. They and other Alliance physicians urged reform of the USPSTF, and addressed other key issues of concern.
“Since the Task Force’s controversial recommendation on PSA screening in 2012, the AUA has been working with a number of other like-minded provider and patient advocacy groups to raise awareness and increase support for more USPSTF transparency and accountability,” said Dr. Ulchaker, chair of the AUA’s Legislative Affairs Committee, in an AUA Policy and Advocacy Brief. “Now, with the Alliance’s backing, this will further illustrate to lawmakers how extensive their controversial recommendations have become.”
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Then, on July 20, the AUA’s immediate past chair of the Public Policy Council, David F. Penson, MD, MPH, met with Mark Miller, PhD, executive director of the Medicare Payment Advisory Commission (MedPAC) and discussed the PSA test and AUA guidelines, as well as the need for shared decision-making. Dr. Penson stressed the importance of including specialists in developing policy around the PSA test and expressed concern about the lack of transparency in governmental bodies, including the USPSTF.
That same day, Dr. Penson met with the majority (Republican) staff of the Senate Health, Education, Labor, and Pensions (HELP) Committee as a follow-up to a letter sent in May by HELP Chairman Lamar Alexander (R-TN) to Health and Human Services Secretary Sylvia Burwell regarding the USPSTF.
Dr. Penson reminded the staff of the impact that the USPSTF recommendation is having on patients and practices. A follow-up meeting at Vanderbilt University between Dr. Penson and Alexander was planned.
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The AUA also took advantage of the July political conventions to strengthen its visibility on key health issues, as Dr. Ulchaker was a special delegate to the Republican National Convention. During the Democratic National Convention, the AUA was contacted by Richard Boxer, MD, a UCLA urologist, who hosted a comprehensive event on the future of health care in the U.S.
So, clearly, the battle for reform of the USPSTF continues, one that is important to every urologist. How that effort will shake out in the new Congress that begins next January with a new president occupying the White House remains to be seen. But it is one issue about which urologists might ask candidates for the House and Senate in their own states as the campaign unfolds.
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