Hundreds of urologists visited Capitol Hill last month as part of the Joint Advocacy Conference, where they met with members of Congress on key issues affecting health care, urology, and urology practices. They did so at a historic time, as lawmakers sought to enact Republican legislation to repeal and replace the Affordable Care Act.
Bob GattyHundreds of urologists visited Capitol Hill last month as part of the Joint Advocacy Conference (JAC), where they met with members of Congress on key issues affecting health care, urology, and urology practices. They did so at a historic time, as lawmakers sought to enact Republican legislation to repeal and replace the Affordable Care Act (ACA).
While the outcome of ACA reform will have a profound impact on health care overall, urologists targeted a list of specific priorities that range from preserving access to PSA screening to reforming the U.S. Preventive Services Task Force (USPSTF) and repealing the Independent Payment Advisory Board (IPAB) established under the ACA.
Just prior to the JAC, the AUA’s Board of Directors approved a revised list of federal legislative priorities, which helped guide discussions by urologists as they met with members of the U.S. House of Representatives and Senate during the Capitol Hill lobbying event.
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Submitted to the AUA Board by the association’s Legislative Affairs Committee with input from the Public Policy Council, the new list of legislative priorities was aided by a survey of domestic AUA organizations and six other urologic organizations.
“The biennial legislative priorities survey offered the committee tremendous insight into what specific issues members hope the AUA will focus on during this new Congress and administration,” said Legislative Affairs Committee Chair Jim Ulchaker, MD. “It was no surprise that ensuring access to prostate-specific antigen screening and reforming the U.S. Preventive Services Task Force grading process continued to be rated highly, but there also was real concern shown by our members with their ongoing ability to treat patients after the diagnosis of serious urologic conditions.”
During the JAC, the AUA urged urologists to “amplify our reach” and contact lawmakers urging their support for legislation to reform the USPSTF recommendations process.
“While the USPSTF has issued several controversial recommendations in recent years, urology is specifically concerned about its 2012 ‘D’ recommendation against PSA-based screening for prostate cancer in all men, regardless of their individual risk,” the AUA wrote in a Policy and Advocacy Brief article posted during the JAC.
“This ‘D’ grade does a great disservice to the many men who could benefit from a PSA test,” the brief added. “As a result, the AUA has been working with Congressmen Marsha Blackburn (R-TN) and Bobby Rush (D-IL) over the past few years to develop and promote the bipartisan USPSTF Transparency and Accountability Act (H.R. 539) to allow for specialist input and create a more transparent recommendation process for the USPSTF.”
That legislation would require USPSTF to publish research plans and make available reports on evidence and recommendations for public comment, ensure medical specialty physicians are included on the Task Force, and establish a stakeholders board to advise it on developing, updating, publishing, and disseminating evidence-based recommendations.
It would also codify the grading system so it cannot be changed without appropriate review, ensure that Medicare or other payers cannot deny payment for preventive services solely based on the Task Force grade, and require that a quality measure related to a USPSTF recommendation may only be applied if it was developed or updated in accordance with the legislation and if the secretary of the Department of Health and Human Services concurs with the rating.
A new priority on the AUA’s revised list is “Advocate for the full continuum of care for prostate cancer survivorship,” which stems from the federal government denying Medicare coverage for vacuum erection devices in December 2014. As a result, there is growing fear that further treatments for erectile dysfunction, which can be a side effect of prostate cancer treatment, will be targeted in the future, the AUA explained.
In addition, the AUA updated its previous priority on work force shortages/graduate medical education to include telemedicine as an example of innovative treatment measures that could alleviate some of the urologist shortages, especially in rural areas.
While the JAC was underway, HHS Secretary Tom Price, MD, told the Senate Finance Committee that he supports enacting balance billing legislation, which would allow physicians to bill Medicare beneficiaries more than the rates approved by the senior health care coverage program. Dr. Price said balance billing would encourage more providers to work with Medicare beneficiaries.
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The drive to enact balance billing legislation was one of Dr. Price’s pet projects during his time in the House of Representatives, when he introduced such legislation several times. In his new position of HHS secretary within President Trump’s cabinet, and with Republicans in control of both chambers of Congress, insiders believe he now is in a stronger position to make balance billing a reality.
It will be interesting to see over the next 2 years the impact of President Trump’s drive to reduce federal spending to finance increased funding for defense on such health care priorities as those listed by the AUA. In addition, the ultimate outcome of ACA reform and the drive by conservatives in Congress to slash Medicare spending also can be expected to impact any effort to increase spending, even for such objectives as cancer research funding.
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