AUA urges, 'Be part of the solution' as reform looms

"Things are going to change," Beth Kosiak, PhD, AUA associate director of health policy, told Urology Times. "But doctors have a lot of knowledge and can help. They can be a part of the solution. However, they have to pay attention to what's going on and talk to their representatives."

When speaking to their elected officials, Dr. Kosiak emphasized the importance of urologists suggesting changes in the health care infrastructure that could improve patient care and reduce costs.

Health care reform will directly affect urologists' practices in myriad ways, raising a number of questions, including:

The broadest question of all is how to finance the expected tab of more than $1 billion over the next 10 years. When President Obama addressed the American Medical Association on May 15, he said that $313 billion in cuts to Medicare and Medicaid would be made, including $109 billion in payments to physicians. How will those cuts be achieved?

In its report to Congress in June, MedPAC said a 21.5% reduction in overall Medicare fees would be required to offset congressional overrides of scheduled cuts for 2007, 2008, and 2009 under the sustainable growth rate formula.

Dr. Kosiak pointed out that the House of Representatives and President Obama have proposed sufficient funding to offset those cuts and to allow a new system for determining fee levels. However, there was opposition in the Senate because of the mounting debt resulting from the massive economic stimulus initiative.

"I don't think we'll face that big cut immediately, but it is not clear what will happen after 2012 or 2013," Dr. Kosiak said. "It looks like they are pushing it off once again."

But MedPAC cautioned, "If current spending and utilization trends continue, the Medicare program is fiscally unsustainable."

AUA is concerned that specialists will be asked to shoulder further cuts to help pay for improved payments to primary care physicians, Dr. Kosiak explained. "We recognize that they need to be strengthened, but not at the expense of specialty medicine," she said.