Political battles rule in debate over SGR repeal

Bob GattyWashington-After 12 years of working in Washington for Rep. C.W. Bill Young (R-FL), most recently as deputy chief of staff, Brad Stine is now the AUA’s new director of government relations and advocacy.

He left the Hill because of his boss’s death last October, and he was happy to land his new position overseeing government relations and congressional policy initiatives for the association.

“I enjoyed handling health issues for the congressman and I wanted to stay on that track, and I wanted to work on issues that theoretically aren’t driven by politics,” Stine said.

That comment came as the AUA and two other urology organizations concluded their Joint Advocacy Conference (JAC) and just a day before the Republican-controlled House of Representatives voted to repeal the sustainable growth rate (SGR) payment system for Medicare physicians-one of the AUA’s and organized medicine’s primary legislative issues.

Only one problem: House Republicans had hijacked the doc fix, attempting to pay for it by delaying a core component of the Affordable Care Act, the individual mandate, for 5 years. Because no one expected the Democrat-controlled Senate to accept that deal, repeal of SGR in time to avert a 24% pay cut for Medicare physicians without yet another temporary patch was in serious doubt.

Thwarted by the Senate’s opposition to that measure, the House on March 27 extended SGR for 1 year to avoid the cuts, and also extended the switch to the ICD-10 coding system until October 2015. Negotiated by House Speaker John Boehner (R-OH) and Senate Majority Leader Harry Reid (D-NV), the measure faced opposition from many Senate Democrats, including Senate Finance Chair Ron Wyden (D-OR). The Senate had not yet voted on the measure as this issue of Urology Times went to press.

Stine said he came to the AUA to work on governmental issues on behalf of physicians and their patients.

“Advocating for patients and doctors is what interests me. That shouldn’t be about Republicans or Democrats. It should be about people,” he said.

Stine intends to advocate for the AUA’s SGR policy: to gain affirmative repeal of the formula that has proven so troublesome over the years for urologists, whose patient population includes a large percentage of Medicare enrollees.

Continue to next page for more.

Highly successful JAC

The JAC-held only a few days after Stine started his new job with the AUA-was highly successful, as more than 200 meetings with lawmakers and staff members took place, involving the three JAC participating organizations-the AUA, the American Association of Clinical Urologists, and the Large Urology Group Practice Association.

During Capitol Hill meetings, members of the three organizations pressed their concerns regarding SGR reform, work force issues (including graduate medical education), reform of the U.S. Preventive Services Task Force (USPSTF), and preserving the in-office ancillary services exception to the Stark law, which continues to be under attack.

Stine reported that several members of Congress agreed to co-sponsor legislation aimed at reforming the USPSTF, which has issued recommendations against PSA-based screening for prostate cancer for all men, regardless of their risk. The AUA supports the legislation, known as the USPSTF Transparency and Accountability Act of 2013, which would improve accountability of the task force and ensure that Medicare or other payers cannot deny payment for preventive services based only on the task force grade.

“That was received well by members of both parties,” he said.

In-office ancillary restrictions threat looms

Although the bombshell news of the House GOP’s effort to tie gutting of the ACA to the doc fix pushed to the sidelines the idea of helping to cover its cost by limiting the in-office ancillary exception, that possibility continues to lurk in the shadows.

President Obama’s budget for 2015, as it did for 2014, proposes such limits that could affect imaging services provided by many urologists, a move strongly opposed by the AUA and other groups. So the threat of these restrictions being imposed as a tradeoff for SGR repeal continues to exist.

Meanwhile, Stine said he is looking forward to the challenges and opportunities in his new position at the AUA.

“Everybody here is first class, and we are going to keep the train rolling,” he said. “I intend to use my Hill experience to help the AUA achieve success with its priority list of issues. Last year, the AUA got the urotrauma bill passed and signed into law, and that was a remarkable success.”

So Stine hopes that track record can continue when it comes to the other key issues on the AUA’s hit list.

“My short-term goal is to work with the team that is in place to push our agenda and create a strong liaison with our doctors who volunteer and help with our governmental issues. We are here to make that part of their job easier,” he said.

Stine drew a parallel between his responsibilities at the AUA and his responsibilities when he worked for Young.

“Our job there was to serve our constituents,” he said. “Here, it is the same. We are here to serve our constituents, the members of the AUA. It’s all about customer service. So that experience translates here."UT

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