At the AUA, there is a list of 10 top priorities on which association lobbyists hope to gain traction.
Bob GattyWashington-The AUA and virtually every other medical organization has an interesting challenge in 2016: how to attract attention and political support on key issues that could affect physicians and patients for many years, far beyond the 2016 elections that will consume lawmakers in the months ahead.
At the AUA, there is a list of 10 top priorities on which association lobbyists hope to gain traction, realizing that lawmakers’ time and attention spans are even shorter than usual, condensed by the calendar as election campaigns move into high gear, especially when the August recess begins.
“A lot of our prime time to meet with congressional figures and try to make our point will be between now and the August recess,” observed James Ulchaker, MD, chair of the AUA’s Legislative Affairs Committee. “And after Labor Day, everybody is going to be in election mode.”
The legislative priorities approved by the AUA Board of Directors are:
• Preserve access to appropriate PSA screening.
• Reform the U.S. Preventive Services Task Force (USPSTF) recommendation process.
• Preserve the use of the in-office ancillary services exception (IOASE) to the Stark law when appropriate.
• Address work force shortages in all urologic practice environments, preserve access to timely and appropriate care, and advocate for increased graduate medical education funding and resources for urology positions.
• Minimize the negative impact of meaningful use/EHR regulations.
• Address the 90-day grace period for recipients of advanced payments in the health insurance marketplace established under the Affordable Care Act.
• Promote urology/cancer research funding.
• Repeal the Independent Payment Advisory Board (IPAB) or modify the current law to provide for congressional oversight of its decisions, appointment of practicing physicians, and review by medical specialty societies.
• Promote medical liability reform.
• Promote bladder health initiatives at the federal and state level.
All of those issues are expected to be addressed at the 2016 Urology Joint Advocacy Conference Feb. 28-March 1 in Washington. The conference will be jointly sponsored by the AUA and the American Association of Clinical Urologists.
PSA screening. “Number one remains preserving access to appropriate PSA screening,” Dr. Ulchaker stressed, noting that the AUA continues to work through the office of Rep. Marsha Blackburn (R-TN) to achieve passage of legislation that would reform the process by which the USPSTF reviews and develops recommendations for clinical preventive services. The USPSTF in 2012 recommended against PSA screening for prostate cancer, and the task force now is developing a new research plan to update that recommendation.
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The PSA decision, of course, is the reason why the AUA and other urology groups want to see the USPSTF required to include input from urologists and other specialists when it issues recommendations that directly impact physician reimbursement and patient access.
“We feel this should be a physician-patient issue, not so much government stepping in and deciding who gets PSA screening and what’s appropriate to be paid for,” Dr. Ulchaker said.
IOASE. The IOASE allows urologists to offer informed patients coordinated, efficient, and high-quality care, Dr. Ulchaker said. The IOASE makes services such as diagnostic imaging, lab tests, and radiation therapy available through the patients’ urologist, without having to go elsewhere for such services.
“The biggest reason,” he explained, “is patient access, especially in rural areas where patients might otherwise have to travel hundreds of miles to get studies performed. It’s patients first, and to achieve that, access to patient care really needs to be maintained.”
Work force shortages. Dr. Ulchaker noted that the AUA supports pending legislation designed to address the shortage of primary care physicians as well as shortages that exist, and continue to grow, in some specialties, including urology.
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“Urology is losing more physicians on a yearly basis than we are producing,” he pointed out. “We’ve got to stay on top of this, and we are recommending that funding needs to go to primary care, but to certain specialties and subspecialties, like urology, as well.”
Meaningful use. The government’s complex “meaningful use” regulations that cover its incentive program for physicians implementing EHRs have drawn the ire of scores of medical organizations, including the AUA, which on several occasions has written the Department of Health and Human Services asking for more time and flexibility for physicians and physician organizations to implement EHR.
Late in December, President Obama signed into law S. 2425, which expands providers’ eligibility for hardship exemptions to Stage 2, creating a blanket exemption from 2015 penalties that would have been assessed in 2017. Eligible professionals have until March 15 to apply for the exemption.
But Dr. Ulchaker said there are open questions regarding just who will be eligible for exemptions under that law or if it would be retroactive.
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Other issues. The AUA continues to seek additional funding for urology-related research, including long-term, debilitating diseases like Parkinson’s that have urologic implications. The AUA also is focusing efforts on promoting bladder health, he said, noting that bladder issues increase with age and stem from such conditions as degenerative brain diseases. Moreover, he said, smoking is the number one cause of bladder cancer in America.
And, the AUA continues its support for legislation to reform product liability laws, a continuing effort to help reduce the upward pressure on product liability premiums.