Urology's advocacy priorities: One down, four to go

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

"A monumental achievement."

"An important night for the Senate and it is going to be long remembered."

In a dysfunctional legislative body that rarely approves anything other than motions to adjourn, these statements by Sen. Orin Hatch (R-UT) and Sen. Ron Wyden (D-OR), respectively, are historic in their own right.

READ - Good riddance, SGR: Urology groups, others react

That they were uttered after the Senate passed legislation of vital importance to physicians should be a source of pride for the entire health care community.

Indeed, without tens of thousands of letters, calls, tweets, and Hill visits made by urologists and their colleagues in recent months, H.R. 2, the bill to repeal the Medicare payment sustainable growth rate formula, would have likely languished for another year or more.

Having completed a well-deserved victory lap, it's time to tune up our engines and head right back to the race track to advance the specialty's remaining advocacy priorities.

IPAB repeal

Without a single member even nominated to serve on the Independent Payment Advisory Board (IPAB), the bureaucratic construct remains worrying. While the growth of the Medicare budgetary line item hasn't reached a point that the IPAB is required to "recommend" cuts to physician payments, that day could come at any time. Without an empanelled IPAB, sole authority rests in the Secretary of Health and Human Services.

Two bills have been introduced to repeal the IPAB. In the House, H.R. 1190 is considered bipartisan, with 196 Republican and 19 Democrat co-sponsors. The Senate's version of the "Protecting Seniors' Access to Medicare Act," S. 141, secured 37 co-sponsors, all of whom fall within the GOP's ranks.

NEXT: USPSTF reform

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USPSTF reform

The U.S. Preventive Services Task Force (USPSTF) is a quasi-independent (ie, unaccountable) panel of family docs, public health experts, and internists who hold great power to recommend for or against disease screening paradigms that save lives. Members of the USPSTF are appointed by an unelected official, and at no point during their review process do they meet with relevant stakeholders. Equally troubling, Medicare and Affordable Care Act insurance exchange payment policies are tied to whether these generalists interpret a test or screening to be "harmful."

ALSO SEE: Urology groups reiterate support for USPSTF bill

To shed some light onto the USPSTF itself and better inform that body's recommendations, organized urology encourages sponsorship and swift consideration of the USPSTF Transparency and Accountability Act of 2015 (H.R. 1151). Introduced by Rep. Marsha Blackburn (R-TN), the proposal would require that the USPSTF:

• publish research plans to guide its systematic review of evidence and new science relating to the effectiveness of preventive services

• make available reports on such evidence and recommendations for public comment

• codify the grading system so it cannot be changed without appropriate review

• establish a stakeholders board to advise it on developing, updating, publishing, and disseminating evidence-based recommendations.

What's more, the bill would ensure that Medicare and other payers cannot deny payment for a preventive service solely based on the Task Force grade.

NEXT: Medicare funding for physician training

Medicare funding for physician training

It's widely known that the United States will face a shortage of more than 100,000 physicians by 2025. Recent attempts to address this pending disaster have focused on training more primary care physicians. Policy makers have turned a blind eye to the fact that specialists are also in terribly short supply. Indeed, at least half of the anticipated shortage will be made up from specialty physicians. Urology has seen a greater than 10% decline in the number of urologists per capita over the past 20 years. Similarly foreboding, the average age of a urologist is 51 years, with more than 38% of urologists age 55 or older, making the specialty second only to thoracic surgeons in terms of "old age.”

READ: Narrow networks expand, raising concern

A bill urologists are pleased to support was recently introduced by Rep. Kathy Castor (D-FL). The Creating Access to Residency Education Act (H.R. 1117) will provide much-needed reforms to improve the nation's graduate medical education (GME) system and preserve access to specialty care. The CARE Act proposes to:

• increase the number of GME residency slots by 15,000 over the next 5 years

• direct half of the newly available positions to training in shortage specialties, including urology

• specify priorities for distributing the new slots (eg, states with new medical schools)

• study the needs of the U.S. health care system and allocate residencies accordingly.

On April 30, 2015, Sens. Bill Nelson (D-FL) and Charles Schumer (D-NY), Senate Minority Leader Harry Reid (D-NV), and Reps. Joseph Crowley (D-NY) and Charles Boustany, Jr., MD (R-LA) introduced the ResidentPhysician Shortage Reduction Act (S.1148, H.R. 2124), legislation that would increase the number of Medicare-supported GME residency positions by 3,000 per year over 2017-2021, totaling 15,000 new slots. Although there are slight differences between the bills, both would:

• require half of all available slots be used to train residents in shortage specialty residency programs

• direct the National Health Care Workforce Commission to study the physician work force

• require a Government Accountability Office study on strategies for increasing health professional work force diversity

• specify the process for distributing positions, including priority for hospitals:

• in states with new medical schools or new branch campuses

• affiliated with Veterans Affairs medical centers

• emphasizing training in community-based settings or in hospital outpatient departments

• or determined as electronic health record meaningful users (Association of American Medical Colleges, May 1, 2015).

Urologists whose elected representatives haven't co-sponsored the legislation referenced in this report are encouraged to utilize tools on the AACU website that facilitate various types of communication with your members of Congress. Whether you send a pre-drafted letter or schedule an in-district meeting, let's strike while the iron is hot by making your voice heard today.

Postscript: Urology's fourth legislative priority, preservation of the in-office ancillary services exception to the Stark law, will be addressed in depth in a future post.

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