AACU News & Notes

AACU Hosts Annual Meeting in Nation’s Capital

posted: October 24, 2019

For more than 50 years, the AACU has remained a steadfast voice for urologists at the state and national levels. As the political and medical practice landscapes have evolved, so too has the AACU. National politics, state advocacy issues, and innovative topics in urologic care came together as urologists from every practice setting and at varied points in their careers gathered in Washington, D.C., for the AACU 2019 Annual Meeting. Over two days in October, notable speakers and special guests led engaging conversations on public policy, leadership development, and cutting edge science.

Policy and Leadership

Telemedicine

The provision of healthcare via telemedicine is characterized as the Fourth Industrial Revolution by Southern California Permanente’s Eugene Rhee, MD, MBA. Dr. Rhee kicked off the AACU meeting by applauding these advances, but recognizing several obstacles to widespread adoption, including reimbursement. Medicare, in particular, lags behind other payers because restrictive statutes and regulations result in partial payment for services delivered remotely. A robust discussion on technology, cross-state licensure, liability, and reimbursement took place, setting the stage for several sessions geared toward urologists interested in 21st Century communication and leadership.

21st Century Communication & Leadership

Stacy Loeb MD, MSc, a New York University urologist and expert on the use of social media in medicine, opened a lot of eyes to online tools that promote collaboration amongst colleagues separated by thousands of miles. A fantastic use of Twitter, Dr. Loeb noted, is a lively prostate cancer virtual journal club that attracts varied physician specialists as well as patients and family members.

An active social media presence promotes approachability, an important quality for effective leaders, according to Harold Frazier, II, MD, FACS, Clinical Director of Urologic Oncology Program at The George Washington University Hospital. Dr. Frazier likewise urged colleagues to show appreciation and, when things go wrong, to be a “bouncer” not a “splatter”. A splatter hits rock bottom, falls apart, and sticks to the bottom like glue. A bouncer, though, bounces up and pulls themselves back together.

Regulatory Update – Stark and 2020 Medicare Reimbursement

Participants were treated to a historical perspective from Deepak Kapoor, MD, on the rising cost of healthcare in the U.S. and how legislative reforms have shifted the way medicine is delivered today. Dr. Kapoor also provided an overview of the legislative and regulatory proposals that have been introduced this year and their potential impact on physicians. In particular, CMS issued a new rule on October 9, which according to CMS Administrator Seema Verma, represents “the most significant changes to the Stark law since its inception”. Dr. Kapoor agreed, and summarized the various elements of the rule and the exceptions it creates for physicians who participate in value-based care payment models. The presentation also included an analysis of CMS’ proposed changes for CY 2020 Medicare reimbursement. Dr. Kapoor argued that despite the widespread attention paid to the annual rules, the proposed changes to CPT codes and other policy changes this year will have a relatively minor impact on urology. He calculated the overall change in reimbursement rates for services performed by urologists to be equal to an increase of 0.79 percent.

Legislative and Political Successes

It was a busy year for AACU legislatively with healthcare policy continuing to be a central focus both on Capitol Hill as well as on the debate stage where presidential candidates have staked out positions that range from restructuring our entire healthcare system to merely tweaking current policy. Robert A. Bass, MD, MBA, highlighted key legislative issues that AACU has been particularly active on in 2019: 1) MACRA reform; 2) reducing the burden of prior authorization; 3) Stark law modernization; and 4) greater transparency at the USPSTF. As Congress addresses these and other issues relevant to the house of medicine, including prescription drug pricing and surprise medical billing, AACU will stay engaged to ensure the urology community is represented. Finally, as UROPAC Chair, Dr. Bass provided an update on year-to-date contributions to UROPAC: Urology’s Advocate on Capitol Hill and the actions it has taken to educate and nurture relationships with political candidates. In the first 10 months of 2019, UROPAC raised more than $70,000 – an increase of $10,000 over what was raised in all of 2018. Those contributions have raised the profile of the PAC in Washington and allowed it greater access to key policymakers from both parties. So far in 2019, UROPAC members have met with nearly 50 members of Congress, including party leaders, former physicians, and key committee chairs.

State Advocacy Network Chair William Reha, MD, MBA, meanwhile, illustrated myriad initiatives under the banner, “Virtual Network, Real Results”. Dr. Reha explained that state legislatures introduce 23 times more bills than Congress, totaling an average of more than 125,000 bills per year. To best represent urologists, the network frequently collaborates with state medical associations and other national specialty physician organizations. When an issue directly impacts urology, however, the AACU quickly moves to Alert, Educate, and Mobilize the entire urologic community. Campaigns identified by Dr. Reha and State Affairs Manager Ross Weber included: Cost-free prostate cancer screening coverage in New York; Nursing assistant authority to diagnose and treat UTIs in Connecticut; Management of conditions contributing to variations in physical sex characteristics in several states; and a national perspective on medical liability reform and state-funded graduate medical education.

Board Certification and Life Long Learning

J. Brantley Thrasher, MD, Executive Director of the American Board of Urology, stepped in to describe the four modules the ABU offers as part of its Life Long Learning (LLL) program. The LLL initiative was created in 2017 to provide certified urologists with a path for ongoing professional self-improvement. A ten year cycle, LLL is comprised of two levels and contains components such as licensure and peer review, continuing medical education, Practice Assessment Protocols, and videos for patient safety among other things. Dr. Thrasher urged attendees to provide feedback on the LLL initiative because the program is still evolving with a more longitudinal and formative assessment on the way. He further stated that through continued collaboration with urology groups like the AACU and AUA, the program will deliver remediation products to fill knowledge gaps, and provide a fair, transparent and valuable certification process.

Cutting Edge Science

In addition to these presentations on public policy and leadership development, the AACU 2019 Annual Meeting included first-rate talks on the art and science of medicine. Vanderbilt Urology was well-represented by Nicole Miller, MD, and Melissa Kaufman, MD, PhD, FACS, who delivered high-yield updates on bladder outlet management and urology trauma. Duke University’s Glenn Preminger, MD, preached the tenets of medical stone management, “a spiritual experience,” according to Florida urologist Kevin Lee, MD, FACS, who was reminded to never “underestimate the impact of sodium intake on hypercalciuria.”

Awards and Leadership Transition

American Medical Association President Patrice Harris, MD, delivered a message of unity in medical advocacy in the annual Hoffman/Carson Lecture, named for two of the AACU’s founding members. Dr. Harris emphasized the importance of collaboration between organizations to advocate for patients and the profession. The meeting also saw the awarding of the inaugural Herb Sohn Award for Excellence in Advocacy to Jeffrey Frankel, MD and Harry Miller, Jr., MD; and the ascension of Scott Sellinger, MD, FACS, and Elliott Lieberman, MD, to the positions of AACU president and president-elect, respectively.

Held as the AACU concluded its 50th year, the 2019 Annual Meeting provided an “opportunity to report on the advocacy successes in this ever-changing political landscape,” according to a Tweet posted by Young Urologist Committee Chair Seth Cohen, MD, who continued, “This organization can only be as effective as the support urology provides it.”

Advocacy Priorities
  • Prostate Cancer Screening and Awareness

    Eliminating Misdiagnosis and Reducing Wasteful Medicare SpendingEvery 20 minutes an American man dies from prostate cancer. The American Cancer Society estimates that 161,360 men were told they have prostate cancer in 2017. Early detection is critical because research shows the five-year survival...

  • IPAB Repeal

    IPAB permanently repealed in a major victory for the AACU and urology communityThe AACU is pleased to report that the Bipartisan Budget Act of 2018 (H.R. 1892) included provisions to repeal the Independent Physicians Advisory Board (IPAB), a 15-member panel of unelected officials that had the...

  • Graduate Medical Education and Physician Workforce Shortage

    Ensuring a Well-Trained Physician Workforce Increase Federally Funded Physician Training ProgramsRequestUrologists urge Congress to acknowledge the importance of specialty medicine and address urological workforce shortages that jeopardize patient access to care. We urge lawmakers to support...

  • The Impact of Pharmacy Benefit Managers on Access to Affordable Treatment

    Pharmacy benefit managers (PBMs) have a significant impact on prescription drug costs and the ability of patients to obtain the medications they need in a timely and affordable manner, and yet very little is known about their role. The AACU is dedicated to working with policymakers at both the...

  • Improve Preventive Task Force Recommendations, Preserve Access to Prostate Cancer Screening

    The United States Preventive Services Task Force (USPSTF) plays a critical role in preventive care because its recommendations dictate what preventive services many health plans must provide without cost sharing. Currently, however, the USPSTF has little accountability. Task Force members are...

  • Medical Liability Reform: Protect Physician Volunteers During National Disasters

    Protection for Physician Disaster VolunteersClinical urologists urge support for the Good Samaritan Health Professionals Act of 2017, introduced in the House by Rep. Marsha Blackburn (R-TN-7) and in the Senate by Sen. Bill Cassidy, MD (R-LA). This crucial legislation seeks to shield medical...

  • Modernize Law Restricting Coordinated Care (“Stark Law”)

    When Congress enacted the Medicare Access and CHIP Reauthorization Act, it replaced a fundamentally flawed reimbursement framework with a program promoting value-based care delivery. Value-based care, as measured by the new Merit-Based Incentive Payment System (MIPS) and alternative payment...

  • Patients Over Paperwork: Reducing the Burden of Medicare Red Tape

    Urologists across the country treat a high volume of Medicare patients and therefore deal with the program’s numerous requirements and complex payment structures on a near daily basis. The AACU is dedicated to working with legislators and policymakers to identify ways to simplify and...

State Advocacy
  • Fair Contracting and Medical Practice Freedom

    Where We Stand Ensure openness and fairness in health care provider contacts. Prevent third-party payors from changing the terms of their provider contract without notice to the provider and without the consent of the provider. Ensure that physician licensure is based upon a physician's...

  • Medical Liability Reform — Expert Witness Qualifications

    Strengthen expert witness standards Ensure that expert witness is from the same specialty as the defendant physician Prevent frivolous lawsuits Improve the practice environment for physicians in your stateWhenever a physician’s conduct is being called into question, it is only fair...

  • Prostate Cancer Awareness & Assessment

    Where We Stand Continue the progress that has been made in the reduction of prostate cancer morbidity and mortality with the appropriate use of prostate cancer testing. Ensure that third-party payors provide for the reimbursement of prostate cancer testing when the patient and his physician...

  • Uniform Prior Authorization for Prescriptions and Health Services

    Where We Stand Prior authorizations cost the health system $728 million in 2012. Prior authorization requests must use a single form, no more than two pages in length. Forms must available for both access and submission electronically. Requests are deemed approved if no response is...

  • Work Force — Scope of Practice

    Where We Stand Allow the maximum patient-to-physician ratio to increase based on the number of physician assistants in a practice. Expand the ability of nurse practitioners and physician assistants to supervise medical assistants when doctors aren’t on the premises.Proactive Physician...

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