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
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.”