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winter 2014

Protecting the Polit ical and Profe s s ional Interest s of Urology Since 1968

Urologists Unveil Future of Health Delivery at AACU Conference By: Ross E. Weber

uropac update page 10

Message froM aacu president page 2

the end of sgr? page 4

9th annual urology joint advocacy conference agenda page 6

Featured in this issue:

Energized by recent legislative victories from Tallahassee to Olympia, urologists looked to the future as they gathered for the 6th Annual AACU State Society Network Advocacy Conference. Taking place just days after the October 1st

launch of open enrollment for health insurance exchange plans, the event focused on the role of urologists and their professional associations in a transformed health care delivery system.

Nationally recognized policy experts and business consultants shared a fresh take on the nascent online insurance marketplaces and the evolution of health care delivery. Speakers described how the pay-for-performance model is evolving and suggested that specialists must work together to establish “pay-for-value” metrics for these new reimbursement programs.

Technology will continue to be a driving force for the future practice of medicine, and attendees heard from experts who spoke on the emerging influence of “big data” on medical decision making. A dynamic trio of speakers explained how public, private, and academic entities can be partners in the technological innovation of medicine. Lisa Delp, director of Ohio-based Innovation Fund America, provided innumerable examples of how government has served as a catalyst, rather than an obstructionist in the development of health care technology.

Urologic community advocacy, as always, featured prominently throughout the conference. The leaders of state and national urology societies shared recent successes and best practices to consider implementing nationwide. In addition, attendees were treated to a special briefing on the AACU’s 2014 agenda. Newly installed President Richard Pelman, MD, explained his desire to secure 50-state participation in next year’s event, as well as to establish societies in those jurisdictions without a state organization representing urologists. He insisted that the collective knowledge of current leaders, as well as the AACU’s ability to mobilize

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SAVE THE DATE

2014 AACU State Society Network Advocacy Conference

September 20 – 21, 2014Rosemont, IL

Don’t have a State Urology Society?Contact the AACU to help start one!

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Letter from the PresidentRichard S. Pelman, MD

Dear Colleagues,

I want to thank the AACU Board of Directors and membership for giving me the opportunity to serve as the AACU president for 2013 – 2014. I am proud and excited to serve as your president for the upcoming year.

This is an important time to be engaged in health policy. The most dramatic restructuring of our country’s health system since the implementation of Medicare has begun – with a rocky start – and members of Congress from both sides of aisle appear to be serious about permanently ending the flawed Medicare Sustainable Growth Rate (“SGR”). Representative Jackie Speier (D-CA) has filed H.R. 2915, the so-called “Promoting Integrity in Medicare Act of 2013,” in the United States House of Representatives this summer seeking to abolish the in-office ancillary services exception to the Stark law, potentially jeopardizing this important component to coordinated quality health care. Mandated ICD-10 implementation is also just around the corner.

States continue to be the most active players in health care with state legislatures debating and passing laws on Medicaid expansion, scope of practice, medical liability, telemedicine, third-party payor issues, and pharmaceuticals, among others. We have seen legislative successes in states like Florida, where active physician engagement led to the passage of a very important medical liability reform law this year which will, in part, require a testifying expert in a medical liability case to be from the same specialty as the defendant physician. In my home state of Washington, after a two-year campaign involving the hard work of Washington State Urology Society along with others, we were able to pass SB 5215 which prohibits the state from tying medical licensure to participation in a particular third-party payor system and bars insurers from changing the terms of their provider contracts without the specific consent of the provider – two issues that are a part of the AACU’s State Initiative Program being launched, as discussed below. SB 5215 was introduced by Senator Randi Becker, recipient of the AACU’s 2011 Distinguished Leadership award, who heard about the threat of compulsory participation in third-payor programs during a presentation on the AACU’s Freedom to Practice Campaign at the 2011 AACU State Society Advocacy Network Conference.

All of this demonstrates the importance of staying engaged and being a member of the AACU. The AACU is the only national organization representing urologists whose sole purpose is advocating our specialty’s widely held views on these and many other issues. The AACU team tracks and monitors the legislation coming out of Washington, D.C. and all 50 states, keeping you alerted to and informed about the important issues that affect your practice and your patients. As you heard at this year’s AACU State Society Advocacy Network Conference, there will soon be an improved and enhanced AACU website, allowing members to proactively influence legislation in their own states, a part of the AACU’s new State Initiative Program. The five issues that will be

the focus of this program are: strengthening expert witness standards in medical liability cases; medical practice freedom and fair contracting; administrative reform through prior authorization simplification; prostate cancer testing mandates; and scope of practice.

Please join us March 9 – 11, 2014 in Washington, D.C. for the 9th Annual Joint Urology Advocacy Conference (JAC), co-sponsored by the AACU and AUA. This annual conference held in our nation’s capitol integrates the national legislative agenda for both organizations along with health policy presentations from Congressional elected officials, staff and policy consultants, ending with visits to the ‘Hill,’ and direct interactions with congressional members and staff. If you have never been to the JAC, I urge you to attend this year. It is important for urologists to experience the process first hand. Please visit www.jac2014.org and register. You will find it a most worthwhile experience.

My goal as president is to continue to build upon our past successes and expand our membership throughout the country. There are a number of states with no urological society and the AACU would like to assist urologists in those states where it can in forming societies. Also, to improve our State Society Network, I would like to increase the number of State Society Network Representatives, the “boots on the ground,” in each of the states so that urologists have the opportunity to more effectively react to and influence health care legislation in the states. To succeed, it is vital that we have a robust and growing membership. I encourage each of you to engage your colleagues who may not be members of the AACU and urge them to join and be a part of this important and influential organization.

We will thrive as individuals and as a specialty if we stick together and act when called upon, whether that’s continuing your AACU membership or sending a message to your elected officials. I urge all of you to not only renew your membership but actively recruit your associates to join us.

Thank you for your support of the AACU, and have a great new year!

Richard S. Pelman, MD2013 – 2014 AACU President

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AACU Sentinel The Newsletter of the American Association of Clinical Urologists (AACU) Protecting the Political and Professional Interests of Urology since 1968

AACU OFFICERS President Richard S. Pelman, MD Bellevue, WA

President-Elect Mark D. Stovsky, MD, MBA, FACS Cleveland, OH

State Society Network Chair Martin K. Dineen, MD Daytona Beach, FL

Secretary/Treasurer Charles A. McWilliams, MD Oklahoma City, OK Past President Mark S. Austenfeld, MD Kansas City, MO Health Policy Chair Jeffrey M. Frankel, MD Seattle, WA

AACU Sentinel Staff Editor: Charles A. McWilliams, MD Managing Editor: Tristan Powell

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Cover Story: Urologists Unveil Future Health 01 Delivery at AACU Conference Letter from the President 02

AACU Officers 03

Will 2014 be the Year for a Permanent Fix to SGR? 04

NDAA Pases House and Senate with 05 Urotrauma Language Included

2014 State Legislative Sessions (Projected) 05

2014 JAC Program 06

AMA House of Delegates Report 08

UROPAC Update 10

Thank You to Our Industry Partners/ 11

Industry Opportunities

Register for JAC Today 12

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physicians in grassroots activity, would be leveraged to support organizational development across the country.

AACU Health Policy Chair Jeffrey Frankel, MD, also led a session during which the AACU’s proactive legislative campaigns were outlined. These campaigns will involve five key issues, as outlined below. Information and advocacy tools surrounding these issues will be a part of the AACU’s new website, which will be rolled out later this year.

AACU proactive advocacy campaigns:• Public Health–Prostate Cancer Screening & Awareness

Goal: State law requiring all payers to cover screening for prostate cancer.

• Scope of Practice–Collaborative Physician-led Care Goal: Expanded scopes of practice for non-physician providers must maintain a physician as the leader in the provision of medical care.

• Administrative Simplification–Uniform Prior Authorization Goal: Require all payers to utilize uniform electronic prior authorization forms for pharmaceuticals, procedures, and services.

• Medical Liability Reform–Expert Witness Standards Goal: Strengthen expert witness requirements to ensure witnesses have specialty-specific expertise and are accountable for the validity of their testimony.

• Work Force–Fair Contracting and Medical Practice Freedom Goal: Ensure fair and open contractual relationships between third-party payers and health care providers and prohibit tying health care provider licensure to participation in a third-party payer program.

Urology societies and individual urologists, empowered with model legislation, talking points, and coalition-building resources fashioned by the AACU, will achieve distinction within the medical community for their progressive push for pro-patient and pro-physician measures. Whether a state urology society already engages in socioeconomic affairs or it currently focuses solely on science, the AACU will encourage and reinforce proactive advocacy campaigns.

Conference attendees, including the leaders of more than two dozen organizations representing urologists, exhibited tenacity and resolve during the AACU State Society Network Advocacy Conference that will sustain the entire urology community as the uncertain future is revealed.

2014 AACU Membership Campaign

Current AACU members have been receiving dues renewal notices as part of the 2014 AACU membership campaign. Please watch your mailboxes or renew online at www.aacuweb.org. Your ongoing commitment helps the AACU tackle the tough issues facing the urologic community.

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As 2013 came to a close, there was flurry activity surrounding the widely unpopular Medicare Sustainable Growth Rate (SGR). Ultimately, lawmakers were able to prevent a roughly 24% cut in reimbursement rates under SGR from going into effect on January 1, 2014, temporarily delaying the reduction for three months, under a provision of the two-year budget deal achieved by the GOP and Democrats in the remaining days of 2013. This temporary fix, which ends March

31, 2014, also provides for a 0.5% increase to physician payments during the three-month time period. However, lawmakers did not end or modify the 2% across-the-board Medicare cuts that went into effect under the 2013 government sequestration, and will be continued through 2023.

Still, in the midst of all this last minute deal-making, a more permanent solution to SGR may be taking shape. Hope for a permanent solution was sparked earlier in the year when the Congressional Budget Office released in February a revised estimate of $138 billion for the cost of repealing SGR and freezing Medicare rates for the next 10 years, down from its prior November 2012 estimate of $244 billion. Also in February, Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV) reintroduced H.R. 574, the “Medicare Physician Payment Innovation Act 0f 2013,” a bill that repeals SGR, and Majority members of the House Energy and Commerce and Ways and Means Committees released a statement of principles for SGR repeal and reform.

As the year progressed, so did movement on SGR. On July 24, Representative Michael Burgess (R-TX) introduced H.R. 2810, entitled the “Medicare Patient Access and Quality Improvement Act of 2013,” which repeals SGR and garnered 40 co-sponsors, 28 Republicans and 12 Democrats. After a number of amendments, the bill passed the full House Energy and Commerce Committee on July 30 with a unanimous 51-0 vote. In October, the Senate Finance Committee in conjunction with the House Ways and Means Committee released a draft proposal labeled a “discussion memo” on the repeal of SGR. Revisions were made to the discussion memo and a subsequent mark-up session by the Senate Finance Committee led to bill, S. 1871, entitled, the “SGR Repeal and Medical Beneficiary Access Improvement Act of 2013.” By voice vote, the Senate Finance Committee passed S. 1871 on December 12. Meanwhile, in the House, the Ways and Means Committee voted on and unanimously passed a revised version of H.R. 2810.

Both H.R. 2810 and S. 1871 seek to repeal SGR and replace it with a new system governing updates and adjustments to Medicare payments. A major difference between the bills is how payment updates are treated for the first 10 years following repeal. Under H.R. 2810, there are annual 0.5% updates (increases) to physician payments from 2014 through 2016, but no automatic annual updates from 2017 to 2023. Under S. 1871, there are no automatic annual updates at all up through 2023. Then beginning 2024 and for each subsequent year, under both bills, there will be 2% annual updates for items and services provided by a qualified alternate pay model (APM) provider, and 1% annual updates for all other items and services.

H.R. 2810 and S. 1871 share a number of other common elements, including the creation of a value-based performance program (“VBP”) that would consolidate and replace the Physician Quality Reporting, Value-Based Payment Modifier and “meaningful use” programs, and beginning 2017 would allow for additional payment increases to high-performing professionals. Both bills also provide for incentive bonuses to physicians who participate in APMs. Additionally, there are provisions addressing the administration of the VBP, how quality measurements are to be determined, and improvements to the accuracy of relative value unit computations and corresponding adjustments.

While no permanent fix of SGR was passed in 2013, there is hope that something will be done in 2014. Indeed, the temporary measure preventing SGR cuts from taking effect January 1 will expire March 31, putting pressure on lawmakers to accomplish something in that time frame. There still remains, however, the question of how to pay for repeal. One idea to help contain costs included in both bills is the development of appropriate use criteria (“AUC”) for imaging services. Ordered imaging services will need to meet AUC – which will be determined with input from physicians -- for reimbursement. While both bills limit the application of the AUC system to imaging services, the bills leave open the possibility that it may be expanded to other services.

There is a concern that some may seek to pay for SGR repeal, at least in part, through the elimination of the in-office ancillary services exception (IOASE) to the Stark law. Representative Jackie Speier (D-CA) filed H.R. 1914, the so-called “Promoting Integrity in Medicare Act of 2013,” seeking to do away with the IOASE last summer. Recently, Senators Tom Coburn, MD (R-OK), John Barrasso, MD (R-WY), Rand Paul, MD (R-KY) and John Boozman, OD (R-AR) wrote to Senate leaders, Harry Reid (D-NV) and Mitch McConnell (R-KY), expressing their support for the IOASE and applauding the development of the AUC found in the Senate Finance and House Ways and Means discussion memo on SGR repeal. The AACU along with the AUA and LUGPA issued a joint press release applauding those Senators’ letter. Also, the AACU is opposed to an agreement that would foster division within the House of Medicine by increasing payments for primary care services at the expense of specialty services.

So expect to see continued debate on SGR repeal as 2014 begins. The medical community will be closely watching how this plays out in Washington, and given the stakes it will be important for all of us to make sure SGR repeal is accomplished conclusively and fairly, and in a way that does not negatively impact access or patient care.

Will 2014 Be the Year For a Permanent Fix to SGR?By: Jeffrey M. Frankel, MD & Daniel Shaffer, JD, Legislative Attorney

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NDAA Passes House and Senate With Urotrauma Language Included By: Mark T. Edney, MD, FACS AACU Board Member, Mid-Atlantic Section Representative

With the passage of the National Defense Authorization Act (NDAA) in the US Senate late in the evening on December 19, organized urology sealed a legislative victory that has been three Congressional sessions in the making.

This NDAA contains the urotrauma language that we have been fighting for, on behalf of injured veterans, for many years. The Department of Defense must now, by law, consider urotrauma as a distinct entity with respect to care coordination and research instead of lumping it in with other injury patterns as it historically has done.

This enormous victory for veterans and for organized urology is a case study in what grass roots advocacy can achieve. There are so many individuals and organizations who played critical roles: AACU, AUA, and LUGPA members, committed staff members of these organizations, our lobbyists at Hart Health Strategies, and our coalition partners, American College of Surgeons, American College of Obstetrics and Gynecology, Society for the Study of

Male Reproduction, American Society for Reproductive Medicine, Society for Male Reproduction and Urology and the long list of veteran advocacy organizations as well as industry partners.

The pistons of the engine that drove this victory were the many different contacts and relationships that urologists have forged with members of Congress. Over the last several Joint Advocacy Conferences (JAC), we took our urotrauma message into offices. Outside of the JAC, several of us have met with members and staffers, and have gone to fundraisers to get a few minutes of face time to highlight our urotrauma effort. A strong UROPAC has been an important component of our advocacy in Washington and it is critical to maintaining urology’s voice on Capitol Hill.

Many have written letters and made phone calls, including many members of our urology coalition in Maryland which was integral in getting Senator Cardin to co-sponsor the amendment in the Senate.

It’s indeed a huge advance for veteran victims of urotrauma past and future. And it’s a great day for organized urology advocacy. We should celebrate this victory and study its anatomy – It’s a template on which we can build future successes.

2014 State Legislative Sessions (Projected)

State Projected Session Dates Alabama 01/14/14 - 04/30/14 Alaska 01/21/14 - 04/20/14 Arizona 01/13/14 - 05/16/14 Arkansas 02/10/14 - 03/11/14 California 01/06/14 - 08/31/14 Colorado 01/08/14 - 05/07/14 Connecticut 02/05/14 - 05/07/14 Delaware 01/14/14 - 06/30/14 Florida 03/04/14 - 05/02/14 Georgia 01/13/14 - 03/31/14 Hawaii 01/15/14 - 05/02/14 Idaho 01/06/14 - 03/28/14 Illinois 01/29/14 - 05/31/14 Indiana 01/06/14 - 03/14/14 Iowa 01/13/14 - 04/22/14 Kansas 01/13/14 - 04/12/14 Kentucky 01/07/14 - 04/15/14

State Projected Session Dates

Louisiana 03/10/14 - 06/02/14 Maine 01/08/14 - 05/31/14 Maryland 01/08/14 - 04/07/14 Massachusetts 01/08/14 - 12/31/14 Michigan 01/08/14 - 12/18/14 Minnesota 02/25/14 - 05/19/14 Mississippi 01/07/14 - 04/06/14 Missouri 01/08/14 - 05/30/14 Montana No regular session in 2014Nebraska 01/08/14 - 03/08/14 Nevada No regular session in 2014New Hampshire 01/08/14 - 06/30/14 New Jersey 01/14/14 - 12/31/14 New Mexico 01/21/14 - 02/20/14 New York 01/08/14 - 06/30/14 North Carolina 05/14/14 - 06/30/14 North Dakota No regular session in 2014

*Subject to change. Most legislatures also establish deadlines for bill drafting, bill introduction, “cross-over”, etc.

State Projected Session Dates

Ohio 01/06/14 - 12/31/14 Oklahoma 02/03/14 - 05/30/14 Oregon 02/03/14 - 03/09/14 Pennsylvania 01/07/14 - 11/30/14 Rhode Island 01/07/14 - 06/30/14 South Carolina 01/14/14 - 06/05/14 South Dakota 01/14/14 - 03/31/14 Tennessee 01/14/14 - 04/30/14 Texas No regular session in 2014 Utah 01/27/14 - 03/13/14 Vermont 01/07/14 - 05/09/14 Virginia 01/08/14 - 03/08/14 Washington 01/13/14 - 03/12/14 West Virginia 01/08/14 - 03/08/14 Wisconsin 01/14/14 - 05/01/14 Wyoming 02/10/14 - 03/07/14

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SUNDAY, MARCH 9, 2014

11:45 a.m. – 12:00 p.m. Welcome Richard Pelman, MD President, AACU Pramod C. Sogani, MD, FACS, FRCS

President, AUA

12:00 p.m. – 1:00 p.m. Keynote Address David Hawkings Senior Editor, Roll Call

1:00 p.m. – 1:15 p.m. Break

1:15 p.m. – 2:15 p.m. The State of Urology Address Richard Pelman, MD President, AACU David F. Penson, MD, MPH Chair, AUA Health Policy Council Juan Reyna, MD President, LUGPA

2:15 p.m. – 2:45 p.m. 2014 Urology Joint Advocacy Priorities Overview: Presenting the “Asks”

Jeffrey M. Frankel, MD Chair, AACU Health Policy Council James Ulchaker, MD Chair, AUA Legislative Affairs Committee

2:45 p.m. – 3:00 p.m. Break

3:00 p.m. – 4:00 p.m. Joint Advocacy Priority: Affordable Care Act Implementation

Moderator: Mark Stovsky, MD AACU President-elect

Panelists:Elizabeth Fowler, PhD, JD Government Affairs and Policy Group, Johnson & Johnson; Former Special Assistant to the President for Healthcare and Economic Policy at the National Economic Council. Taylor Burke, JD, LLMAssociate Professor, Department of Health Policy, School of Public Health & Health Services, George Washington University

9th Annual Urology Joint Advocacy ConferenceHyatt Regency Washington on Capitol HillWashington, D.C.March 9–11, 2014

4:00 p.m. – 4:45 p.m. Keynote AddressDavid Hoyt, MD, FACS Executive Director, American College of Surgeons

5:00 p.m. – 7:00 p.m. Welcome Reception Room Congressional Room A/B

MONDAY, MARCH 10, 2014

7:00 a.m. – 8:00 a.m. Breakfast

8:00 a.m. – 8:30 a.m. UROPAC Update Arthur Tarantino, MD Chair, UROPAC James Ulchaker, MD Vice-Chair, UROPAC

8:30 a.m. – 9:30 a.m. A View from the Hill: Sustainable Growth Rate

Moderator: Christopher Gonzalez, MD Vice Chair, AUA Health Policy Council Panelists:

Karen Fischer Professional Staff, Majority; Senate

Finance Committee Dan Todd Health Policy Advisor, Minority; Senate Finance Committee Brett Baker Professional Staff, Majority, House Ways & Means Committee

9:30 a.m. – 10:30 a.m. A View from K Street: Urology’s Policy

Priorities Moderator: Eugene Rhee, MD, MBA Panelists:

Vicki Hart Principal, Hart Health Strategies John McManusPresident, The McManus Group

Tracy Spicer Partner, Avenue Solutions

10:30 a.m. – 10:45 a.m. Break

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10:45 a.m. – 11:45 a.m. Joint Advocacy Priority: Medical Liability Reform Moderator: Patrick McKenna, MD Panelist:

Neil Dunn, MD Elizabeth Healy Director Government Relation, The Doctors Company

11:45 a.m. – 12:00 p.m. Break 12:00 p.m. – 1:00 p.m. UROPAC Luncheon Room Regency B

12:30 p.m. – 1:15 p.m. UROPAC Keynote AddressMichael Barone Respected political historian; Senior writer, U.S. News & World Report

1:15 p.m. – 1:30 p.m. Break

1:30 p.m. – 2:30 p.m. Grassroots Campaign Development: Men’s Health

Moderators: Jonathan Henderson, MD Juan Reyna, MD

Panelists: Justin Borland VP Government Affairs, ZEROPete Anthony SVP, Advocacy and Engagement, CQ Roll CallBrandon Legnard Director Strategic Initiatives, Mens Health Network

2:30 p.m. – 3:30 p.m. AACU Russell Carson Memorial LectureCongressman Andy Harris (R-MD)

3:30 p.m. – 3:45 p.m. Break 3:45 p.m. – 4:45 p.m. How Congress Really Works

Judy Schneider Specialist on the Congress, Congressional Research Service

4:45 p.m. General Session Adjourned

5:00 p.m. – 6:00 p.m. UROPAC Reception Room Congressional A TUESDAY, MARCH 11, 2014

8:00 a.m. – 8:30 a.m. Breakfast & Last Minute Logistics Room Columbia A/B

9:00 a.m. – 11:30 a.m. Senate Meetings Senate Office Buildings

11:30 a.m. – 12:30 p.m. Luncheon on Capitol Hill Room 106 Dirksen Senate Office Building

1:00 p.m. – 4:30 p.m. House Hill Meetings House Office Buildings

5:00 p.m. Conference Concludes

Michael Barone is Senior Political Analyst for the Washington Examiner and a Resident Fellow at the American Enterprise Institute. He is a contributor to Fox News Channel and co- author of The Almanac of American Politics. He grew up in Detroit and Birmingham, Michigan. He was graduated from Harvard College (1966) and Yale Law School (1969), and was an editor of the Harvard Crimson and the Yale Law Journal.

Mr. Barone served as Law Clerk to Judge Wade H. McCree, Jr., of the United States Court of Appeals for the Sixth Circuit from 1969 to 1971. From 1974 to 1981 he was a Vice President of the polling firm of Peter D. Hart Research Associates. From 1981 to 1988 he was a member of the editorial page staff of the Washington Post. From 1989 to 1996 and again from 1998 to 2009, he was a Senior Writer with U.S. News & World Report. From 1996 to 1998 he was a Senior Staff Editor at Reader’s Digest.

Mr. Barone is the principal co-author of The Almanac of American Politics, published by National Journal every two years. The first edition appeared in 1971, and the 22nd edition, The Almanac of American Politics 2014, appeared in August 2013. He is also the author of Our Country: The

UROPAC Keynote Address: Michael BaroneShaping of America from Roosevelt to Reagan (Free Press, 1990), The New Americans: How the Melting Pot Can Work Again (Regnery, 2001; paperback edition, July 2006), Hard America, Soft America: Competition vs.Coddling and the Competition for the Nation’s Future (Crown Forum, 2004; paperback edition, 2005), Our First Revolution: The Remarkable British Upheaval That Inspired America’s Founding Fathers (Crown Forum, 2007) and the Shaping Our Nation: How Surges of Migration Transformed America and Its Politics (Crown Forum, October 2013).

Over the years he has written for many other publications in the United States and several other countries, including the Economist, the Times Literary Supplement and the Daily Telegraph and the Sunday Times of London. His column is syndicated by Creators Syndicate.

Mr. Barone received the Bradley Prize from the Lynde and Harry Bradley Foundation in 2010, the Barbara Olsen Award from The American Spectator in 2006 and the Carey McWilliams Award from the American Political Science Association in 1992.

Mr. Barone lives in Washington, D.C. He has traveled to all 50 states and all 435 congressional districts. He has also traveled to 54 foreign countries and has reported on recent elections in Britain, Italy, Russia and Mexico.

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Report from the Interim Meeting of the AMA House of DelegatesBy: Jeffrey Kaufman MD, FACS

The Interim meeting of the AMA House of Delegates convened at the Gaylord Hotel, National Harbor, Maryland just outside of Washington, D.C. this week. As usual, there was considerable discussion of a range of topics including public health issues like regulation of electronic cigarettes and immunizations; status of industry financial support of health care education; scope of practice; internal AMA administrative and organizational issues; and pharmaceutical issues like

medication shortages, off label medication use and control of compounded pharmacies; however, most of the discussion centered on addressing the myriad issues raised by the Affordable Care Act (including multiple calls to repeal many of its components), halting or paying for ICD-10 and repeal of the SGR formula.

There was a call for federal legislation to shorten the waiting interval between signing informed consent and performing permanent sterilization procedures (tubal ligation and vasectomy) from 30 days for Medicaid patients and other groups. To discourage inappropriate and illegitimate work by the RAC contractors, there was reaffirmation of policy asking for penalties, interest and payment of costs generated by successful appeals when the RAC claim is later overturned to cover the financial burden necessary to defend against RAC audits. A resolution supported continued exemption from Stark and Anti-kickback laws for financial support provided to physicians for EHR software. Similarly, the House reaffirmed policy to abolish fines for failing to comply with Meaningful Use phase two and three without eliminating the bonus paid for successful compliance. A position paper combining current AMA policies regarding the Affordable Care Act included a phrase that could be taken to support conclusions made by the USPSTF despite vigorous urology caucus testimony against. It will be necessary to introduce another resolution next year to change this policy (AMA Policy H-330.896). Because of ongoing confusion, the AMA requested further clarification from CMS of the two midnight rule that determines inpatient status versus outpatient observation. There was yet another call to abolish the IPAB (see below for more on this).

The AMA has called on the private insurance industry to establish a fairer retro-authorization process and eliminate automatic pre- payment audits for arbitrary reasons lacking demonstrated indications. Fees are being cut universally; adding unfair costs and hurdles to collecting for honest charges should not continue.

The delegates approved a number of resolutions regarding the Affordable Care Act such as a resolution against making insurance exchange participation mandatory, a resolution requiring real time eligibility verification and a resolution making authorization of care linked to guarantee payment. Current law allows patients who are delinquent paying premiums a 90 day grace period before their insurance is cancelled. However, the insurance company is not required to tell the treating physician that the patient has entered

such a grace period. Although the insurer is responsible to make payment for care provided within the first 30 days of that period, they will pend all claims for care delivered between the 31st and 90th day without notifying the treating provider of such a status. If the patient comes current with his premiums during that time, payment will ultimately be made. However, if the patient fails to pay his premiums, all care charged beyond the 30th day is the patient’s responsibility, the insurer will not pay (even though they said the patient was covered by insurance that made them eligible for coverage). Given that many of these patients are economically disadvantaged, the chances of collect-ing more than three months after care was delivered from the patient who has lost coverage is between slim and none. The AMA is calling for transparency and fairness: the insurance company must notify the provider when the patient enters this grace period and how far into it he is, provide concurrent real-time verification of eligibility, allow the doctor to collect a deposit if the patient is within the grace period and he decides to treat anyway (minimizing the provider’s jeopardy) and makes the insurer responsible for payment if the provider is not notified of the patient’s delinquency (authorization guarantees payment). While AMA policies are not enforceable, this proposal directs AMA lobbyists to advocate for correction of current ACA law.

The ACA requires that ICD-10 be used for all billing subject to HIPPA beginning October 1, 2014. Although current AMA policy is to repeal ICD-10, we have been told by Congress and CMS that there will be no repeal and no further delays. This transition will cost physicians between $28,000-85,000 per doctor depending on their practice status and create a potential delay in payments lasting up to six months, subject providers to increased audits and denials while providing no benefit to patients, providers or the health care system. This radical change in coding and documentation involving entirely new codes and an explosion in the number of codes used creates a granularity of detail far beyond any needed for clinical care or even most research. The House of Delegates called again for maximal efforts to prevent ICD-10 but asks, if it is imposed, that Congress provide funds to offset physician costs. Legislation is pending that calls for ICD-10 repeal which should be supported by every practicing urologist (HR 1701 “The Cutting Costly Codes Act” and its companion Senate bill S 972). PLEASE CONTACT YOUR CONGRESSMAN AND SENATORS TODAY TO REQUEST THAT THEY COSPONSOR AND SUPPORT THIS LEGISLATION.

The AMA reaffirmed its support of Fee for Service as well as integrated multi-specialty group practice among a range of choices that are appropriate in a pluralistic model that allows healthcare delivery in a diversified system without favoring any single option over another recognizing that different patients will benefit from different types of healthcare.

An informational presentation regarding AMA negotiations over SGR repeal on Saturday was followed by vigorous discussion and debate over related resolutions for the rest of the meeting. The Congressional Energy and Commerce committee passed SGR repeal legislation with bipartisan support 51-0 on July 31 but the $180 billion pay-for has not been solved. The Senate Finance and House Ways and Means committees have gone forward and floated a bipartisan bicameral draft proposal that would freeze physician fees for 10 years but allow for some bonuses based on quality performance. The negatives attached to this are obvious since it does not index for medical inflation that has and will continue to increase the costs of providing medical care. The myriad of current quality reporting programs will be streamlined and combined into one score that will impact payments no matter how many of us feel that current metrics do not accurately measure quality or properly attribute costs. Although the draft does not promise that fees are immune from future IPAB cuts, the freeze is likely to keep healthcare costs sufficiently under control that it’s unlikely that the IPAB will make cuts even if such a panel is created. The

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overall goal is to freeze FFS fees while allowing some bonus payments for value based performance. The “freeze” applies to global Medicare payments allowing continued redistribution among physicians which still threatens to cut specialty payments in favor of primary care. The freeze will still create a debt to be paid under current Congressional rules but this money has now been earmarked to come from other sources. If the SGR continues, another one year freeze for 2014 will cost $18 billion and the $139 billion price tag would almost certainly swell but, if the SGR is repealed, the cost for future small increases (if any are forthcoming) will be much less due to calculations on past interest no longer accruing on deferred cuts. The bill does not address tort reform or otherwise include limits on unfunded mandates that continuously increase overhead (meaningful use of EHR, PQRS reporting, etc.). Future participation in two sided alternative payment models (accepting risk in return for potential profit) will allow for potential bonuses but is not required.

This is not a good deal and AMA members voiced considerable displeasure and frustration. However, leadership repeatedly emphasized that the alternative to accepting this painful compromise is to suffer the SGR-dictated 24.4% cut January 1 or, perhaps even more harmful, continued moderate cuts to reimbursement annually for several years leading to even lower rates. Recognize that

physicians have already endured a 12 year freeze during which time overhead has risen by 30%. Most other factions in healthcare have escaped this control and enjoyed cost of living increases that match medical inflation annually. It has only been physicians who are asked to suffer so much. By the time this is read, much of this negotiation will have played out, voices will be raised and few will be satisfied. Repeating my message above, if we are forced to endure further freezes, Congress should mitigate the impact by halting imposition of ICD-10. PLEASE CONTACT YOUR CONGRESSMAN AND SENATORS TODAY TO DEMAND THAT ICD-10 BE AVERTED. This is a timely issue. If we delay in pressing the message, it will be too late. Let them know how further lost income and dramatic increases in overhead will impact your ability to deliver care to your patients. The loudest argument is Washington regards access to care. If I cannot afford to remain in practice, it is my patients who suffer.

I hope to have better news with my next update (hope springs eternal). As usual, please contact me for any questions on these or other matters.

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UROPAC UpdateBy: Arthur Tarantino, MD

With the completion of the new affiliation agreement between the AACU and the AUA, UROPAC, the only Federal PAC that speaks for all of Urology, has been totally restructured. I am honored and excited to be the new UROPAC Chair, and would like to thank the AACU Board of Directors and membership for this opportunity. Gary Kirsh, MD has done a phenomenal job as UROPAC Chair, and I would like to personally thank him for all his hard work and dedication in making UROPAC the political action committee (“PAC”) that it is today.

PAC restructuring has included the following:

New Articles of OrganizationTotally rebuilt website – www.UROPAC.org Revised Standard Operating ProceduresBudgeting and Financial ResponsibilitiesTargeted Giving Strategy to Key LegislatorsStrategic Fundraising Initiative to be Launched

Our New Board of Directors is as follows: Chair: Art Tarantino, MD (AACU) Vice Chair: Jim Ulchaker, MD (AUA) Secretary: Dave Penson, MD (AUA) Treasurer: Tom Brown, MD (AACU)

At Large: Jeff Frankel, MD (AACU) Gary Kirsh, MD (LUGPA) David Glazier, MD (LUGPA)

There have been dramatic administrative changes as well. UROPAC started working with Aristotle, a Washington, D.C. based PAC consulting, services and software firm with years of experience in assisting PACs. Its Aristotle 360 database will facilitate the communications and grass-roots efforts of UROPAC. Our website has been totally redesigned and contains features such as a Politico newsfeed, political resources for members, and a convenient way to contribute to UROPAC. UROPAC now has infrastructure to be an even stronger voice in Washington, D.C.

2014 is going to be a consequential election year. All 435 seats in the House of Representatives are up for election in 2014 as are 1/3 of the Senate seats. Congress may be on the verge of finding a permanent solution to the Medicare Sustainable Growth Rate, and there will be continued challenges to be faced with the Affordable Care Act implementation, among many other issues. For more information on UROPAC, please visit the new website at www.UROPAC.org.

I thank you for your support.

Arthur Tarantino, MD2013 – 2014 UROPAC Chair

If you have an article or item of interest that you would like to be considered for publication in the AACU Sentinel, please submit to:

Tristan PowellEmail: tristan@wjweiser.com

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AACU Corporate Membership and Promotional OpportunitiesPromotional Partnerships are a vital part of our success. The AACU is currently seeking corporate members who share our commitment to growth and excellence in the field of urology. Through this program, we hope to work in tandem with our industry colleagues to identify ways to enhance our current member programs and implement new projects that will lead to im-proved patient care through better physician education and mentoring. Please invite your industry contacts to become AACU corporate members. Please ask them to contact JP Baunach at jp@wjweiser.com for more information.

Thank You to Our 2013 AACU State Society Network Industry Partners

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Two Woodfield Lake 1100 E Woodfield Road, Suite 350

Schaumburg, IL 60173-5116

ADDRESS SERVICE REQUESTED

REGISTER TODAY9th Annual Urology Joint Advocacy Conference

March 9 – 11, 2014Hyatt Regency Washington on Capitol Hill | Washington, DC

Visit www.jac2014.org for more information.