August 2021 - AUA Public Policy Council Update for MAS

From the Chair

MAAUA Chair 2020

I am pleased to share updates from the AUA Public Policy Council that may benefit your Section members. Our updates include information on the AUA’s analysis of the 2022 Medicare Physician Fee Schedule proposed rule, updates on the Veterans’ Prostate Cancer Treatment and Research Act reintroduction, and a recap of the Annual Urology Advocacy Summit including further details on agency meetings.

We also welcome Jeremy Haines, MA, as our new Legislative & Political Affairs Manager. Jeremy comes to us from the Society of Interventional Radiology where he was the Manager of Health Policy, PAC and Grassroots Advocacy. There, Jeremy held numerous responsibilities – serving as an advocacy representative for the organization before congressional offices and federal regulators. In addition, he strategized with senior staff and organization stakeholders to define their advocacy priorities. Prior, Jeremy was the Grassroots Advocacy Coordinator at the Amputee Coalition where he coordinated advocacy efforts resulting in the engagement of legislative initiatives and organized meetings and trainings for the organization’s National Hill Day.

Jeremy’s experience with advocacy, implementing grassroots strategies, and analyzing state and federal health issues will help him make an immediate impact for the AUA. His lobbying portfolio will primarily include House Energy & Commerce Committee and Senate Health, Education, Labor & Pensions Committee members. He will serve as the staff liaison to the Legislative Affairs Committee. Please join me in welcoming him to the AUA!

SAVE THE DATE! The 5th Annual Urology Advocacy Summit is slated for March 14-16, 2022 in Washington, DC.

AUA Update to Members on the CY 2022 Medicare Physician Fee Schedule

On July 29, the AUA published a deep-dive analysis of the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) proposed rule. The Centers for Medicare & Medicaid Services’ (CMS) proposed rule includes numerous proposed policy changes that include the following:

  • A $1.31 reduction in the Medicare conversion factor used to calculate physician reimbursement.
  • An increase in clinical labor rates as a component of the direct practice expense formula, which results in significant decreases for some procedures commonly performed by urologists.
  • Medicare contractor pricing for four new periurethral adjustable balloon continence devices as recommended by the Relative-Value Scale Update Committee (RUC).
  • Changes with respect to split/shared Evaluation & Management visits in the facility setting with an emphasis on duplication of care and medical necessity of visits.
  • Changes to the Merit-Based Incentive Payment System (MIPS), including the implementation of MIPS Value Pathways (MVPs) beginning in 2023 in anticipation of the proposed phase out of traditional MIPS in 2027.

The overall impact of the CY 2022 MPFS proposed rule on an individual physician’s reimbursement will depend upon their patient case mix. The AUA’s analysis also includes tables that detail the specialty impacts and facility and non-facility impacts on a number of urology-focused CPT codes and Evaluation & Management CPT codes. The AUA is participating in several medical coalitions and workgroups to strategize on these issues and finalize formal comments to the agency.

Veteran’s Prostate Cancer Legislation Reintroduced in the House
On July 29, the Veteran’s Prostate Cancer Treatment and Research Act was reintroduced in the U.S. House of Representatives (H.R. 4880). This important legislation directs the Secretary of Veterans Affairs to establish a national clinical pathway for prostate cancer within the National Surgery Office of the Veterans Administration for all stages of prostate cancer.

Since 2019, the AUA has been working closely with other urologic stakeholders, such as ZERO – The End of Prostate Cancer, to have this legislation move through the legislative process. It passed the House last September, but failed to move in the Senate, so the bill required reintroduction this year. Representative and urologist Neal Dunn, MD (R-FL-02) is the bill’s primary sponsor. Original cosponsors include the other urologist serving in congress, Rep. Greg Murphy (R-NC-03), as well as Rep. Elissa Slotkin (D-MI-08), and Rep. Colin Allred (D-TX-32).

On August 4-5, the AUA had follow-up meetings with staff in the offices of Representatives Bob Good (R- VA-05), Lauren Underwood (D-IL-14), and Mariannette Miller-Meeks (R-IA-02) and on August 10 with staff in the office of Representative Burgess Owens (R-UT-04) to garner support and co-sponsorship of the recently introduced Veterans’ Prostate Cancer Treatment and Research Act (H.R. 4880).

Critical prostate cancer care for our veterans – featuring this particular legislation – was one of four congressional “leave behind” topics that attendees discussed with their legislators during the July 21 Virtual Hill Day as part of the 2021 Annual Urology Advocacy Summit. Moving forward, the AUA will ramp up to find Senate champions to ensure that a companion bill is introduced in the upper chamber.

The AUA has created a grassroots alert that allows any domestic AUA member to contact their federally elected officials to ask them to cosponsor this legislation. To access this action center, click here or simply text AUA to 52886 to get started.

2021 Annual Urology Advocacy Summit Recap

Thank you to all that joined us for the virtual Annual Urology Advocacy Summit. More than 265 attendees registered for the Summit this year, including more than 85 medical students, residents, and fellows. Summit attendees participated in more than 160 virtual meetings with congressional offices from 35 states. AUA members were able to discuss critical health policy issues with lawmakers and/or members of their staff covering telehealth expansion, physician specialist workforce shortages, veterans’ prostate cancer care, and urology research funding.

The Summit opened with a Patient Roundtable Event showcasing how AUA’s committees partner with patient advocacy organizations to advocate for greater access to care and development of stronger patient-provider communications on care options.

Other highlights included a Student, Resident, and Fellow Advocacy Night featuring Representative Kim Schrier, MD (D-WA-08). Representative Schrier emphasized the importance of physician advocacy. Attendees also had the opportunity to participate in four different breakout sessions with AUA leadership in the areas of patient/practice advocacy, research advocacy, workforce advocacy, and political advocacy.

On July 20, there was a two-hour comprehensive review session of the congressional “asks”: support H.R. 944 to address specialty medicine physician shortages in rural areas, support legislation to develop a national prostate cancer clinical pathway for veterans, support the CONNECT for Health Act of 2021 to permanently expand telehealth services, and support federal funding for urological research.

Ashish Jha, MD, MPH, who is recognized globally as an expert on pandemic preparedness and response as well as on health policy research and practice, was the AUA Summit Keynote Speaker. Dr. Jha updated attendees on where the nation stands with respect to COVID-19 and shared tremendous insight on the current challenges facing our healthcare delivery system. “As physicians, all of us have a role to play to combat organized misinformation and concerted efforts to cause confusion. Advocate for evidence, science, and data like we practice the craft of medicine,” he advised Summit participants.

Agency Meetings Update

Agency for Healthcare Research and Quality
On July 19, Public Policy Council Chair Eugene Rhee, MD, MBA; Urology Telehealth Task Force Chair Aaron Spitz, MD; and Coding and Reimbursement Committee Chair Jonathan Rubenstein, MD, FACS, met with Agency for Healthcare Research and Quality (AHRQ) officials to discuss the AUA’s telehealth priorities and provide expertise on telehealth utilization during the COVID-19 pandemic. Those priorities include eliminating the originating site requirement for telehealth, continuing the expanded use of audio-only telehealth when appropriate, ensuring payment parity for telehealth services and the ability to continue virtual supervision of staff and residents.  

In the coming months, AHRQ’s research seeks to understand what evidence can be gleaned from the COVID-19 pandemic as it relates to telehealth implementation. Over the course of the meeting, AHRQ shared their current data on specialty utilization of telehealth and discussed ways in which the AUA could help build upon that evidence base through continued engagement with AHRQ over the course of the year. According to David Meyers, MD, Acting Director of AHRQ, “CMS has the ability to work with other sub-surgical specialties and try to create that framework for how telehealth should be used. You’ve helped us understand that it’s not just primary care, it’s not just mental healthcare that are opportunities…”.

National Cancer Institute

On July 29, the AUA met with the National Cancer Institute (NCI). The virtual meeting included discussions about individualized risk approaches to diagnosis of prostate cancer and the utilization of active surveillance, the BCG shortage, access to urologic clinical trials, and environmental causes in urologic cancers. AUA Immediate Past President John Lynch, MD, FACS, and Research Advocacy Committee Chair Michael Hsieh, MD, PhD, FASTMH, led the meeting with nine of the top representatives from the National Cancer Institute, including the NCI Director Ned Sharpless, MD. Dr. Sharpless and his team at the NCI noted three of their top priorities:

  • Increasing paylines, which requires robust funding through the Congressional Appropriations process;
  • Better supporting diversity within the surgeon scientist community; and
  • Protecting accelerated approvals for therapeutics – 85% of drugs the Food & Drug Administration uses for oncologic drugs have been through accelerated approvals.

National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Allergy and Infectious Diseases

On August 9 & 11, the AUA met virtually with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Institute of Allergy and Infectious Diseases (NIAID) respectively. The AUA highlighted the relevance of urologic conditions to their specific agencies and how advocates for urologic research funding have contributed to recent gains in NIH funding. Conversations addressed the appreciation for, opportunities with, and challenges in urologic research. Collaboration within NIH institutes/centers (I/Cs) continues to be a challenge for urologic research, as urology covers such a broad group of conditions. Many potential grants fall into multiple I/Cs. This has created an issue with urologic researchers being “passed around” within the NIH, and mixed feedback from I/Cs.

Director of the NIDDK Griffin Rodgers, MD, MACP and various members of their top leadership met with a select group of AUA representatives including AUA President-elect Raju Thomas, MD, FACS, FRCS, MHA. Key messages in the meeting included discussion of NIDDK’s strategic plan, the importance of mentorship, especially with underrepresented scientists, telehealth, and areas of potential collaboration in working together for upcoming workshops. As a reminder, the AUA submitted input for the NIDDK Strategic Plan in 2020 and will be submitting additional comments on the draft Strategic Plan in the coming weeks.

The AUA also met with the NIAID for the first time. The NIAID funds the third highest amount of urologic research across all NIH institutes and centers. Key messages with the NIAID included highlighting the relevance of urology in NIAID’s research portfolio and AUA’s advocacy relevant to NIAID’s interests including the Bladder Health Alliance and NIH funding. Additional discussion items included prioritization of antibacterial resistance research, microbiomes research, and opportunities for future discussions and partnerships.

ICYMI: Updates from the AUA Policy & Advocacy Brief blog

AUA Conducts Follow-Up Summit Meeting with Senator

On August 10, as a follow-up to the Annual Urology Advocacy (AUA) Summit, the AUA met with the office of Senator Raphael Warnock (D-GA). During the meeting, Summit registrant Anders Olsen, who is currently a medical student at Emory University, discussed the need for enhanced veterans’ prostate care at the Atlanta VA, the shortage of urologists, the demand for telehealth, and the need for more urologic research funding at the National Institutes of Health. Senator Warnock is a cosponsor of the CONNECT Act, one of the four primary “asks” during last month’s AUA Summit. The CONNECT Act would remove geographic and originating site restrictions and ensure telehealth at clinics and hospitals in rural areas. Additionally, it enhances the Department of Health and Human Services’ authority to determine appropriate telehealth providers and services (including audio-only) and remove mental and behavioral health service restrictions.

The AUA set up a grassroots alert for the CONNECT Act. Click here to encourage your legislators to support the bill.

AUA Opens Gallagher Scholar Application

On August 1, the AUA opened the 2022 application for the Gallagher Health Policy Scholar Program. This yearlong scholar program provides AUA members with opportunities to attend key health policy meetings, the Brandeis Health Leadership Program in Health Policy and Management, and more. Highly seasoned AUA health policy volunteers mentor the Gallagher Scholar throughout their tenure. Interested members can find more about the program and the application portal here. Please share this opportunity and the application link with your colleagues. The application window closes October 12. Learn more about the program here and reach out to Juliana Nicolini at [email protected] with any questions or for more information.

Coalition Urges Congressional Leadership to Maintain Conversion Factor Increase, CMS to Meet on Global Code Policies
On July 22, the AUA joined more than 20 other surgery-focused organizations to urge the Centers for Medicare & Medicaid Services (CMS) to incorporate the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC)-recommended work and time incremental increases for the revised office/outpatient visit Evaluation & Management (E/M) codes into all 010-day and 090-day global period codes. CMS implemented numerous E/M code changes in CY 2021 – including update RVU values – but did not apply these changes to 010-day and 090-day codes that include office/outpatient E/M visits in their respective global periods. The groups requested a meeting with CMS to discuss this issue in more detail and stress that it is inappropriate for CMS not to apply the RUC-recommended E/M changes to these global codes. Not applying these E/M changes to the 010-day and 090-day global period codes specifically disrupts the relativity in the Physician Fee Schedule, creates specialty differentials whereby CMS pays physicians differently for the same work, and ignores the E/M recommendations endorsed through the RUC process by nearly all medical specialties (by a 27-1 vote) in 2019 to incorporate the E/M code increases into the 010-day and 090-day global period codes. The letter also notes that there is precedent for CMS to address the valuation of global codes during a subsequent year.

On July 23, the AUA joined other organizations representing more than a million physician and non-physician healthcare providers to urge Congressional leaders to maintain the 3.75% conversion factor increase through 2023. The conversion factor increase provided a lifeline to healthcare providers during the COVID-19 pandemic, ensuring continued care for rural and underserved patient groups. The letter stressed that “. . .  physicians, therapists, and other health care providers are forced into an adversarial role when fee schedule payment policies are developed and/or implemented. The result is that patients suffer as providers adjust to unpredictable and excessive reductions to reimbursement that inhibit their ability to ensure beneficiaries have access to the care they need; services that improve outcomes and lower costs.” The letter concludes by offering to work with Congress to address the long-term challenges associated with Medicare payment policy, particularly budget neutrality.

If you’d like a copy of the letters, please reach out to Policy & Advocacy Manager Gregory Craig at [email protected]. You can find more information about the AUA’s work on the Medicare Physician Fee Schedule proposed rule on the Policy & Advocacy Brief.

AUA to NCI: Increase Opportunities for Mentorship, Tenure, and Promotion of URM Scientists

The AUA responded to a Request for Information (RFI) from the National Cancer Institute regarding diversity and inclusion in the cancer research workforce. In the RFI, the AUA recommended increasing opportunities for mentorship, tenure, and promotion of underrepresented minority (URM) scientists, as well as mechanisms to ensure that R01 grants are awarded more widely across minority groups. Increasing health equity is a priority of the AUA and working to ensure there is more diversity among research scientists is a major step in the right direction.

Additionally, the AUA responded to an RFI from Congresswoman Diana DeGette (D-CO-01) and Congressman Fred Upton (R-MI-06) regarding the recently proposed agency within the National Institutes of Health (NIH) Advanced Research Projects Agency for Health, more commonly known as ARPA-H. The RFI asked to what level ARPA-H should be funded, how its priorities should be chosen, and how it should seek to interact with other federal entities. The AUA’s response focused on ensuring that the other institutes/centers are funded at equal rates to ARPA-H and prioritizing collaboration and transparency with other federal entities. The response also focused on high-level priorities and was in alignment with One Voice Against Cancer’s response to the same RFI, of which the AUA also signed on to and can be found here.

Below are insurance updates from national insurance carriers. If you have questions about insurer issues, contact Gregory Craig at [email protected].

CGS Administrators

CGS Administrators reviewed its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MolDX) (A58065) Local Coverage Article (LCA) with the following change:

  • Removed cystectomy from criterion for decipher bladder indicating that the member has not yet received pelvic radiation or chemotherapy for treatment of bladder cancer.

Read the update.

CGS Administrators published its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MoIDX) (J15) (L38586) Local Coverage Determination (LCD), effective July 18.

Read the update.

Humana

Humana published its Urinary Bladder Dysfunction Policy with the changes to its description and coverage determinations.

Read the update.

Noridian

Noridian retired its Genomic Health Oncotype DX Prostate Cancer Assay (MolDX) (JE) (A56371) Local Coverage Article (LCA), effective June 30. Noridian has incorporated this policy within the Prostate Cancer Genomic Classifier Assay for Men with Localized Disease (MolDX) LCA.

Read the update.

Noridian retired its Oncotype DX Genomic Prostate Score (MoIDX) (JF) (L37321) Local Coverage Determination (LCD), effective July 6. Noridian has incorporated this policy within the MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease LCD.

Read the update.

Noridian retired its Oncotype DX Genomic Prostate Score (MolDX) (L37305) Local Coverage Determination (LCD), effective July 6. Noridian has incorporated this policy within the MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease LCD.

Read the update.

Noridian retired its Oncotype DX Prostate Cancer Assay (L36364) Local Coverage Determination (LCD), effective July 6. Noridian has incorporated this policy within the MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease LCD.

Read the update.

Noridian retired its Oncotype DX Prostate Cancer Assay (L36368) Local Coverage Determination (LCD), effective July 6. Noridian has incorporated this policy within the MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease LCD.

Read the update.

Novitas

Novitas retired its Prostate Mapping Biopsy (JH, JL) (A56966) Local Coverage Article (LCA), effective July 8.

Read the update.

Novitas retired its Prostate Mapping Biopsy (JH, JL) (L35009) Local Coverage Determination (LCD), effective July 8.

Read the update.

 

Palmetto

Palmetto reviewed its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MolDX) (JJ, JM) (A58028) Local Coverage Article (LCA) with the following change:

  • Removed cystectomy from criterion for decipher bladder indicating that the member has not yet received pelvic radiation or chemotherapy for treatment of bladder cancer.

Read the update.

Palmetto published its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MolDX) (JJ, JM) (L38576) Local Coverage Determination (LCD), effective July 18.

Read the update.

WPS Government Health Administrators

WPS Government Health Administrators reviewed its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MolDX) (JJ, JM) (A58211) Local Coverage Article (LCA) with the following changes:

  • Removed cystectomy from criterion for decipher bladder indicating that the member has not yet received pelvic radiation or chemotherapy for treatment of bladder cancer.

Read the update.

WPS Government Health Administrators published its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MolDX) (J5, J8) (L38684) Local Coverage Determination (LCD), effective July 18.

Read the update.

Local and Regional Updates

The following are updates in your Section. The AUA routinely monitors state legislative, regulatory, and insurance policy trends. Please contact AUA State Advocacy Manager Catherine Hendricks at [email protected] for more information on any of these issues.

Delaware

H.B. 21 – Nurse Practitioner ENACTED

Introduced by Representative Mimi Minor-Brown (D), H.B. 21 seeks to make Delaware part of the nursing compact. Governor John Carney, Jr. signed the bill into law August 4. Read the bill.

H.B. 141 – Nurse Practitioner ENACTED

Introduced by Representative Mimi Minor-Brown (D), H.B. 141 seeks to provide independent practice for nurse practitioners. Governor John Carney, Jr. signed the bill into law August 4. Read the bill.

New Jersey

Horizon BCBS New Jersey

Horizon BCBS New Jersey reviewed its Transurethral Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia Policy with the following changes:

  • Changed coverage decision for transurethral water vapor thermal therapy from investigational to medically necessary for the treatment of benign prostatic hyperplasia when criteria are met
  • Indicated that transurethral water vapor thermal therapy is not considered medically necessary when the member does not meet all of the criteria.
  • Indicated that transurethral water vapor thermal therapy for other indications, including repeat procedures, is considered investigational.

AUA has drafted a response to Horizon BCBS New Jersey regarding this determination.

Read the update.

Pennsylvania

Cap Blue Cross

Cap Blue Cross retired its Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management Policy on July 1.

Read the update.

S.B. 815 – Pelvic Exam

Introduced by Senator Katie Muth (D), S.B. 815 requires informed consent (verbal and written) prior to a pelvic, rectal, or prostate exam. The bill provides for civil action, compensatory and punitive damages, along with reasonable attorney fees and costs. The patient may choose statutory damages of $5,000 per violation. The bill was referred to the Senate Health and Human Services Committee. Read the bill.

S.B. 818 – Certificate of Need

Introduced by Senator Judy Ward (R), S.B. 818 seeks to allow certain ambulatory surgical facilities to seek an exception or waiver from the department of health for surgical procedures not specified on the CMS Ambulatory Surgical Center Covered Procedures List (ASC-CPL) or otherwise as provided by law. The DOH will maintain the complete ASC-CPL on the department’s website. The bill was referred to the Senate Health and Human Services Committee. Read the bill.