February 2022 - 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 progression of the Veterans’ Prostate Cancer Treatment and Research Act (H.R. 4880/S. 2720) in Congress and the AUA’s continued support for protecting the physician workforce and telehealth.

We also recognize Mid Atlantic Section member, AUA Coding & Reimbursement Committee Chair, and CPT Advisor Jonathan Rubenstein, MD for his recent Burgess Gordon Memorial Award from the American Medical Association’s CPT Panel.

Apply Now: 2022 Holtgrewe Legislative Fellowship

The AUA is now accepting applications for the 2022 Holtgrewe Legislative Fellowship Program, an exciting and unique opportunity for young urologists to engage on policy issues and legislation that affects the specialty of urology. The program is open to all AUA residents in their research year, fellows and first year post-graduates and features a four- to six-week fellowship in a legislative office on Capitol Hill, where the Fellow will gain critical insight and information about key policy topics. Applications are open and will close on April 15. Contact Jeremy Haines at jhaines@auanet.org with any questions about the program. Learn more and apply online!

AUA to Host Panel for Medical Students and Patients of Color on February 23

Please join the AUA, Urology Care Foundation, and the Prostate Cancer Impact Alliance for a webinar on the importance of increasing the number of Black and African-American urologists. This webinar will be held on February 23 from 2–4 p.m. ET, encompassing two hour-long panels. Both panels will be recorded and available for later viewing.

In the first panel, Black physicians from R. Frank Jones Urologic Society, Oregon Health and Science University, and SUNY Downstate Health Sciences University will discuss their journeys in their urologic careers, how culturally competent care shapes patient outcomes, and why Black voices are vitally needed in urology. The goal of the webinar is to introduce Black medical students to the meaningful path they could take if they were to choose a career in urology, and how their presence as Black physicians can make a difference in the lives of their patients.

In the second panel, Black patients will present their experiences with the medical system and ways that it can be improved and made more inclusive. The panel will touch on access to care and screenings, community-based outreach, care coordination, and other pressing issues experienced in patient care.

AUAPAC Board of Directors Adds Fundraising Chair

Kevin Koo, MD, MPhil, a current member of the AUAPAC Board of Directors, recently accepted the role of AUAPAC Fundraising Chair. AUAPAC Chair and Vice-Chair Robert Bass, MD, MBA, and Eugene Rhee, MD, MBA, understand the importance of establishing a comprehensive fundraising strategy and having a long-term donor retention plan for AUAPAC. Given these goals and Dr. Koo’s level of enthusiasm and passion for advocacy and health policy, Drs. Bass and Rhee invited Dr. Koo to expand his current Board duties and take the role of Fundraising Chair. Dr. Koo will serve in this capacity through the completion of his term in December 2023.

AUA, Surgical Coalition Urge Congress to Hold Hearings on Medicare Physician Payment

The AUA joined the Surgical Coalition in a letter urging Congress to hold hearings on the future of the Medicare Physician Fee Schedule and the status of other policies included in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), including the Quality Payment Program. The letter arose out of a coalition effort at the end of 2021 to pass federal legislation that mitigated a nearly 10% across the board cut to Medicare funding. The letter notes that the budget neutral nature of the Medicare Physician Fee Schedule and other existing statutes (including the budget sequester and the Pay-As-You-Go Act) means that physicians will inevitably face such cuts in the future absent Congressional action on an overhaul of the Medicare funding system.

Please contact AUA Policy & Advocacy Director Ray Wezik at rwezik@auanet.org for a copy of the letter.

ICYMI: Updates from the AUA Policy & Advocacy Brief blog

AUA Continues Work to Address Physician Workforce Shortages

The AUA continues to advocate for various bills that would address the physician workforce shortages across the country. On February 3, the AUA participated in a meet and greet hosted by the Health Leadership Council for Representative Kim Schrier, MD (D-WA-08). Rep. Schrier is the first pediatrician to serve in the U.S. Congress and one of three physicians in the House Democratic Caucus. She also serves on the House Energy & Commerce Subcommittee on Health, which has jurisdiction on physician workforce issues. Rep. Schrier is a cosponsor of the Resident Physician Shortage Reduction Act (H.R. 2256) that expands graduate medical education (GME) training and funding over a five-year period. This issue was discussed at length during the coalition meeting.

In addition, on February 10, the AUA joined with other medical specialty groups to endorse the Resident Education Deferred Interest (REDI) Act. The REDI Act would allow medical residents to defer their student loans interest-free while in residency, saving them tens of thousands of dollars in interest. Senators John Boozman (R-AR) and Jacky Rosen (D-NV) plan to introduce the REDI Act later this month. In June 2021, Representatives Brian Babin (R-TX-36) and Chrissy Houlahan (D-PA-06) introduced the House companion, H.R. 4122.

The AUA is committed to addressing the ongoing physician workforce shortages in urology and other specialties. As a result, the AUA will continue promoting bills such as the REDI Act and work with like-minded stakeholders to improve the future of the physician workforce.

CPT Editorial Panel Honors Jonathan Rubenstein, MD, with Award for Excellence

The CPT Editorial Panel awarded the Burgess Gordon Memorial Award to Jonathan Rubenstein, MD, at the February 2022 CPT Editorial Panel Meeting. Dr. Rubenstein has been AUA’s CPT Editorial Panel Advisor since 2021 and serves as chair of the AUA’s Coding and Reimbursement Committee, which provides guidance on CPT issues. The Burgess Award represents a major recognition of Dr. Rubenstein by his peers on the CPT Editorial Panel and American Medical Association staff.

Burgess Gordon is considered the father of the CPT coding system and this annual award honors a CPT Advisor for outstanding service. The CPT Editorial Panel Awards Committee selects a CPT Advisor who responds completely and promptly to Advisor Response forms on the CPT website, demonstrates an understanding of the full range of CPT issues (even beyond their specialty area), provides technical support to CPT users and serves as an advocate for the CPT process.

AUA Supports Continued Telehealth Flexibilities and Telehealth Reform

On January 14, the AUA joined more than 70 other patient advocacy organizations, specialty societies and individual organizations in signing onto a letter urging key senators and representatives to retroactively reinstate the bipartisan policy changes that allowed 32 million Americans in the employer market with high-deductible health plans coupled with Health Savings Accounts (HDHP-HSAs) to receive telehealth benefits from their employer or health plan pre-deductible. These policy changes expired on December 31, 2021.

Given the ongoing COVID-19 pandemic and resulting challenges to in person care, the organizations urged Congress to reinstate flexibility to life saving telehealth services, which was granted as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 (P.L. 116-136). Without reinstatement, those with HDHP-HSAs must meet minimum deductibles defined in statute before the cost of telehealth can be covered by their employer or health plan.

In an additional letter to Congress, the AUA joined the Alliance for Connected Care in calling for a pathway to comprehensive permanent telehealth reform. The letter urges for reform that would provide certainty to beneficiaries and our nation’s health care providers while providing sufficient time for Congress and the Administration to analyze the impact of telehealth on patient care. The AUA is a member of the Alliance and the letter had support from over 360 organizations.

Following the letter, the bipartisan Telehealth Extension and Evaluation Act (S. 3593) was introduced by Senators Cortez Masto (D-NV) and Todd Young (R-IN). The act will establish a two-year extension of the widely supported telehealth services Congress enacted during the pandemic, while ensuring a thorough evaluation of these services prior to future permanent action by Congress. The legislation also includes extremely important provisions to ensure the continued provision of telehealth services by critical access hospitals, rural health clinics, and federally qualified health centers. Lastly, the bill includes important provisions to ensure continued access to medication assisted treatment through telehealth.

Please contact AUA Policy & Advocacy Director Ray Wezik at rwezik@auanet.org for a copy of the letter.

Telehealth coverage remains a top priority for the AUA. The AUA will continue to engage key stakeholders to ensure continued telehealth access for both patients and members. A copy of the letter is attached.

AUA Supports Expanding Civil Liability Protections

On February 4, the AUA joined with the Health Coalition on Liability and Access (HCLA) to submit comments to Senate Health, Education, Labor and Pensions (HELP) Committee leadership urging them to consider adopting civil liability protections for medical professionals and facilities outlined in the Coronavirus Provider Protection Act and the Good Samaritan Health Professionals Act. The comments were made on the heels of the HELP Committee’s draft legislation designed to improve America’s preparedness and response to future pandemics (PREVENT Pandemics Act).

The civil liability protections HCLA suggestions are as follows:

Liability protections should apply to all care affected by the pandemic, including care that was altered due to government guidance, and not just for care for COVID-19 patients or suspected patients;
Liability protections should be for a limited duration;
Liability protections should be limited to care provided under the scope of licensure/certification, but not limited to normal scope of practice;
Care that constitutes gross negligence or willful misconduct should not be protected.

Medical liability reform routinely rates at the top of the biennial legislative and advocacy survey of domestic AUA members. Thus, it remains a top priority for the AUA, particularly while the public health emergency remains in effect.

Please contact AUA Legislative & Political Affairs Director Brad Stine at bstine@auanet.org for a copy of the letter.

Funding Push Begins for Congressionally Directed Medical Research Programs (CDMRP) in 2023

In January, the AUA attended the Defense Health Research Consortium’s (DHRC) annual stakeholder meeting, which focused primarily on the issue of potential year-long Continuing Resolution (CR). As in the past, the AUA plans to prioritize a push to create a Bladder Cancer Research Program (BCRP) within the CDMRP. Bladder cancer has a much higher incidence rate among veterans than the civilian population and is currently funded under a larger umbrella program called the Peer Reviewed Cancer Research Program. While this is a significant request, we are hopeful the need for bladder cancer funding will be recognized this year. The AUA will begin this advocacy in March with a virtual briefing for congressional staff on the program.

Veterans’ Prostate Cancer Treatment and Research Act (H.R. 4880/S. 2720) Expected in Veteran’s Healthcare Omnibus Package

In January the AUA learned that the Veterans’ Prostate Cancer Treatment and Research Act (H.R. 4880/S. 2720) is going to be included in a comprehensive veterans’ healthcare omnibus package this year. Staff on the House and Senate Veterans’ Affairs Committees have effectively agreed to its inclusion. Other parts of the omnibus are still being negotiated, but we hope to get the bill through Congress by February or March.

On January 12-13, the AUA met with staff in the office of Representatives Drew Ferguson (R-GA-03), Hank Johnson (D-GA-04), and Fred Upton (R-MI-06) in conjunction with the Congressional Men’s Health Caucus. The purpose of this meeting was to discuss co-sponsorship of H.R. 4880.

On February 3, Jeffrey Jones, MD, chair of the AUA’s Veteran’s Healthcare Work Group, participated in a Capitol Hill virtual congressional briefing sponsored by ZERO – The End of Prostate Cancer to discuss veterans’ urologic issues and prostate cancer genesis and statistics. The briefing was designed to further support the Veterans’ Prostate Cancer Treatment and Research Act (H.R. 4880/S. 2720).

H.R. 4880 and S. 2720 add co-sponsors

Senators John Boozman (R-AR) and Christopher Coons (D-DE) recently agreed to co-sponsor S. 2720, raising the number of co-sponsors of the senate bill to five. Additionally, Representatives Derek Kilmer (D-WA-06) and Debbie Lesko (R-AZ-08) signed on as co-sponsors of H.R. 4880, bringing the total to 21 cosponsors. The AUA held direct meetings with staff in these offices, which ultimately led to them supporting the bill.

AUA Seeks Republican Sponsor for Senate Version of the SPARC Act

Throughout January and February, the AUA met with staff in the offices of Senators Joni Ernst (R-IA), John Hoeven (R-ND), James Inhofe (R-OK), James Risch (R-ID), and Robert Wicker (R-MS) to discuss serving as the Republican sponsor for the Specialty Physicians Advancing Rural Care (SPARC) Act along with Senator Jacky Rosen (D-NV). The senators’ staff showed an interest in the legislation because it would both increase the number of specialists in their respective states and help reduce the burden on patients in need of care.

Additionally, the AUA met with staff in the office of Representative Raul Ruiz, MD (D-CA-36) to discuss co-sponsorship of H.R. 944 on January 12.

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

AUA Comments on the 2023 Notice of Benefits and Payment Parameters for Marketplace Insurance Plans

The AUA submitted a comment letter and signed onto an additional comment letter (both attached) in response to the proposed rule Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023. Our comments support: adding Gender Identity and Sexual Orientation back to a list of anti-discrimination protections, and, ensuring coverage requirements are based on clinical evidence.

The AUA’s comment letter expresses support for a regulatory amendment that protects individuals from discrimination on the basis of “sexual orientation and gender identity” with respect to marketing practices and benefit design for health plans sold on the federal exchanges. The proposed rule would add gender identity and sexual orientation back to a list of anti-discrimination protections under Section 1557 of the Affordable Care Act. In the letter, the AUA supports this policy amendment and urges the agency to remove any barriers (e.g., acquiring health insurance that covers all health care needs) to the patient/health care provider’s collaborative decision-making process relative to medical decisions and quotes the AMA’s Principles of Medical Ethics – which the AUA Board reaffirmed in 2018 – and states that this access to health insurance would help reduce disparities faced by LGBTQI+ populations.

The AUA also signed onto a comment letter from the Alliance for Specialty Medicine. This letter supports the agency’s proposal to revise its regulations to ensure that benefit designs, particularly benefit limitations and plan coverage requirements, are based on clinical evidence – specifically with respect to prescription drug benefits. This letter also supports the agency’s proposal to resume its own evaluation of network adequacy across Marketplace plans but urges key improvements to ensure robust consumer access to specialty medical care and the inclusion of specialists in provider networks.

Please contact AUA Policy & Advocacy Director Ray Wezik at rwezik@auanet.org for a copy of these letters.

Below are insurance updates from national insurance carriers. If you have questions about insurer issues, contact Ray Wezik at rwezik@auanet.org.

Aetna

Aetna updated its Office Consultation Codes Policy stating it will no longer pay office consultation codes 99241–99245, effective March 1.