July 2021 - AUA Public Policy Council Update for MAS

From the Chair

MAAUA Chair 2020 I am delighted to share updates from the AUA Public Policy Council that may benefit your Section members. Our updates include information on this month’s 2021 Annual Urology Advocacy Summit and the upcoming application window for the AUA Gallagher Health Policy Scholar Program. We also have included information regarding our advocacy efforts on the urologic workforce, prior authorization, and the Veteran’s Prostate Cancer Research and Treatment Act.

In addition, Research Advocacy Committee Chair Michael Hsieh, MD, PhD, represented research advocacy as a panelist in the patient and physician advocacy webinar for the 2021 AUA Summit.

Save the Date: Our next quarterly call with our Public Policy Council and Committee Chairs is scheduled for September 27 from 11:00-12:00 p.m. EDT. As a reminder, this call serves to provide Section leadership updates on the policy and advocacy efforts from the Public Policy Council.

Annual Urology Advocacy Summit: July is Advocacy in Action Month

The 2021 Annual Urology Advocacy Summit successfully launched on July 8 with “The Perfect Pair in Urologic Advocacy – A Conversation with Urologic Advocacy Leaders” webinar. The webinar featured conversations between Research Advocacy Committee, Legislative Affairs Committee, and State Advocacy Committee members and patient advocacy group representatives. Discussions noted the importance of these relationships to ensure the patient voice continues to be a focus of the work that we do at the AUA. The pairing of an AUA member and a patient advocacy group representative brought together a strong, well-rounded, advocacy dream team, which highlighted the expertise of the physician and the patient experience.

The webinar will be available in full, and also broken down into podcasts in the coming weeks. We will be sure to share this information with you when it becomes available.

It is not too late to register for the Annual Urology Advocacy Summit in order to access upcoming events. You can register here.

Upcoming Events

Looking ahead, more than 225 members already have registered for the AUA Summit. Here are the details of upcoming events.

Event: Student, Resident, and Fellow Advocacy Night

Date: July 19 at 7:00 – 9:00 p.m. EDT

Details of the Event

More than 40 medical students, residents, and fellows have registered to participate in this two-hour event comprised of two separate sessions. The first session will feature Rep. Kim Schrier, MD (D-WA-08), a former pediatrician that will talk about current health policy, what it is like to make the transition from clinic to Congress, and take live questions from the audience.

The second session will provide direct interaction with AUA advocacy leaders. The session will include four physician-led breakout rooms focusing on patient and practice advocacy, research advocacy, workforce advocacy, and political advocacy. The rooms will be rotated every 15 minutes to allow all participants to meet with each advocacy leader.

Please share this information with medical students, residents, and fellows. They must register for the AUA Summit to attend and will be emailed a Zoom link for the event.

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Event: Hill Educational Session

Date: July 20 at 6:00 – 8:00 p.m. EDT

Details of the Event

This event will feature a comprehensive review session on the congressional “asks”, which will cover issues related to telehealth, workforce shortages, veterans’ prostate cancer care, and urologic research funding. AUA physician leaders will lead the event and be accompanied by various stakeholders from urologic specialty organizations and patient advocacy organizations.

Registrants: Look for an email with the Issue Briefs today.

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Event: 2021 AUA Summit Keynote Speaker

Date: July 21 at 12:00 – 1:00 p.m. EDT

Details of the Event

Dr. Ashish Jha, Dean of Brown University’s School of Public Health, will address the Summit registrants. He is featured on MSNBC and CNN and serves as a world authority on the COVID-19 pandemic.

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Event: Virtual Capitol Hill Day

Date: July 21 at 1:00 – 5:00 p.m. EDT

Details of the Event

Registrants will be provided a unique opportunity to connect with key federal lawmakers and their staff on the topics impacting urologic practices and patients! They can take part in these virtual meetings by sharing their voice and personal stories with those shaping the laws and regulations.

CMS 2022 Medicare Physician Fee Schedule Proposed Rule Projects Urology and General Surgery Will See No Change in Total Allowed Medicare Charges

On July 13, the Centers for Medicare & Medicaid Services (CMS) issued the CY 2022 Medicare Physician Fee Schedule proposed rule. The AUA is analyzing the proposed rule and will issue a high-level overview shortly followed by a comprehensive analysis in the next week. Of note, the agency has reduced the conversion factor by approximately 3.89% from $34.8931 to $33.5848. This is largely a result of the expiration of a 3.75% increase to the conversion factor at the end of calendar year 2021, as averted for 2021 by Congressional action. CMS projects urology will see no change in total allowed Medicare charges for CY 2022 (this estimate does not include the across the board reduced allowable charges associated with the proposed conversion factor reduction). CMS also estimates that general surgery will see no change in total allowed Medicare charges for CY 2022 and that internal medicine will see a 1% increase in total allowed Medicare charges for CY 2022; these estimates will vary based on an individual physician’s case mix. Look for ongoing updates in the AUA Policy & Advocacy Brief.

AUA Gallagher Scholar Application Process Opens August 1

The AUA’s Gallagher Health Policy Scholar Program applications process opens August 1. The Gallagher Scholar Program is open to AUA physician members who demonstrate a commitment to or have deep interest in the field of health policy. Scholars receive mentoring from seasoned physician volunteers, participation in key meetings and conferences and public policy activities as outlined by the Public Policy Council. The AUA provides a stipend and previous Gallagher Scholars have gone on to become Chairs of the Public Policy Council. Science and Quality Council, and reporting committees. Learn more about the program here and reach out to Juliana Nicolini at jnicolini@auanet.org with any questions or for more information.

AUA Partners with AMA in Supporting Prior Authorization Reform

On July 6, the AUA signed a support letter, orchestrated by the American Medical Association, advocating for the passage of H.R. 3173, the Improving Seniors’ Timely Access to Care Act. This bipartisan legislation, which was reintroduced in May for this 117th Congress, would protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under Medicare Advantage plans. It would provide much-needed oversight and transparency of health insurance for America’s seniors. AUA members frequently cite prior authorization as a significant administrative burden that can have negative consequences for patient health.

As a reminder, removing various barriers to care, including prior authorization and step-therapy burdens, remains a top legislative and regulatory priority at the AUA. We will continue operating independently and working with other provider coalitions to address this critical issue in the future. Learn more about the AUA’s work on regulatory burdens here.

AUA, GME Advocacy Coalition Advocates for Additional GME Slots

On June 21, the AUA joined the Association of American Medical Colleges and other members of the Graduate Medical Education (GME) Advocacy Coalition in sending a letter to the Centers for Medicare & Medicaid Services (CMS) regarding the Inpatient Prospective Payment System (IPPS) proposed distribution of 1,000 new Medicare-supported GME slots. The letter (attached) urges CMS to adopt Alternative 2, explained in detail below, with the modification that hospitals can receive more than 1.0 FTE. The AUA also will be submitting more tailored comments to CMS on the IPPS proposal in the coming days.

As a reminder, the Consolidated Appropriations Act (CAA), enacted late last year, originally provided these new GME slots. In the rule, CMS has proposed two alternative methodologies for slot distribution:

Alternative 1 – Distribute the slots solely on Health Professional Shortage Area (HPSA) score and not the other three categories identified in the CAA (rural, hospitals training residents in excess of their current Medicare direct graduate medical education and indirect medical education caps and hospitals in states with new medical schools/new locations/new branches), and would last for all five years of the distribution; and
Alternative 2 – Distribute 200 slots based on all 4 categories outlined in the CAA for the first year, and allow CMS more time to work with stakeholders to refine the methodology for subsequent years.

Unfortunately, both of the proposals only allocate 1.0 full-time employee per hospital, which may be impractical for teaching hospitals to be able to build programs or meaningfully expand existing programs.

As a reminder, addressing the physician workforce shortage is a top legislative priority for the AUA and we have been advocating to increase GME funding for many years. We will closely monitor this plan to expand federal GME training positions and will continue to work to ensure urology is eligible to apply moving forward. If you would like a copy of the letter, please inquire with Brad Stine, Director of Legislative & Political Affairs at bstine@auanet.org.

ICYMI: Updates from the AUA Policy & Advocacy Brief blog

AUA Seeks Democratic Cosponsor on Pending Veteran’s Legislation

The week of June 22, the AUA met with staff in Representative Colin Allred’s office (D-TX-32), who serves on the House Veterans’ Affairs Committee, and Representative Donald Payne’s office (D-NJ-10), who co-chairs the Congressional Men’s Health Caucus and the Congressional Colorectal Cancer Caucus. On July 8-9, the AUA met with staff in the office of Representatives Lauren Underwood (D-IL-14), David Trone (D-MD-06), and Ruben Gallego (D-AZ-07). The purpose of these meetings was to strongly urge the lawmakers to consider becoming lead sponsoring democrats on the Veteran’s Prostate Cancer Research and Treatment Act, which directs the Secretary of the VA to establish a national clinical pathway for prostate cancer within the National Surgery Office of the Veterans Administration for all stages of prostate cancer. This measure passed the House last September but it failed to move in the Senate, therefore needs to be reintroduced this year. Representative and urologist Neal Dunn, MD (R-FL-02) is the main sponsor of the bill and is looking to make it a bipartisan effort in Congress.

Critical prostate cancer care for our veterans – featuring this particular legislation – will be one of four legislative topics that attendees will be discussing with their legislators during the July 21 Virtual Hill Day as part of the 2021 Annual Urology Advocacy Summit.

AUA Physicians Participate in Alliance of Specialty Medicine Virtual Fly-In with Members of the House and Senate

On June 18, Drs. Eugene Rhee, Anurag Das, and Kevin Koo participated in a virtual fly-in hosted by the Alliance of Specialty Medicine. More than 100 physicians from 11 different medical organizations participated in meetings with 14 House and Senate leaders to discuss health policy. Event attendees and Members of Congress covered the following legislative issues:

Medicare Access and CHIP Reauthorization Act (MACRA);
Physician reimbursement (sequester, PAYGO, conversion factor);
Patient access/utilization management (prior authorization/step therapy);
Telehealth and the continuation of waivers and benefits following the public health emergency;
Workforce/graduate medical education (Resident Physician Shortage Reduction Act & loan repayment for specialists in rural/underserved areas);
Medical liability reform (Coronavirus Provider Protection Act with mentions of need for comprehensive reform and Good Samaritan law).

Workforce issues were of particular interest to the AUA as AUA-led legislation H.R. 944 would create a student loan forgiveness program for specialty physicians who practice in a rural area. Members of Congress and event attendees discussed the bill during these meetings and the goal is to continue to build congressional support for the bill by garnering additional cosponsors in the 117th Congress. You can participate in urging your legislators to cosponsor the bill here.

AUA, Other Provider Groups Oppose American Academy of Physician Assistants’ Renaming Effort

On June 15, the AUA, along with 11 other physician organizations, issued a joint statement opposing the American Academy of Physician Assistants’ (AAPA) effort to change their title to “physician associate”. The letter states: “Ambiguous provider nomenclature, misleading advertisements, and the myriad of individuals one encounters at each point of service exacerbates patient uncertainty.” As a reminder, the AUA strongly supports the physician–led collaborative care team and recognizes the vital role all providers play in the healthcare delivery system. Learn more about the physician-led collaborative care team in AUA’s Current State of Advanced Practice Providers in Urologic Practice White Paper. For a copy of the letter, please reach out to our Director of Legislative & Political Affairs Brad Stine at bstine@auanet.org.

Below are insurance updates from national insurance carriers. If you have questions about insurer issues, contact Gregory Craig at gcraig@auanet.org.

Aetna

Aetna reviewed its Urinary Incontinence Policy with the following changes:

Added additional medically necessary criterion regarding continued monthly usage of percutaneous tibial nerve stimulation (PTNS):
- Member’s symptoms has improved after 12 PTNS treatments
Added the following experimental and investigational procedure:
- Moxibustion for the treatment of post-stroke urinary incontinence