September 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 our finalized comments to the Centers for Medicare & Medicaid Services (CMS) on the 2022 Medicare Physician Fee Schedule proposed rule and our continued Capitol Hill meetings to advocate for H.R. 944, the specialty physician loan repayment bill, and H.R. 4880, the Veterans’ Prostate Cancer Treatment and Research Act.

We also have included details on our meetings with CMS and the National Institutes on Aging, with special thanks to Mid-Atlantic Section member, Coding and Reimbursement Committee chair, and CPT advisor Jonathan Rubenstein, MD, FACS; and Mid-Atlantic Section and Research Council member Tullika Garg, MD, MPH for their participation.

Mark your calendars: The 5th Annual Urology Advocacy Summit will be March 14-16, 2022 in Washington, DC. (Last month, we inadvertently listed the dates as March 14-17.)

AUA Submits Comments on the Calendar Year 2022 Medicare Physician Fee Schedule Proposed Rule

On September 10, the AUA submitted comments in response to the Calendar Year (CY) 2022 Medicare Physician Fee Schedule. Our comments to the Centers for Medicare & Medicaid Services (CMS) focus on the following:

CMS’ Proposed Update to Direct Practice Expense Clinical Labor Rates
Implementation of Telehealth and Other Services Involving Communications Technology
010-day and 090-day Global Period Codes Policies
CY 2022 Identification and Review of Potentially Misvalued Services
Proposed Valuation of Specific Codes for CY 2022 (Periurethral Adjustable Balloon Continence Devices)
Split (or Shared) Evaluation and Management (E/M) Visits
Quality Payment Program Provisions

The AUA placed particular emphasis on CMS’ proposed update to the direct practice expense (PE) clinical labor rates. This component of the direct PE inputs formula has not been updated since CY 2002 and would have a significant negative impact on reimbursement for urological procedures that involve high supplies and equipment input costs, such as CPT code 52442 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure), which is estimated to experience an overall 22.04% cut based on CY 2022 proposals. The AUA also met with the Clinical Labor Coalition and the Alliance for Specialty Medicine, shared the impact of the proposed clinical labor rate update on urologists, and co-signed coalition letters submitted to CMS.

The AUA previously met with CMS, as detailed below, to discuss these issues and expects CMS to issue the CY 2022 Medicare Physician Fee Schedule final rule in early November 2021. For a copy of the AUA’s finalized comment letter, please reach out to our Director of Policy & Advocacy Ray Wezik at rwezik@auanet.org.

Telehealth and Clinical Labor Inputs Highlight AUA Meeting with CMS on Proposed Medicare Physician Fee Schedule

On August 25, the AUA met with Centers for Medicare & Medicaid Services (CMS) to discuss AUA priorities within the proposed calendar year 2022 fee schedule related to telehealth, clinical labor inputs, split/shared visits, and health equity.

The AUA commended CMS for its data driven approach in retaining telehealth codes until 2023 and requested retaining the category 3 process following the public health emergency to allow for data collection on service delivery via telehealth. The AUA recognized the need for further congressional action in order to provide CMS with the statutory authority to make more telehealth benefits, such as audio-only telehealth, permanent. The AUA requested CMS share data on fraud, waste and abuse concerns to help the AUA and other medical societies develop a joint strategy for guidelines on telehealth that may eliminate those concerns.

The AUA expressed deep concern on the timing and impacts of the reductions to supply and equipment payments under the direct Practice Expense (PE) inputs formula as a result of CMS’ proposal to increase clinical labor payment rates. This proposal could be potentially dramatic and unpredictable given other cuts occurring to provider payment (e.g., the Medicare conversion factor), as well as the lack of regular updates to the inputs (CMS has not updated clinical labor rates since CY 2002). The AUA urged CMS to consider a four year phase-in period with the first year as a hold-harmless period, as well as more regular and predictable direct PE input updates going forward. The AUA explained that specialties that perform procedures with high supply and equipment input costs, such as urology, would be disproportionally impacted by the current section as written.

The AUA noted the potential for CMS’ proposal regarding the selection of the level of split/share evaluation and management (E/M) visits in the facility setting to increase physician burden by causing them to constantly monitor time and to take away their ability to exercise their clinical judgment. Specifically, CMS’ proposal would essentially remove a physician or non-physician practitioner’s ability to select the level of E/M visit in the facility setting based on medical decision-making by imposing stringent time and activity documentation requirements on the physician and non-physician practitioner.

The AUA thanked CMS for their renewed efforts to gather data on health equity and diversity and reiterated the shared desire to improve outcomes for patients in traditionally underserved areas. CMS, while technically in a listen-only posture, commented positively on AUA’s input, particularly in telehealth and clinical labor inputs.

A special thank you to the following AUA members for participating in the call:

Arthur Tarantino, MD	Member, AUA Board of Directors Immediate Past Chair, State Advocacy Committee
Eugene Rhee, MD, MBA	Chair, Public Policy Council
Jonathan Rubenstein, MD, FACS	Chair, Coding and Reimbursement Committee CPT Advisor
Aaron Spitz, MD	Chair, Urology Telehealth Task Force
Thomas Turk, MD	Member, Coding and Reimbursement Committee RUC Advisor

AUA Public Policy & Advocacy Engagement Opportunities

The AUA Gallagher Scholar application is open until October 12. 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.

In addition, the AUA is soliciting applications for the Policy & Advocacy Resident Work Group. The Policy & Advocacy Resident Work Group, currently chaired by Mei Tuong, MD, MS, is seeking four resident/fellow members and two medical student members. Medical students have a one-year term limit and residents/fellows serve a one-year term with the option to renew for a second year. The work group reports to the Legislative Affairs Committee and meets quarterly to plan state advocacy-related educational activities for residents, fellows, and medical students. In the past, the group has hosted fireside chats focusing on AUA legislative priorities and an interview with Rep. McKinley, sponsor of the AUA’s specialty workforce bill.

2022 Policy & Advocacy Resident Work Group members include Ruchika Talwar, MD; Juan Andino, MD, MBA; Vikas Bhatt, MD; Rishi Sekar, MD; Soum Lokeshwar, MD, MBA; Hiten Patel, MD, MPH; and Raevti Bole, MD.

Interested applicants should submit their current resume or CV and a paragraph explaining their interest in the work group, as well as previous experience in policy and advocacy, to Juliana Nicolini at jnicolini@auanet.org. The application window closes October 12. Please share this opportunity with any residents, fellows, or medical students you work with!

AUA Meets With National Institutes on Aging Leadership

On August 17, the AUA met with the National Institutes on Aging (NIA) leadership, including NIA Director Richard Hodes, MD. Meeting attendees discussed the need to diversify the urologic research workforce through AUA/NIA collaborative efforts in scholarship programs, supplemental grants, and increased mentorship opportunities for underrepresented minorities. Dr. Hodes noted the importance of collaboration within the urologic community and the NIA for programs with similar and overlapping goals such as co-morbidity research, focus on neurogenetics and incontinence, and the links to Alzheimer’s and urologic conditions in older adults.

A special thank you to the AUA Members who participated in this meeting:

E. Ann Gormley, MD	Member, AUA Board of Directors
Toby Chai, MD	Immediate Past Chair, Research Advocacy Committee
Tullika Garg, MD, MPH	Member, Research Council
Gail Prins, PhD	Member, Research Advocacy Committee
Charles Scales, Jr., MD, FACS, MS	Member, Research Advocacy Committee

ICYMI: Updates from the AUA Policy & Advocacy Brief blog

Representatives Bera and Bucshon Circulate Dear Colleague Letter on Medicare Payment Stability

On August 24, Representatives Ami Bera (D-CA-7) and Larry Bucshon (R-IN-8) began circulating a Dear Colleague letter outlining the breadth of potential payment cuts on the horizon and urging Congressional leaders to act to provide continued payment stability for providers while work begins in earnest to identify/advance much-needed systemic reforms. This letter, developed in part through the work of the Surgical Coalition of which AUA is a member, notes the financial impacts of imminent payment cuts stemming from Physician Fee Schedule adjustments as well as the Medicare sequester and the Statutory Pay-As-You-Go (PAYGO) Act. Reps. Bera and Bucshon urge their Congressional colleagues to extend the 3.75% payment adjustment to the Medicare conversion factor under the Consolidated Appropriations Act of 2021 while they consider a framework to ensure appropriate reimbursements and improve the Medicare payment system broadly. For a copy of the letter, please reach out to the AUA Policy & Advocacy Manager Gregory Craig at gcraig@auanet.org.

AUAPAC Attends Meeting with House Member
MAAUA Chair 2020

On August 17, AUAPAC participated in a fundraiser for Representative Dwight Evans (D-PA-03). Ruchika Talwar, MD, a resident physician at the University of Pennsylvania, constituent, and Policy & Advocacy Resident Work Group member attended. Rep. Evans is a member of the House Ways and Means Subcommittee on Health, which is one of two main committees that oversee health policy in the House. He has a longstanding interest in protecting healthcare and reducing health disparities, and supports expanded access to telemedicine whenever possible. AUAPAC raises the house of urology’s profile and fosters relationships with members of Congress in Washington, DC, as well as in their home districts, thereby providing opportunities to engage lawmakers and strengthen our advocacy networks. For more information on AUAPAC, visit myAUAPAC.org.

AUA Continues to Promote H.R. 944 and H.R. 4880 in Meetings with Incumbent and Freshmen Lawmakers

Contact Your Federally Elected Officials to Ask Them to Cosponsor These Bills.

On August 18-19, the AUA met with staff in the office of Senators Bob Casey (D-PA), Patty Murray (D-WA), and Bill Cassidy, MD (R-LA) to garner support and sponsorship for a Senate companion of H.R. 944, the specialty physician loan repayment bill. As a reminder, Representatives David McKinley (R-WV-01) and Peter Welch (D-VT-AL) introduced this legislation in February 2021. It establishes a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians. Offices remain receptive to the idea of incentivizing specialists to practice in rural areas while helping patients gain much-needed access to care.

On August 25, the AUA met with staff in the office of Representative Paul Tonko (D-NY-20) to garner support of the aforementioned H.R. 944. He is a member of the House Energy & Commerce Committee, which is the committee that has jurisdiction over various health policy measures, including the loan repayment bill for specialists. Rep. Tonko cosponsored the legislation following the meeting.

Since August 30, the AUA has met with staff in the offices of Senators Tim Scott (R-SC) and Tina Smith (D-MN) to garner support and sponsorship for a Senate companion to H.R. 944. Additionally, the AUA has met with staff in the offices of Representatives Michael Burgess, MD (R-TX- 26), Yvette Clarke (D-NY-09), Jim Costa (D-CA-16), and Brian Fitzpatrick (R-PA-01) to discuss co-sponsorship of H.R. 944.

The AUA also has held meetings with staff in the offices of Representatives Mike Bost (R-IL-12), Michael Cloud (R-TX-23), Rodney Davis (R-IL-13), and Bobby Rush (D-IL-01) to garner support and cosponsorship for H.R. 4880. As a reminder, this legislation would establish, within the Department of Veterans Affairs, a viable prostate cancer clinical pathway to support the men who selflessly served this nation in uniform. Representative and urologist Neal Dunn, MD (R-FL-02) is the bill’s primary sponsor. Original cosponsors include urologist Representative Greg Murphy, MD (R-NC-03), Representatives Elissa Slotkin (D-MI-08) and Colin Allred (D-TX-32).

Finally, the AUA met with staff in the offices of freshmen Representatives, Scott Franklin (R-FL-15), Diana Harshbarger (R-TN-1), Ronny Jackson, MD (R-TX-13), Young Kim (R-CA-39), August Pfluger (R-TX-11), Deborah Ross (D-NC-02), and Beth Van Duyne (R-TX-24). The purpose of these meetings was to establish connections within each office, as well as educate staff about the AUA’s legislative priorities, including H.R. 944 and H.R. 4880. The AUA is committed to furthering its conversations with these, and other first-term offices, within the 117th Congress.

The AUA also has created a grassroots alert that allows any domestic AUA member to easily contact their federally elected officials to ask them to cosponsor both pieces legislation. To access the action center for H.R. 944, click here or simply text AUA to 52886 to get started. To access the action center for H.R. 4880, click here.

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

CGS Administrators

CGS Administrators retired its Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC) (MolDX) (J15) (L37836) Local Coverage Determination (LCD) effective July 25. The contractor states this LCD is retired because the information in this policy has been incorporated within the LCD for “Phenotypic Biomarker Detection from Circulating Tumor Cells (MoIDX)” (L38584).