September 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 AUA’s response to the Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule and multiple programmatic opportunities to engage in AUA advocacy.

A special thank you to Mid Atlantic Section member, Coding and Reimbursement Committee chair, and CPT Advisor Jonathan Rubenstein, MD, FACS for his participation in the AUA’s meeting with the Centers for Medicare and Medicaid Services last month.

Welcome Maureen Cones, Chief Legal and Policy Officer

It is with great pleasure that I am introducing my successor Maureen Cones, Esq. Maureen is the Chief Legal and Policy Officer for the American Urological Association. Maureen brings a wealth of legal and policy knowledge experience to AUA, having worked in Executive and General Counsel positions with responsibility for legislative and regulatory affairs and public policy for Walden University and as the Chief Legal & Compliance Officer for the American Nurses Association, where she worked from 2008-2019. In her role at Walden University, Maureen was responsible for all legal, government relations and regulatory compliance strategy and support for all of the university’s healthcare education programs. Maureen also brings to AUA a deep understanding of scope of practice, licensure, certification and accreditation and strategic leadership.

As a reminder, my last day at the AUA is October 17. Maureen will assume the leading role in public policy starting in September. Her contact information is phone: 410-689-3710; email: mcones@AUAnet.org.

Please join me in welcoming Maureen!

Reminder: AUA Gallagher Health Policy Scholar Application Open

As a reminder, the application window for the Gallagher Health Policy Scholar Program closes on October 14. 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. Please do not hesitate to reach out to Juliana Nicolini at jnicolini@auanet.org with any questions or any issues submitting an application.

AUAPAC Champions Program Seeking Applicants

The application process is now open for the AUAPAC Champions Program. The program is looking for individuals with a passion to promote the value of political giving for the specialty of urology, help to advance the house of urology’s legislative agenda and cultivate invaluable leadership, diplomacy and advocacy skills. To apply, you must:

Be a 2022 AUAPAC Member-level donor ($200+ for active urologists, $25+ for residents/fellows)
Have attended your relevant AUA Section or specialty society meeting at least once in the last two years
Complete the application form

If you are interested or know someone who may be, please apply or share the application form today! Applications close on September 30 and decisions made by October 17. If you have any questions, please contact the AUA’s Juliana Nicolini at JNicolini@AUAnet.org.

AUA Submits Comments on the Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule, Reiterates Concerns from Meeting with CMS

On September 1, the AUA submitted comments in response to the Calendar Year (CY) 2023 Medicare Physician Fee Schedule. Our comments to the Centers for Medicare & Medicaid Services (CMS) focus on the following:

Conversion Factor Update

CMS’s Proposed Valuation of Urology-Specific Codes for CY 2023 (Percutaneous Nephrolithotomy)
Evaluation and Management (E/M) Services
Payment for Medicare Telehealth Services
Requiring Manufacturers of Certain Single-dose Container or Single-use Package Drugs to Provide Refunds with Respect to Discarded Amounts
Strategies for Improving Global Surgical Package Valuation
Rebasing and Revising the Medicare Economic Index (MEI)
Strategies for Updates to Practice Expense Data Collection and Methodology
Medicare Potentially Underutilized Services
Merit-Based Incentive Payment System (MIPS) Value Pathways (MVPs)
Request for Information: Health Equity Measures

The AUA placed particular emphasis on CMS’ proposed valuation of urology-specific codes for Percutaneous Nephrolithotomy (PCNL) CPT codes (50080 and 50081), urging CMS to finalize the RUC-proposed values as it maintains the relativity of the procedures and accounts for the time, mental effort and skill associated with the codes. The AUA also signed onto comment letters regarding the proposed implementation of the clinical labor rate submitted to CMS by the Clinical Labor Coalition and the Alliance for Specialty Medicine.

The AUA’s comment letter is available online here. The AUA expects CMS to issue the CY 2023 Medicare Physician Fee Schedule final rule in early November 2022.

In developing this comment letter, the AUA met with CMS to discuss the issues outlined above, including valuation of specific urology codes, the implementation of the single-dose container and single-use package policy, and telehealth.

A special thank you to Public Policy Council chair Eugene Rhee, MD, MBA; Coding and Reimbursement Committee chair and CPT Advisor Jonathan Rubenstein, MD, FACS; Urology Telehealth Task Force chair Aaron Spitz, MD; and Coding and Reimbursement Committee member and RUC Advisor Thomas Turk, MD for participating in the call.

AUAPAC Chair Updates North Central Section on AUAPAC in 2022

This weekend, AUAPAC chair Robert Bass, MD, MBA, was invited to present on AUAPAC during the health policy session at the North Central Section’s Annual Meeting. During the presentation, Dr. Bass provided a history of AUAPAC, educated attendees on the role and purpose AUAPAC plays in advocacy efforts, and detailed the selection criteria AUAPAC uses when giving to candidates. Dr. Bass expressed his appreciation for the opportunity to represent the AUAPAC board at the NCS Annual Meeting. “Being there reaffirms the great working relationship between the organizations,” said Dr. Bass.

AUAPAC is determined to continue educating domestic AUA members from all eight sections about AUAPAC and its role in successful urologic advocacy. The AUAPAC Board of Directors continues to seek additional opportunities to educate and engage AUA members this fall. If you are interested in having an AUAPAC session or presentation at your Section or specialty society meeting, please do not hesitate to reach out to LegislativeAffairs@AUAnet.org. As always, learn more about AUAPAC at www.myAUAPAC.org.

ICYMI: Updates from the AUA Policy & Advocacy Brief blog

AUA Cites Specialists’ Exclusion from National Health Service Corps in Highlighting the Need for SPARC Act

Over the last month, the AUA met with staff in the offices of Senators Maria Cantwell (D-WA), Kirsten Gillibrand (D-NY), Bob Casey (D-PA), Bill Cassidy, MD (R-LA) and Jeff Merkley (D-OR) to discuss co-sponsorship of the Specialty Physicians Advancing Rural Care (SPARC) Act (S. 4330).

During these meetings, Senate staff often comment that constituent outreach is critical in the decision to cosponsor the SPARC Act. You can help by contacting your Senators today to ask them to cosponsor this legislation. Take action now!

Sen. Cantwell’s staff was empathetic about the need for a program that helps alleviate specialty physicians’ burden regarding student loan debt and decisions about where they will practice. Sen. Cantwell’s staff also understood that such a program would help increase access to care in rural areas throughout the country, especially in Washington.

Sen. Gillibrand’s staff was understanding about the need for such a program because the National Health Services Corps (NHSC) does not include specialty physicians. Additionally, staff expressed interest regarding the program’s design, specifically incentivizing specialists to serve in rural areas, even in New York, where urologists are in high demand and short supply.

Sen. Casey’s staff appreciated the purpose of AUA’s advocacy for a specialty physician loan repayment program, especially since one does not currently exist. They recognized that the continued increase in student loan debt results in a disproportionate distribution of specialists in metropolitan areas resulting in a lack of access to specialty care in rural areas. AUA’s focus on these facts resulted in Sen. Casey’s staff expressing interest in the legislation because it aligns with Sen. Casey’s positions on access to care and physician workforce shortages.

Additionally, Sen. Cassidy’s staff understood how a specialty physician loan repayment program can financially support specialists so they can afford to work in rural America, which will increase access to specialty care. However, Sen. Cassidy’s staff expressed concern regarding the loan repayment structure, program financing and utilization of the program in rural states like Louisiana. They did appreciate the AUA bringing the bill to their attention in advance of the 118th Congress.

Sen. Merkley’s staff were generally supportive of the SPARC Act and appreciated efforts to increase access to specialty care in rural communities. While they did raise questions regarding how the Health Resources & Services Administration might define specialty physicians and rural communities, they would like to continue the discussions going into the 118th Congress.

AUAPAC Participates in Fundraiser for Senate Finance and HELP Committees Member

On September 8, AUAPAC participated in a fundraiser for Senator Maggie Hassan (D-NH), hosted by a coalition of Medical and Dental Political Action Committees (MaDPAC). Sen. Hassan serves on the Senate Finance Committee, Senate Veterans’ Affairs Committee and Senate Health, Education, Labor & Pensions (HELP) Committee, which has jurisdiction over most of the agencies, institutes and programs of the Department of Health and Human Services. During the fundraiser, Sen. Hassan expressed support for issues facing the medical community, especially the need to reform the Medicare payment system and curbing Medicare Advantage prior authorization practices.

No Surprises Act Final Rule

The Departments of Labor, Health and Human Services (HHS), and the Treasury issued the Final Rules and FAQs on the No Surprises Act (NSA) which address several provisions of the payment process for out-of-network care. Specifically, the document finalizes disclosure requirements relating to information that group health plans and health insurance issuers must share about the qualifying payment amount (QPA) under the interim final rules (IFR) issued in July 2021. It also finalizes select provisions under the October 2021 IFR to address requirements related to the consideration of information when a certified independent dispute resolution (IDR) entity makes a payment determination under the Federal IDR process.

The Final Rules remove the requirements on the arbiter to presume that the QPA is the appropriate out-of-network rate and states that arbiters should select the offer that best represents the value of the service. The Final Rules also clarify that the initiating party to an open negotiation is always permitted to send the standard Federal initiation notice, requires plans to provide information on why a claim was downcoded if the QPA is based on a downcoded service or modifier and clarifies that plans must calculate QPAs separately for each physician specialty to address the impact of non-negotiated contract rates on the median.

The Final Rules are effective 60 days after the date of publication in the Federal Register. The AUA is currently reviewing the Rule’s impact on urology and will provide a detailed summary.

CMS Releases Health Care System Resiliency, Medicare Waiver Fact Sheets

CMS is beginning to release fact sheets to prepare healthcare providers for the eventual end of the COVID-19 Public Health Emergency (PHE) and the emergency waivers and flexibilities put into place early in the pandemic. The Health Care System Resiliency Fact Sheet is linked below.

Health Care System Resiliency Fact Sheet

In addition, CMS is making healthcare providers aware that pre-pandemic health and safety standards for billing practices will need to be re-established. CMS’ fact sheets are available to healthcare providers in an effort to help guide the healthcare sector through the transition of operations once the PHE ends. Additional CMS fact sheets released on August 19 summarize the current status of the Medicare waivers and flexibilities as well as the Medicaid flexibilities that are separated by provider type.

The AUA continues to monitor the status of the PHE to assist in providing physicians and patients with next steps in reimbursement and access to care.

Below are insurance updates from national insurance carriers. If you have questions about insurer issues, contact Bhavika Patel at bpatel@AUAnet.org.

Aetna

Aetna reviewed its Benign Prostatic Hyperplasia Policy adding CPT code 0714T to the non-covered list.