AUA Advocacy Snapshot: Week of April 3, 2017

By Policy and Advocacy Brief posted 04-05-2017 11:48

This week’s update shares information on our advocacy on medical liability reform, Independent Payment Advisory Board (IPAB) repeal, and federally funded cancer research, as well as presentations on physician burnout with the Surgical Coalition and Centers for Medicare & Medicaid Services (CMS).

IPAB Repeal: Request for In-District Meetings During Upcoming Recess
From April 10-21, both the House of Representatives and the Senate will be in recess and working from their district offices. We are asking that urologists reach out to your district offices and set up a meeting with your Representative and Senators to urge them to repeal the IPAB. This is a crucial time to do so as it both provides a follow-up from recent JAC meetings, and because the CMS Actuary is supposed to determine if the IPAB will be triggered by the end of April.
If you need any help with these meetings, please contact the AUA at We can provide digital copies of documentation and educational materials, as well as contact information for your district offices.

Congressional Outreach: Continued Meetings with Freshman Offices
Last week, the AUA met with the offices of Reps. Darren Soto (D-FL-9), Stephanie Murphy (D-FL-7), Drew Ferguson (R-GA-3), and Jim Banks (R-IN-3). Reps. Murphy and Banks both serve on the Armed Services Committee, with Banks also serving on the Veterans’ Affairs Committee; both of these relationships could be helpful as the AUA re-engages on its urotrauma issue. All four are freshman members and part of the AUA’s continued efforts to meet with and educate first-term offices on urologic-specific issues.

Medical Liability Reform: Support for Saving Lives, Saving Costs Act and Reintroduction of Good Samaritan Health Professionals Act
On March 30, the AUA issued a letter of support to Rep. Andy Barr (R-KY-6) upon his reintroduction of the Saving Lives, Saving Costs Act (H.R. 1565). This bill would allow physicians who can demonstrate they followed the recommended best practices to benefit from increased liability protection in the form of a legal safe harbor. Though the AUA has been supportive of the legislation since its original introduction in 2014, a request for a letter came from AUA Past President Dr. Bill Gee following his meeting with the office during the Joint Advocacy Conference earlier this month.
A few weeks ago, we informed you about a support letter we signed onto with our partners in the Health Coalition on Liability and Access (HCLA) in regards to the pending reintroduction of the Good Samaritan Health Professionals Act. That bill officially was reintroduced last week by Rep. Marsha Blackburn (R-TN-7) – H.R. 1822 – and Sen. Bill Cassidy, MD (R-LA) – S. 781. The bill would shield a health care professional from liability under federal or state law for harm caused by any act or omission if: 1) the professional is serving as a volunteer in response to a disaster, and 2) the act or omission occurs during the period of the disaster, in the professional's capacity as a volunteer, and in a good faith belief that the individual being treated is in need of health care services.

American College of Surgeons (ACS): Surgical Coalition Meeting
On March 29, current Gallagher Scholar Dr. Jim Dupree and Legislative Affairs Committee Chair-Elect Dr. Tom Rechtschaffen represented the AUA during the 2017 Surgical Coalition Leadership meeting sponsored by the ACS. Our current Holtgrewe Fellow, Dr. Hans Arora, stepped off the Hill and was able to attend a portion of the meeting as well. It featured 19 surgical specialty societies coming together to identify and push forward legislative, regulatory, and other advocacy topics of common interest to surgical patients and surgical societies.
This particular meeting focused on several health policy topics including recent federal efforts to repeal the Affordable Care Act, potential changes to the structure of 10- and 90-day global surgery codes (see below for more information), physician payment changes associated with the Medicare Access and CHIP Reauthorization Act (MACRA), advocacy around graduate medical education funding (an AUA legislative priority), and an excellent discussion on physician burnout that was led by Dr. Rechtschaffen. Several other specialties identified burnout as a very concerning issue for their members and expressed interest in partnering with the AUA moving forward.

Watch the AUA’s Policy & Advocacy Blog for more information about this meeting.

Physician Burnout: Call with CMS Office of Clinician Engagement

On April 3, Christopher Gonzalez, MD, Chair, AUA Public Policy Council; Patrick McKenna, MD, Chair, AUA Workforce Workgroup;  Amanda North, MD,  Member of the Leadership Class project on physician burnout; and AUA staff conferenced with the two physician co-leads of the CMS Office of Clinician Engagement. The AUA shared AUA census data and other literature projecting a workforce shortage in urology in the future and noted that physician burnout will lead to even more physicians leaving the workforce. We also added that regulatory burdens associated with meeting Meaningful Use and Quality Payment Program requirements are leading to burnout. A full report on the meeting will be in next week’s Advocacy Snapshot.

Global Surgery Codes: Required Data Reporting for Post-Operative Care in Nine States and CMS Call
On April 25 from 1:30 to 3:00 p.m. ET, CMS will hold a call on reporting the data for post-operative procedures. The Calendar Year 2017 Medicare Physician Fee Schedule (MPFS) final rule adopted a data reporting requirement for practitioners furnishing specified global procedures in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island. CMS will use reported data, along with other data, to establish payment rates under the MPFS.
During this call, learn about the new requirements that go into effect July 1, 2017, and resources you can use for reporting. A question and answer session follows the presentation.
To register or for more information, visit MLN Connects Event Registration.

Patient & Research Advocacy: Prior Authorization, Partner Activities and Protecting Cancer Research Funding
On March 14, we shared that the AUA signed a letter in support of prior authorization reform in West Virginia (SB 49). The coalition supporting this legislation is developing a proposed legislative interim study resolution requesting an examination of the issues associated with prior authorization outlined in SB 49. There is no deadline for introduction or action on resolutions of this type and their introduction alone is enough to cause the topic to be examined by legislative leaders for potential study after the conclusion of the Regular Session. We will keep you apprised of feedback received regarding this study.
In response to the Administration’s proposed fiscal year (FY) 2018 budget that would cut billions of dollars in cancer research funds from the National Institutes of Health (NIH) and ultimately the National Cancer Institute, the AUA attended a full House Oversight and Government Reform Committee hearing. The hearing, titled “Federally Funded Cancer Research: Coordination and Innovation,” emphasized the value of federally funded cancer research and included testimony from Mary Beckerle from the Huntsman Cancer Institute, Tyler Jacks from the Massachusetts Institute of Technology, and patient testimony that was powerful in conveying that a cut in cancer research funds is detrimental to the cancer community and will halt the development of lifesaving treatments. Of note, Rep. Mark DeSaulnier (D-CA-11) announced he will be starting a Cancer Survivor’s Caucus later in the year and Chairman Jason Chaffetz (R-UT-3) stated he intends to hold an additional hearing in a few months.
As a reminder, research funding is facing an uncertain future because Congress has yet to complete its work on FY 2017 appropriations. Any further delay in completing work or even subjecting the spending bills to a long-term continuing resolution could inflict irreversible damage to key accounts such as the Congressionally Directed Medical Research Programs (CDMRPs) at the Department of Defense. As a reminder, several urologic conditions benefit from CDMRPs, including prostate cancer, bladder cancer, kidney cancer and interstitial cystitis. The NIH is also facing the possibility of losing a $2 billion increase if FY17 work is not completed. The current temporary funding agreement expires on April 28.
On March 30, the AUA attended the 2017 Astellas Patient Advocacy Summit, which provided stakeholder presentations from government agencies, patient advocates, and members of industry about value-based care and shared decision making. Many of the AUA’s key partners were in attendance including Prostate Health Education Network, Men’s Health Network, Caregiver Action Network, and National Association for Continence. The program was widely attended and promoted dialogue about how to advance patient outcomes by implementing patient-focused practices.

Alternative Payment Models: American College of Surgeons-Brandeis Alternative Payment Model Workshop
The AUA participated in the ACS-Brandeis Alternative Payment Model (APM), Episode Based Quality Measurement Workshop on March 30. The discussion centered on measures needed for alternative payment models and what would be required for participation in the ACS-Brandeis model for APMs. The AUA was used as a test case at the workshop: The group looked at the urology measures available and how we might fare in the model with those measures.  Some gaps were identified in the ACS surgical phases of care (preoperative, immediate post-operative, intra-operative, post-operative and post-discharge) template. One of our measures, biopsy is already topped out so we may have to develop additional urologic measures to allow broader participation. Dr. Frank Opelka stated that “the AUA has a good start with the measures available.” Dr. James Dupree, Chair, and the AUA APM Steering Workgroup, continues to monitor the activities around alternative payment models for urology. Updates on this activity will be shared in the AUA’s Policy & Advocacy Blog.

MIPS Quality Scoring and Episode-based Measure Development: CMS Listening Session
Last week, staff attended a CMS listening session, hosted by the American Medical Association (AMA), to provide education on the scoring methodology used for the Quality performance category of the Merit-based Incentive Payment system (MIPS). CMS also answered questions about the MAV-like process, specialty measure sets and reporting of quality measures on Physician Compare. In addition, CMS provided an overview of the Application Program Interfaces (APIs) under development for the Quality Payment Program. API’s are software applications for electronic exchange of information that do not require manual intervention and can function independent of an electronic health record (EHR) system. CMS will begin API product testing this year.
The AMA hosted a subsequent CMS meeting this week to provide education on the work its contractor, Acumen, LLC is doing to develop episode-based measures. Episode measures will be a major component of the MIPS Cost performance category in future years. For new measure development, a more structured process will be used based on a simpler set of rules and clinical input. Last December, CMS posted a list of 119 clinical areas for episode-based measure development on its web site, which included Urologic Disease Management. Measure development for the clinical areas will occur in three waves starting this fall. The first wave will include seven clinical areas. Urologic Disease Management will be included in the second or third wave. Acumen will convene clinical subcommittees to create the measures and is seeking input on basic concepts development. Comments will be accepted until April 24.

Practice Management: Practice Management Conference, PMC Highlight
The AUA is ready to release a new installment of our Practice Management Conference Highlight Series this week. Each entry in the series will feature a brief introduction for one of the conference’s featured speakers and give a preview of their presentations. This week’s highlight will be on Max Rieboldt. During his presentation, “Seven Years after ACA Passage – Top Ten Lessons Learned,” Rieboldt will discuss the changing national reimbursement paradigm. Our latest highlight will be posted to the AUA’s Policy and Advocacy Blog this week.

This year’s Practice Management Conference will feature many presentations on national practice reimbursement. Along with Max Rieboldt’s presentation, conference attendees can look forward to a presentation from Dr. Neil Baum, who will discuss how practices can transition from a healthcare model that focuses on patient volume to one that focuses on quality of patient care. Dr. Baum gave a preview of his presentation during the last episode of the PMN Podcast, which is available for stream or download at
Visit our website to view the conference schedule for each day and register for the 2017 AUA Practice Management Conference.