This week’s update includes information on the American Medical Association’s State Advocacy Roundtable, advocacy to delay and withdraw the Medicare Part B Drug Payment Model, Congressional meetings on our legislative priorities and the AUA-LUGPA supported Medicare Care Coordination Improvement Act. This update also provides a report from the Centers for Medicare & Medicaid Services (CMS) Physician Regulatory Issues Team on the Transforming Clinical Practice Initiative (TCPI), the inaugural National Provider Enrollment Conference, and the Quality Payment Program.
State Advocacy: AUA Attends American Medical Association (AMA) State Advocacy Roundtable Meeting
On August 1-3, the AUA participated in the 2017 American Medical Association’s (AMA) State Advocacy Roundtable Meeting in Santa Ana Pueblo, New Mexico. The purpose of this meeting was to bring together state legislative staff from state medical associations, national specialty associations, and the AMA to discuss potential policy issues for the upcoming state legislative cycle.
Discussion topics included out-of-network legislation, concerns regarding drug costs, prior authorization, step therapy rules, and state efforts to curb the opioid epidemic. Of particular interest was a session on recent maintenance of certification legislation in various states. A key takeaway from the discussion centered on the fact that there is an inherent risk to physicians to seek legislative changes to the MOC process, as it takes oversight capacity away from the broader medical community and gives it to state agencies. The American College of Surgeons discussed their recently adopted policy which states that the responsibility to set standards should rest with the respective specialty organization and not state legislatures.
The meeting also provided excellent relationship building opportunities, as 34 state medical associations, 25 specialty associations, and numerous other allied organizations were represented.
Congressional Outreach: Continued Meetings with Freshman Offices and Introduction of AUA Priorities to House Ways & Means
As part of the AUA’s continued efforts to meet with and educate freshman offices on urologic specific issues, on August 1 and 2, the AUA met with staff in the offices of Reps. Ruben Kihuen (D-NV-4), Donald McEachin (D-VA-4), and Tom Garrett (R-VA-5). At this point, the AUA has met with 80 percent of all freshman offices in both the House and the Senate, and will continue to do so to advance urology’s position and relationships on the Hill.
Also last week, the AUA began a series of meetings with members of the House Ways & Means Committee, the oldest standing committee in the House of Representatives and one of the two major health policy committees in the House. The goal of these meetings is to familiarize the offices with the AUA’s most current legislative priorities and identify opportunities for collaboration. The AUA met with the offices of Reps. Jackie Walorski (R-IN-2), Lynn Jenkins (R-KS-2), Erik Paulsen (R-MN-3), Kenny Marchant (R-TX-24), Mike Bishop (R-MI-8), Kristi Noem (R-SD-AL), Brian Higgins (D-NY-26), Patrick Meehan (R-PA-7), and Tom Reed (R-NY-23).
U.S. Food and Drug Administration (FDA) Reauthorization: Bill Passes the Senate
Last week, we informed you about the AUA’s coalition effort in urging the Senate to address FDA Reauthorization before they leave Washington, DC, for recess. The bill – which would extend the user-fee programs for prescription drugs, medical devices, generic drugs, and biosimilar biological products – passed with overwhelming support in a 94-1 vote. The only dissenting voice came from Sen. Bernie Sanders (I-VT).
As the bill already has cleared the House of Representatives and the Senate did not amend the language, the measure will be sent to the President’s desk for his consideration. While there is no indication that President Trump will veto the bill, if it is not enacted, the FDA must send out layoff notices to its employees, and it could have adverse effects on the implementation of the 21st Century Cures Act that was passed in 2016. As a reminder, the AUA supported the 21st Century Cures Act.
Stark Law on Physician Self-Referral: Draft Bill to Address Care Coordination in Alternative Payment Models (APMs)
Working with other provider partners such as LUGPA, the AUA began participating in a series of meetings with House of Representatives’ offices to build support for a draft bill that would address barriers to care coordination in the new Merit-Based Incentive Payment System and APMs. On August 2, AUA and LUGPA representatives met with the office of Rep. Leonard Lance (R-NJ-7), who serves on the House Energy & Commerce Subcommittee on Health and voted in favor of the 2015 bill that created APMs (Medicare Access and CHIP Reauthorization Act – MACRA).
The Medicare Care Coordination Improvement Act would provide the CMS with the authority to waive the Stark and anti-kickback laws, remove the “value or volume” prohibition in the Stark law so that practices can incentivize physicians to abide by best practices and succeed in the new value-based APMs, and create a more workable standard that only triggers penalties for knowing and willful violations of the law.
Medicare Part B: Alliance of Specialty Medicine Letter
On August 1, the AUA joined its colleagues in the Alliance of Specialty Medicine in urging members of the House of Representatives to request that Health & Human Services Secretary Tom Price, MD, formally withdraw the Medicare Part B Drug Payment Model. As you may recall, CMS halted implementation of the Part B model on December 15, 2016. But, it has never been formally withdrawn, and still has the opportunity to be implemented as a way to control Medicare drug costs.
The program would reduce the average sales price (ASP) add-on amount for Medicare Part B medicines over the course of a two-phase demonstration. Under Phase I, CMS would create two study cohorts; one cohort would receive Part B drug payments under the current payment methodology (ASP+6 percent), whereas the other cohort would receive a reduced add-on payment (ASP+2.5 percent) plus a flat fee of $16.80. With the sequestration in effect, this translates to as little as 0.5 percent above cost.
The demonstration received strong opposition from the physician and pharmaceutical communities. A resolution was passed during the June 2016 AMA House of Delegates opposing the drug demonstration, the AUA worked with its partners in the Alliance in drafting a letter to Congress opposing the demonstration, added the issue to its list of 2016 legislative priorities, and the AUA ran a grassroots campaign at the behest of Rep. Michael Burgess, MD (R-TX-26) asking Congress to have the program withdrawn. We will continue to keep you updated as this issue progresses.
Top takeaways from the August 4, 2017 Centers for Medicare & Medicaid Services (CMS) Clinician Outreach Meeting
Top takeaways are available from the August 4, 2017 CMS Clinician Outreach Meeting focused on the Transforming Clinical Practice Initiative (TCPI), upcoming National Provider Enrollment Conference, and the Physician Regulatory Issues Team (PRIT) Reporting Tool Pilot. Read more.
Insurance Updates: Week of August 7, 2017
The AUA is publishing weekly updates on the latest insurance issues pertaining to urology, such as provider remittances, provider maintenance forms and ABN modifiers. For more information, click here.
Practice Management: PMN Coding Podcast, PMC Recordings
New Practice Managers’ Network Service.
The AUA is preparing to launch a new service for Practice Managers’ Network subscribers this month: the PMN Coding Podcast. The new podcast will be completely devoted to discussing challenging coding issues that are prevalent in the urological community. Each discussion will be 10-15 minutes and will be available for stream or download in the PMN library. The first episode of the new podcast series will be available on August 30, 2017.
The AUA has recently released a new product, the 2017 Practice Management Conference Recordings. Our Practice Management Conference Recordings product includes full-length recordings of each presentation, lecture, and breakout session of the 2017 Practice Management Conference. Customers will be able to hear experts from the field of urology discuss important issues such as MACRA implications for practices, increasing physician compensation, and maximizing practice revenue streams. Previews for each recording will be featured weekly on the Practice Managers’ Network online community.
Visit the PMN Products page to learn more.