On Eve of Meetings With Congressmen, Urologists Agree on Four Lobbying Priorities

Jim Ulchaker, MD

Attendees of the Urology Joint Advocacy Conference were asked to focus on four goals as they left the Washington, DC gathering to meet with congressmen and senators on Capitol Hill.

Two leaders in the community of urologic physicians, one from the American Association of Clinical Urologists (AACU) and one from the American Urological Association (AUA), asked audience members to lobby their government representatives on the issues of:

• graduate medical education;
• the in-office ancillary services exception (IOASE);
• Medicare physician payment; and
• the US Preventive Services Task Force (USPSTF).

Lobbying was emphasized at the meeting because it was a “fly-in” event, at which three urology advocacy groups developed and explained talking points before attendees dispersed to the Hill to discuss those legislative priorities with members of the Senate and House.

Jeffrey M. Frankel, MD, health policy chair for the AACU, and Jim Ulchaker, MD, chair of the Legislative Affairs Committee for the AUA, presented the four “asks,” or lobbying platforms, which were based on feedback from those two associations and LUGPA.

The request involving graduate medical education, Ulchaker said, is for members of the House and Senate to cosponsor HR 1180/S 577, the “Resident Physician Shortage Reduction Act,” and/or HR 1201, the “Training Tomorrow’s Doctors Today Act.”

The passage of those bills would increase the number of hospital positions available to urology residents—important, speakers said, because the profession is facing a growing workforce shortage. The field has seen a decline of more than 10% in the number of urologists per capita over the past 20 years. In addition, according to literature handed out at the meeting, the average age of a urologist is 52.5 years, with more than 18% of urologists 65 years or older, making the specialty the second-oldest after thoracic surgery.

Ulchaker advised the group to discuss the issue in terms of granting patients access to the doctors they need, saying, “You are always going to have better results on Capitol Hill when you talk about patient benefits: how this request will benefit the patient, and how the request will benefit the country. That is how you are going to gain the most traction for your request.”

The next ask was for the repeal of the sustainable growth rate (SGR) formula, a concept for which many physician groups have lobbied, but whose ultimate resolution was postponed by legislators shortly after the JAC meeting. In a March 14 vote, the House approved an SGR repeal bill by a 237—182 margin. The bill was an amended version of the Sustainable Growth Rate Repeal and Medicare Provider Payment Modernization Act of 2014 (HR 4015). But the amended bill, authored by Dave Camp (R-Michigan), chairman of the House Ways and Means Committee, contained language that made its passage in the Senate questionable, potentially derailing the possibility of a permanent fix before the SGR pay cut was set to go into effect after March 31. That language stipulated that no American would incur a penalty tax for failure to obtain government-approved health insurance until 2019.

With questions also looming about how to pay for a permanent fix, the bill did not, in fact, pass in time, and the Senate and House instead approved a patch bill that would delay the 24% cut in Medicare physician reimbursement for 1 year; after the Senate's March 31 vote, the bill was awaiting President Obama's signature. In addition to delaying the SGR cut, the measure also would put off implementation of ICD-10 coding for a year.

Urologists should be sure to participate in discussions about how a repeal would be paid for, Ulchaker said. Eliminating the IOASE to the federal Stark Law in order to help plug that financial hole, which has been proposed, will not be an acceptable solution, he and Frankel said. Repeal of the IOASE provision would make it illegal for physician practices to integrate ancillary services (eg, radiation therapy, diagnostic imaging, pathology, and physical therapy) into their practices and ultimately force patients to receive these services in a hospital setting, thereby reducing access and increasing costs, the speakers said.

That was why the group also planned, as its third “ask,” to call attention to the issue by urging senators and representatives to protect patient access to appropriate use of the IOASE.

Finally, In a fourth request, urologists urged Congress to require that the USPSTF—which, 2 years ago, discouraged prostate-specific antigen (PSA) testing by giving it a “D” rating—have greater accountability and transparency. Specifically, JAC attendees requested that Congress cosponsor HR 2143, the “USPSTF Transparency and Accountability Act of 2013,” introduced by Representatives Marsha Blackburn (R-Tennessee) and John Barrow (D-Georgia).

The bill would require the USPSTF to publish research plans to guide its systematic review of evidence and new science relating to the effectiveness of preventive services, make available reports on such evidence and recommendations for public comment, codify the grading system so it cannot be changed without an appropriate review, and establish a preventive services stakeholders board to advise it on developing, updating, publishing, and disseminating evidence-based recommendations. In addition, the bill would ensure that Medicare or other payers could not deny payment for a preventive service solely based on its task force grade.

As the panel discussion closed, a member of the audience pointed out that congressmen know that physicians are volunteering to meet with them, and that they are not paid lobbyists. The physicians in attendance get a lot of respect for taking time out of their busy practices to discuss these issues, the audience member said, so they shouldn’t be shy about it.