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    Urologists bemoan health care reform bill on several counts


    Washington—On March 23, the day that Congress finally passed the sweeping new health care reform law, a record number of urologists—members of AUA and the American Association of Clinical Urologists (AACU)—were in the nation's capital for their annual Joint Advocacy Conference.

    They came armed with position papers and talking points, but by the time the smoke had cleared, many of those documents were rendered virtually useless as lawmakers on that day approved the most comprehensive health care legislation since the Medicare program was signed into law in 1965 by President Lyndon Johnson.

    Jeffrey Frankel, MD
    Certainly, most physicians, including urologists, were pleased to see Congress take steps to provide coverage for millions more of the uninsured, prohibit insurers from denying coverage for pre-existing conditions, take steps to close the "doughnut hole" in the federal prescription drug program, establish a program for comparative effectiveness, and create a system of insurance exchanges to help provide affordable coverage.

    "It is good to see health care as the focus of the country," said Jeffrey Frankel, MD, a Seattle-based urologist who serves as president of AACU. "But this bill and the whole political process involving it were so flawed."

    Urologists meet with partisan legislators

    While the Washington conference had been scheduled for more than a year, it was a coincidence that brought those physicians to Capitol Hill on that historic day. Unfortunately, for some at least, it was a disappointing experience.

    Karen Lencoski, JD, MBA
    "The members of Congress that we talked with were very partisan," Dr. Frankel said. "It was very unfortunate. And it was a very partisan discussion that influenced the final nature of this bill."

    While both AUA and AACU supported the broad objective of expanding affordable health care coverage to more Americans and closing insurance industry abuses, the devil is in the details.

    But the battle is not over, said Karen Lencoski, JD, MBA, AUA's government relations and advocacy manager.

    "This is really just the beginning," she said. "Now, our effort is going to be to see what we can fix."

    Some reform provisions will kick in this year
    A huge reason for concern by urologists and other physicians with large Medicare patient practices is a provision in the new law that will establish a new Independent Payment Advisory Board (IPAB) that is charged with reducing the per capita rate of growth in Medicare spending indefinitely.

    Another key objection is the new law's failure to include reform of the Medicare fee schedule system, which has caused repeated crises in recent years with physicians constantly facing reductions—to the point where on April 1 a 21.2% reduction was technically implemented—although it was once again, in late April, put on hold by Congress until June 1.

    A third concern was the failure of the legislation to reform the medical liability system in a way that would ease upward pressure on medical liability insurance costs.

    In addition, the new law includes provisions related to imaging and self-referral that will affect urologists.


    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.