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    Urologists say independent payment advisory board defeat may still be possible

    AUA also pushing for passage of urotrauma, USPSTF bills


    Bob Gatty
    Washington—The re-election of President Obama and the strengthened numbers of Democrats in both the House and Senate mean that key provisions of the Affordable Care Act (ACA) are likely to be implemented over the next 2 years.

    Nevertheless, top leaders at the AUA are optimistic that one of their key priorities involving the ACA, elimination of the Independent Payment Advisory Board (IPAB), can be achieved along with several of their other key legislative objectives.

    In a post-election interview, James C. Ulchaker, MD, chair of the AUA Legislative Affairs Committee, and Chris M. Gonzalez, MD, vice chair of the AUA's Health Policy Council, said the AUA will continue with its pre-election strategy to obtain passage of the AUA's urotrama legislation, reform of the U.S. Preventive Services Task Force (USPSTF), Medicare physician payment reform, and support for funding to help train new urologists.

    "We are going to approach these issues the same way as we did before the election," said Dr. Gonzalez. "I think we are right on cue, and there is no reason to change."

    "We will continue to be very vigilant in terms of watching the implementation of the ACA," said Dr. Ulchaker. "We know that some form of that law is here to stay, and we are going to stay on top of it as these various parts of the ACA come into play."

    While a huge priority for the AUA, the American Medical Association, and other physician specialty and subspecialty groups prior to the election was to convince Congress to eliminate the IPAB, seen as a mechanism to reduce Medicare costs by cutting physician fees, that effort has so far been unsuccessful.

    Although legislation to dump the IPAB has not moved through Congress, largely due to opposition from Senate Democrats and some influential House Democrats, both Dr. Ulchaker and Dr. Gonzalez believe the initiative can succeed.

    "We think we've got a real chance to do something," Dr. Gonzalez said. "The pre-election atmosphere will die down; we have some bipartisan support; and we're looking to build new relationships on Capitol Hill and with coalitions."

    Dr. Ulchaker noted that House Democrats originally opposed including the IPAB in the ACA, but caved into the demands of Democrats in the Senate.

    "Actually, there is a lot of support for repeal of the IPAB," he said, adding that even President Obama may be more willing to compromise now that the election is over.

    Urotrauma bill sponsors re-elected

    Drs. Ulchaker and Gonzalez were pleased that the sponsors of the AUA's proposed urotrama legislation, which would establish a commission to study war-related injuries to the urinary tract of soldiers, survived their elections and are still in Congress.

    That bill, sponsored by Rep. Brett Guthrie (R-KY), currently has 15 Democrats and 11 Republicans signed on as co-sponsors and is pending before the House Subcommittee on Military Personnel. The measure requires the commission to provide a report to the congressional defense and veterans committees following the study.

    Likewise, they noted that the key sponsors of the USPSTF Transparency and Accountability Act of 2012 also were re-elected. Supported by the AUA, the American Association of Clinical Urologists, and the Large Urology Group Practice Association, the bill would require a "balanced representation of primary and specialty care providers" and other health care community representatives to be involved in the development and review of recommendations. It also would establish a Preventive Services Task Force Board that would include providers, patient groups, and federal agency representatives, which would suggest evidence for consideration when a particular service is proposed for review, and provide feedback on draft and final recommendations.

    Drs. Ulchaker and Gonzalez recognized that reform of the Medicare fee schedule system is unlikely during the lame-duck session of Congress now under way, but expressed hope that another temporary fix would be approved to avoid huge fee reductions in January and that the new Congress will find a permanent solution.

    They pointed out that access to care is a major priority of lawmakers of both parties and that Medicare physician payment reductions will jeopardize such access for Medicare beneficiaries. Moreover, as millions of new patients come into the system as a result of the ACA, that coverage will do little good if they cannot get care.

    Aging work force cause for concern

    In that regard, Dr. Gonzalez expressed concern about the growing shortage of urologists that is occurring as the current work force ages. He said studies also are warning of a growing shortage of academic urologists, the prime providers of urology graduate medical education (GME).

    Congress, he said, needs to deal with the existing cap on GME funding for residency training.

    "Urology is facing a severe work force shortage overall and in the academic setting," Dr. Gonzalez said. "These shortages, in combination with the 1997 cap on GME funding, have led to a very precarious situation regarding the ability to train high-quality urologists in the near future."

    So, the election has come and gone. The players largely remain the same. The issues of primary concern to urologists are still there. And the AUA intends to be remain fighting, as Dr. Ulchaker said, "on many fronts."

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

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

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