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    Joint Advocacy Group states its case to Congress

    Delegation outlines concerns on imaging, PQRI, other issues


    Bob Gatty
    Washington—With Congress and the Obama administration working on health care reform, much is at stake for urologists, as issues involving physician reimbursement, imaging, quality assurance, research, and many others are in play.

    In mid-March, 130 urologists convened in Washington at the fourth annual Urology Joint Advocacy Conference sponsored by AUA and the American Association of Clinical Urologists (AACU), an initiative intended to educate policymakers about the important role urologists play in health care as well as their specific public policy concerns.

    Hailing from 35 states, urologists participated in 72 meetings in the Senate and 122 in the House of Representatives, sharing with Congress urology's legislative agenda. Here's a summary of their message for each issue:

    Prostate cancer. Congress must improve access to PSA testing and to full and appropriate coverage for African-American men, whose prostate cancer mortality rates are more than twice those of other racial and ethnic groups. Coverage also must extend to men in rural areas, who are more likely to be disadvantaged than men in urban areas.

    Imaging. Ultrasound is an essential tool for diagnosis and treatment in urology, lawmakers were told, and they were asked not to enact measures that could impede access to appropriate imaging, especially in-office ultrasound imaging, and high-quality patient care. Congress was urged to prohibit the Centers for Medicare & Medicaid Services from using radiology benefit managers in the Medicare program, continue to exclude ultrasound from the accreditation requirement for other imaging modalities, and support a study that compares the clinical effectiveness of imaging interventions for a variety of urologic conditions.

    Quality. A reasonable time frame and additional resources are needed to implement the quality infrastructure that will influence payments under Medicare reform proposals. Congress must consider facilitating a public-private partnership to pool resources of multiple stakeholders to fund clinical registries, clinical guidelines, quality measures, and best practices. Congress must allow CMS additional time and funding to pilot the Physician Quality Reporting Initiative program to resolve problems and ensure beneficiaries get accurate and reliable information about their doctors.

    Reimbursement. Starting in 2010, physician payments will be cut by 21% unless the sustainable growth rate formula is reformed. Congress should apply President Obama's budget plan to re-base the formula and eliminate the debt that has been generated in recent years, as reductions required as a result of the formula have been sidetracked by Congress.

    "Without this fix, health care reform is impossible," AUA declared in a briefing paper, which also urged structural reform of the payment formula and inclusion of specialists as reforms are developed.

    Research. A Urological Diseases Research Branch should be established at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), where funding for urology research has declined more rapidly than for other NIDDK programs. "A urological branch would focus and integrate the currently scattered efforts, providing a visible platform to coordinate research activities across all of the NIH Institutes, many of which currently fund urological research," the AUA briefing paper noted.

    RAC. The Medicare RAC program, which was rolled out at beta test sites in California, Florida, and New York, provides contingency payments to auditing firms that identify improper payments issued under Medicare. Congress has authorized Medicare to expand the program to all 50 states by 2010. However, major problems have not been resolved, and the AUA-AACU delegation asked Congress to direct CMS to fix already-identified problems before the program is fully implemented nationally.

    Medical Home. Proposals are on the table to establish a "Medical Home" to help improve coordination of patient care, but not all of those qualified and able to provide Medical Homes are included. The Tax Relief and Health Care Act of 2006 directed CMS to launch a Medical Home demonstration, but many specialties were excluded.

    "Urologists may be the most appropriate Medical Home for patients with certain chronic urologic conditions, such as prostate cancer, urinary incontinence, and benign prostatic hyperplasia (BPH)," the AUA briefing paper said. "These patients often have long-established relationships with their urologists and have trust and confidence in their care. Arbitrary severance of this relationship through exclusion of urologists from participation does not serve the goals of this program."

    This fourth Joint Advocacy Conference certainly helped to educate members of Congress about urologists' concerns about key issues as health care reform proposals are being considered. Now the challenge will be to build upon that progress in the months ahead and to remain involved as decisions are made.

    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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