American Association of Clinical Urologists www.aacuweb.org
A National Perspective on Policies Impacting
Physicians and th...
American Association of Clinical Urologists www.aacuweb.org
Everything you always wanted to know…
1. About Health Care Ref...
American Association of Clinical Urologists www.aacuweb.org
About the AACU
• AACU has been a dynamic force
for urologists ...
American Association of Clinical Urologists www.aacuweb.org
Wilson Era Health Care Reform (1912-1920)
• National health in...
American Association of Clinical Urologists www.aacuweb.org
Wilson Era Health Care Reform (1912-1920)
• At present [Dec. 1...
American Association of Clinical Urologists www.aacuweb.org
Obama Era Health Care Reform (2010 - …)
• Hospitals and Insure...
American Association of Clinical Urologists www.aacuweb.org
Obama Era Health Care Reform (2010 - …)
• Hospitals and Insure...
American Association of Clinical Urologists www.aacuweb.org
Obama Era Health Care Reform (2010 - …)
• Hospitals and Insure...
American Association of Clinical Urologists www.aacuweb.org
Obama Era Health Care Reform (2010 - …)
Hospitals and Insurers...
American Association of Clinical Urologists www.aacuweb.org
Obama Era Health Care Reform (2010 - …)
• Hospitals and Insure...
American Association of Clinical Urologists www.aacuweb.org
Obama Era Health Care Reform (2010 - …)
• Hospitals and Insure...
American Association of Clinical Urologists www.aacuweb.org
Joint Advocacy Campaigns
SGR Repeal and Medicare Payment Refor...
American Association of Clinical Urologists www.aacuweb.org
Joint Advocacy Campaigns
SGR Repeal and Medicare Payment Refor...
American Association of Clinical Urologists www.aacuweb.org
Joint Advocacy Campaigns
SGR Repeal and Medicare Payment Refor...
American Association of Clinical Urologists www.aacuweb.org
Joint Advocacy Campaigns
IPAB Repeal
• H.R. 1190: Protecting S...
American Association of Clinical Urologists www.aacuweb.org
Joint Advocacy Campaigns
• USPSTF quasi-independent
(i.e., una...
American Association of Clinical Urologists www.aacuweb.org
Joint Advocacy Campaigns
• H.R. 1151: USPSTF
Transparency and
...
American Association of Clinical Urologists www.aacuweb.org
Joint Advocacy Campaigns
Preserve the In-Office Services Excep...
American Association of Clinical Urologists www.aacuweb.org
Joint Advocacy Campaigns
Support Training of Tomorrow's Doctor...
American Association of Clinical Urologists www.aacuweb.org
Professional Standards and Physician Training
• Med school gra...
American Association of Clinical Urologists www.aacuweb.org
Legislative Exports
• Definition of Surgery
– First approved i...
American Association of Clinical Urologists www.aacuweb.org
Opportunities for Engagement
Life does not consist in Thinking...
American Association of Clinical Urologists www.aacuweb.org
Get Involved! Be Heard!
IPAB
• Call to Action: Cosponsor and
s...
American Association of Clinical Urologists www.aacuweb.org
Get Involved! Be Heard!
USPSTF Transparency & Accountability
•...
American Association of Clinical Urologists www.aacuweb.org
Share Your Experience, Learn What Works
American Association of Clinical Urologists www.aacuweb.org
Collective Action
American Association of Clinical Urologists www.aacuweb.org
Education and Relationship Building
www.uropac.org
American Association of Clinical Urologists www.aacuweb.org
Get Involved! Be Heard!
• Action Items:
– Join the AACU
– Cont...
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National Perspective on Policies Impacting Physicians

March 2015 presentation on the impact of federal health care reform on the practice and business of medicine. AACU and AUA Joint Advocacy Priorities including USPSTF Reform, IPAB Repeal, Graduate Medical Education Funding. Particular focus on policies the threaten to devalue physician training and degrade professional standards.
Published on: Mar 3, 2016
Published in: Government & Nonprofit      
Source: www.slideshare.net


Transcripts - National Perspective on Policies Impacting Physicians

  • 1. American Association of Clinical Urologists www.aacuweb.org A National Perspective on Policies Impacting Physicians and the Practice of Medicine Ross E. Weber Empowering Urologists to Advocate for their Patients, Practice and Profession
  • 2. American Association of Clinical Urologists www.aacuweb.org Everything you always wanted to know… 1. About Health Care Reform  1912 – 1920  2010 – … 2. About Urology Joint Advocacy Campaigns  SGR  IPAB  USPSTF  GME  IOASE 3. About Threats to Professional Standards 4. About Opportunities to Engage
  • 3. American Association of Clinical Urologists www.aacuweb.org About the AACU • AACU has been a dynamic force for urologists across the country for over 40 years • Urologists increasingly realize state laws and regulations impact their practice; whether independent, employed or academic • AACU State Society Network supplies physician representatives with tools to advance the interests of their practice and patients The AACU is professionally-managed by
  • 4. American Association of Clinical Urologists www.aacuweb.org Wilson Era Health Care Reform (1912-1920) • National health insurance proposed during the 1912 presidential campaign by Theo. Roosevelt • Wilson's first inaugural address (1913): Federal government should safeguard the nation's health – Never seriously pursued this issue • Other Priorities • Tainted because of its connection to Germany (1883), Trade Unions and Socialism
  • 5. American Association of Clinical Urologists www.aacuweb.org Wilson Era Health Care Reform (1912-1920) • At present [Dec. 1916] the United States has the unenviable distinction of being the only great industrial nation without compulsory health insurance. Within another six months, it will be a burning question. – Yale economist Irving Fisher • 95 years later…The Patient Protection and Affordable Care Act
  • 6. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive – Tenet Healthcare Corp. • Patient volume +4% (2Q 2014) • Uninsured admin -22% (2Q 2014) – HCA Holdings • Revenue +9.2% (2Q 2014) – Aetna • Clients (Via Public Exchanges) +560,000 (2013-2014) • Stock price +30% (2014-2015) – UnitedHealth • Clients (Via Public Exchanges) +400,000 (2014-2015) • Medicaid Managed Care: +1 million • Physicians and Patients Thrive?
  • 7. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive • Providers exposed to “Grace Period” risk – ACA mandates 90-day grace period for subsidized Marketplace/Exchange plans • Most states/ins. companies grant 30-day grace period for non-ACA, private plans – 30 days: remains covered, insurer will pay for services rendered – 60-90 days: insurer will hold claims, paying only if account becomes current
  • 8. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive • Providers exposed to “Grace Period” risk – Law already REQUIRES insurers to notify providers • Specifics left unaddressed • States stepping in – Insurer must provide real-time info within 3 days – Prompt Payment Laws
  • 9. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) Hospitals and Insurers Thrive Providers exposed to “Grace Period” risk Consolidation drives patients to higher-cost settings
  • 10. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive • Providers exposed to “Grace Period” risk • Consolidation drives patients to higher-cost settings • ER utilization unabated
  • 11. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive • Providers exposed to “Grace Period” risk • Consolidation drives patients to higher-cost settings • ER utilization unabated • King v. Burwell decision key to future of ins. market reforms – Not surprisingly, insurers filed a “friend of the court” brief in support of the law.
  • 12. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns SGR Repeal and Medicare Payment Reform House: 392-37; Senate: 92-8
  • 13. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns SGR Repeal and Medicare Payment Reform • SGR repealed immediately • Annual 0.5% payment updates July 1, 2015 – Dec. 2019 • Quality Reporting Programs Streamlined: MIPS • Medical liability protections: Quality Measures ≠ Standard/Duty of Care • 5% Incentive for participation in alternate payment models (2019- 2024) • Fee-for service retained
  • 14. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns SGR Repeal and Medicare Payment Reform • What does the bill say about the release of physician claims data? • Does the bill address private contracting? • Will Medicare’s plans to eliminate the 10-day and 90-day global surgical service bundles be addressed? • Myth: H.R. 2 mandates physician participation in Maintenance of Certification (MOC). • Myth: H.R. 2 sets a new requirement that the quality of physicians’ care must be compared with the quality of care by non-physicians Source: American Medical Association
  • 15. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns IPAB Repeal • H.R. 1190: Protecting Seniors' Access to Medicare Act of 2015 – Introduced: Mar 2, 2015 – 210 cosponsors (192R, 18D) • Rep. Wittman, Robert J. [R-VA-1] • Rep. Rigell, E. Scott [R-VA-2] • Rep. Forbes, J. Randy [R-VA-4] • Rep. Hurt, Robert [R-VA-5] • Rep. Goodlatte, Bob [R-VA-6] • Rep. Brat, Dave [R-VA-7] • Rep. Griffith, H. Morgan [R-VA-9] • Rep. Comstock, Barbara [R-VA-10] • S. 141: Protecting Seniors' Access to Medicare Act of 2015 – Introduced: Jan 8, 2015 – 37 cosponsors (37R)
  • 16. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns • USPSTF quasi-independent (i.e., unaccountable) • Members appointed by Agency Director • Does not meet with relevant stakeholders during review process • No medical specialists
  • 17. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns • H.R. 1151: USPSTF Transparency and Accountability Act of 2015 – Introduced: Feb 27, 2015 – 3 cosponsors (2R, 1D) • Process improvements • Remove any tie to Medicare/Payer policy
  • 18. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns Preserve the In-Office Services Exception to the "Stark" Law • Profession has taken significant steps to ensure that only medically necessary and appropriate ancillary services are performed. – training guidance, appropriate use criteria, practice guidelines, and decision support tools – complex billing, supervision, and location requirements.
  • 19. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns Support Training of Tomorrow's Doctors Today • H.R. 1117: Creating Access to Residency Education (“CARE”) Act of 2015 – Introduced: Feb 26, 2015 – 5 cosponsors (3D, 2R) • H.R. 1006: Building a Health Care Workforce for the Future Act (Scholarship Programs) • H.R. 1272: Doctors Helping Heroes Act of 2015 (Visa Requirements) • H.R. 1707: Access to Frontline Health Care Act of 2015 (Loan Repayment)
  • 20. American Association of Clinical Urologists www.aacuweb.org Professional Standards and Physician Training • Med school grads stuck in residency bottleneck granted 'Assistant Physician' license – 2014: Missouri – 2015: Ark., Kan., Okla. • Pay equality not sufficient for Oregon nurses – Authority to perform male sterilization procedures w/o supervision • Multi-state licensing compact to facilitate telemedicine usurps state authority to license physicians – Authority of legislators and licensing boards would be questioned, if not compromised
  • 21. American Association of Clinical Urologists www.aacuweb.org Legislative Exports • Definition of Surgery – First approved in Va. 2012 – Under active consideration in Connecticut and Massachusetts • Medical Practice Freedom – No health care provider licensed by this state shall be required to participate in any public or private third-party reimbursement program as a condition of licensure. – 2011, VA HB 2218 – 2012, GA HB 785 – 2013, WA SB 5215 – 2014, AL SB 22 – 2015, AZ; MS
  • 22. American Association of Clinical Urologists www.aacuweb.org Opportunities for Engagement Life does not consist in Thinking, it consists in Acting. - Woodrow Wilson (Lawyer, Academic, President of the United States)
  • 23. American Association of Clinical Urologists www.aacuweb.org Get Involved! Be Heard! IPAB • Call to Action: Cosponsor and support consideration Protecting Seniors’ Access to Medicare Act of 2015 (H.R. 1190/S.141) •Rep. Scott, Robert [D-VA-3 (Richmond)] •Rep. Beyer, Don [D-VA-8 (Alexandria)] •Rep. Connolly, Gerry [D-VA-11 (Arlington)] •Sen. Warner, Mark [D-VA] •Sen. Kaine, Tim [D-VA] Physician Training/GME Funding • Call to Action: Cosponsor and support consideration Creating Access to Residency Education Act of 2015 (H.R. 1117)
  • 24. American Association of Clinical Urologists www.aacuweb.org Get Involved! Be Heard! USPSTF Transparency & Accountability • Call to Action: Cosponsor and support consideration USPSTF Transparency & Accountability Act of 2015 (H.R. 1151) – Rep. Wittman, Robert J. [R-VA-1] – Rest of the delegation, as well • Call to Action: Reconsideration Recommendation – Call on USPSTF to reconsider the prostate cancer screening recommendation ASAP – www.bit.ly/uspstf-reconsider
  • 25. American Association of Clinical Urologists www.aacuweb.org Share Your Experience, Learn What Works
  • 26. American Association of Clinical Urologists www.aacuweb.org Collective Action
  • 27. American Association of Clinical Urologists www.aacuweb.org Education and Relationship Building www.uropac.org
  • 28. American Association of Clinical Urologists www.aacuweb.org Get Involved! Be Heard! • Action Items: – Join the AACU – Contribute to UROPAC – Engage as a State Society Network Physician Representative – Keep Up-to-Date: AACU and the News; Urology Times; AACU Sentinel – AACU State Advocacy Conference; Sept. 18-19; Metropolitan Chicago

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