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Urology Health Policy (update from 2013 Joint Advocacy Conference)

My presentation at The George Washington University Department of Urology Grand Rounds on March 27, 2013. Presentation for educational purposes only.
by

Christopher Bayne

on 14 April 2013

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Transcript of Urology Health Policy (update from 2013 Joint Advocacy Conference)

GME Funding USPSTF Transparency and Accountability Act
of 2012 Rayburn Building Cannon Building Longworth Building Russell Building Joint Advocacy Conference
Meetings on Capitol Hill Independent Advisory Payment Board (IPAB) repeal Urotrauma Task Force Urology
Health Policy First convened in 1984 by US Pubic Health Service
Sponsored by the Agency for Healthcare Research and Quality since 1998
Leading "independent panel of private-sector experts in prevention and primary care"
Before the Patient Protection and Affordable Care Act (ACA), USPSTF recommendations weren't bound to policy and reimbursement; recommendations were simply the "gold standard" Introduced June 21, 2012 to 112th Congress as H.R. 5998
Sponsor Rep. Marsha Blackburn, TEN-7
Bill died in committee (House Energy and Commerce and House Ways and Means)
Has not been introduced yet in 2013 Ask of Congress: Support reintroduction of H.R. 5998
Enhance specialist presentation in decision-making, including making recommendations accountable to specialist organizations (e.g., AUA)
Eliminate ability to Secretary of Health and Human Services to eliminate Medicare coverage of preventative services based on recommendation grade
Require GAO to assess impact of USPSTF recommendations
Review May 2012 PSA recommendation (Controversy) Associated Press. Task Force Says It Poorly Communicated Breast Cancer Guidelines [video on the Internet]. 2009 Dec 2 [cited 2013 Mar 18]. Available from: Genitourinary organ injuries account for 5-10% of battlefield injuries
Compared to Iraq, incidence of urotrauma injuries in Afghanistan have increased 350%
Has not received policy attention and resource allocation similar to extremity, eye, brain, and psychological injury
Urotrauma can lead to fertility issues, especially as women can now serve on the battlefield
Neurologic and brain injuries can lead to fertility issues, as well http://www.senate.gov/fplayers/jw57/commMP4Player.cfm?fn=vetaff062712&st=6355 Senate testimony on psychological and fertility consequences of urotrauma (H.R. 984) Introduced to 112th Congress as H.R. 1612 on April 15, 2011
Sponsor Rep. Brett Guthrie, KY-2
Bill died in committee (House Armed Service and House Veterans' Affairs)
Reintroduced March 6, 2013 and has been referred to House Armed Services: Military Personnel and House Veterans' Affairs Key points: Bill does not "unlock" therapy, only investigates problem, reviews resources and logistics for research and treatment
Task Force is a "sunset" commission (expires in four years)
Score is already established in Department of Defense discretionary budget
Represents more than a urological issue. Obstetricians and gynecologists should be joining forces to pass bill Ed Kashi, The Digital Journalist. Aging in America [image on the Internet]. 2003 Dec [cited 2013 Mar 22]. Available from: http://digitaljournalist.org/issue0312/kashi_11.html Aging America 10,000 new seniors age into Medicare each day



By 2030, 20% of the population will be over the age of 65



50% of active urologists are over the age of 55 Who will care for the increased need? Congress is well aware of this question,
but they haven't found an answer National shortage of physicians Urology is likely worse Urology workforce experienced 6% increase between 1996 and 2006 Overall, supply of urologists per capita in US has been decreasing since 1991 In 2009, there was 1 urologist for every 31,446 US citizens* Age of average US urologist is 52.5* 18% are over 65 How many non-citizens? US Department of Health and Human Services predicts a need of 16,000 urologists by 2020 Recognize shortages in specialties is just as great and significant, if not more so, than primary care
Eliminate current Medicare GME funding caps
Increase urology GME funding
Provide incentives for rural urology Ask of Congress: Projected urologist workforce by 2020 = less than 8,000* Supply vs. demand deficiency of greater than 50%** Current projections do not account for growing physician burnout Approximately 270 urologists entering workforce each year
vs.
Approximately 500 urologists retiring from workforce each year There are 7 urban urologists for every rural urologist Ed Kashi, The Digital Journalist. Aging in America [image on the Internet]. 2003 Dec [cited 2013 Mar 22]. Available from: http://digitaljournalist.org/issue0312/kashi_29.html J. Scott Applewhite, The Associated Press. President Obama signs the health care bill into law at the White House on March 23, 2010 [image on the Internet]. 2008 Jun 28 [cited 2013 Mar 22]. Available from: http://www.wgbh.org/Blogs/Home.cfm?topicID=341 Independent Payment Advisory Board "Reduce the per capita rate of growth in Medicare spending" What (and who) is IPAB? 15-member board appointed by the President with congressional advice and consent
President appoints 3, then has to "consult" with Senate and house leaders (4) for additional 3 appointments, each Should Congress be in recess, President may make unilateral appointments to vacant board positions Individuals directly involved in provision or managing delivery of Medicare items and services may not constitute a majority of IPAB Members must include (but not limited to) physicians and health care specialists with national recognition
Represent consumers, elderly, diverse backgrounds IPAB members may not be engaged in any other business, vocation, or employment What will IPAB do? Beginning in 2013, the Centers for Medicare and Medicaid Services (CMS) Actuary's Office will make cost projects for next two years
When "projections" exceed "targets," IPAB is called to make recommendations due January 15 By 2019, the target spending will be nominal Gross Domestic Product per capita + 1% Spending rate reductions have been established:
0.5% in 2015; 1% in 2016; 1.25% in 2017; 1.5% in 2018 and beyond
If Congress fails to pass legislation by August 15 each year to achieve the required savings, IPAB’s recommendations become law The IPAB is prohibited from submitting proposals that would ration care, change benefits, modify eligibility, or increase beneficiary cost sharing or premiums Hospitals and hospice are exempt from IPAB cost reductions from 2015 through 2019 What's (or who) is left? If IPAB can't cut services ... If IPAB can't cut hospital reimbursements ... If clinical physicians can't realistically serve on IPAB ... Providers You Abigail Alliance
Action CF
AdvaMed
Advocates for Responsible Care
AIDS Delaware
AIDS Drug Assistance Programs Advocacy Association
AIDS Housing Association of Tacoma
AIDS Institute
Alabama Orthopaedic Society
Alabama Podiatric Medical Association
Alaska State Chamber of Commerce
Alaska State Grange
Alder Health Services, Inc.
Alliance for Aging Research
Alliance of Specialty Medicine
ALung Technologies, Inc.
Alzheimer's & Dementia Resource Center
Alzheimer's Arkansas
American Academy of Facial Plastic & Reconstructive Surgery
American Academy of Neurology
American Academy of Otolaryngology & Head and Neck Surgery
American Academy of Physical Medicine and Rehabilitation
American Association for Homecare
American Association for the Study of Liver Diseases
American Association of Clinical Endocrinologists
American Association of Clinical Urologists
American Association of Neurological Surgeons
American Association of Orthopaedic Executives
American Association of Orthopaedic Surgeons
American Autoimmune Related Diseases Association
American College of Emergency Physicians
American College of Emergency Physicians – Indiana Chapter
American College of Mohs Surgeons
American College of Osteopathic Surgeons
American College of Radiology
American College of Rheumatology
American College of Surgeons
American College of Surgeons - Missouri Chapter
American Congress of Obstetricians and Gynecologists
American Gastroenterological Association
American Healthcare Education Coalition
American Hospital Association
American Liver Foundation - Allegheny Division
American Medical Association
American Osteopathic Academy of Orthopedics
American Osteopathic Association
American Physical Therapy Association
American Podiatric Medical Association
American Society of Anesthesiologists
American Society of Breast Surgeons
American Society of Cataract and Refractive Surgery
American Society of General Surgeons
American Society of Nuclear Cardiology
American Society of Plastic Surgeons
American Society of Plastic Surgeons
American Society of Radiation Oncology
American Urological Association
Americans for Prosperity
Americans for Tax Reform
Amigos por la Salud
Arizona BioIndustry Association
Arizona Medical Association
Arizona Podiatric Medical Association
Arizona Urological Society
Arkansas Medical Society
Arkansas Orthopaedic Society
Arkansas Podiatric Medical Association
Associated Industries of Florida
Association for Behavioral Healthcare
Association of Nurses in AIDS Care
Association of American Physicians and Surgeons
Asthma & Allergy Foundation of America - California Chapter
Asthma & Allergy Foundation of America - New England Chapter
Bay Bio
BEACON (Biomedical Engineering Alliance & Consortium), Connecticut
BIOCOM
BioNJ
BioOhio
Biotechnology Industry Organization (BIO)
Bismarck-Mandan Chamber of Commerce
California Healthcare Institute
California Hispanic Chambers of Commerce
California Medical Association
California Orthopaedic Association
California Podiatric Medical Association
California Rheumatology Alliance
California Urological Association
Capital Region Action Against Breast Cancer!
Cardiology Advocacy Alliance
Center of the American Experiment
Center for Freedom and Prosperity
Children's Rare Disease Network
Coalition for Affordable Health Coverage
Coalition of State Rheumatology Organizations
Colorado Academy of Family Physicians
Colorado BioScience Association
Colorado Cross-Disability Association
Colorado Gerontological Society
Colorado Podiatric Medical Association
Colorado Retail Council
Colorado Springs Health Partners
Community Health Charities of Florida
Community Health Charities of Nebraska
Community Oncology Alliance
Concerned Women for America
Congress of Neurological Surgeons
Connecticut Orthopaedic Society
Connecticut Podiatric Medical Association
Connecticut State Urology Society
Council of University Chairs of Obstetrics & Gynecology Organizations
Delaware Academy of Medicine
Delaware Ecumenical Council on Children and Families
Delaware HIV Consortium
Delaware State Orthopaedic Society
Deleware Podiatric Medical Association
Docs 4 Patient Care
Doctor Patient Medical Association
Easter Seals
Easter Seals Crossroads
Easter Seals of Arkansas
Easter Seals of Iowa
Easter Seals of Maine
Easter Seals of Massachusetts
Easter Seals of New Jersey
Easter Seals of South Florida
Easter Seals of Southeastern PA
Easter Seals UCP North Carolina
Elder Care Advocacy of Florida
Florida Chamber of Commerce
Florida Medical Association
Florida Podiatric Medical Association
Florida Society of Neurology
Florida Society of Rheumatology
Florida Society of Thoracic & Cardiovascular Surgeons
Florida State Hispanic Chamber of Commerce
Florida Transplant Survivor's Coalition
Florida Urological Society
Freedom Works
Galen Institute
Georgia Association for Home Health Agencies
Georgia Bio
Georgia Orthopaedic Society
Georgia Podiatric Medical Association
Global Genes
Global Healthy Living Foundation
Grand Rapids Area Chamber of Commerce
HEALS of the South
Healthcare Institute of New Jersey
Healthcare Leadership Council
HealthHIV
Heart Rhythm Society
Hemophilia Foundation of Maryland
Hispanic Leadership Fund
Hoosier Owners and Providers for the Elderly
HSA Coalition
Idaho Medical Association
Idaho Podiatric Medical Association
Illinois Association of Orthopaedic Surgeons
Illinois Biotechnology Industry Organization—iBIO®
Illinois Chamber of Commerce
Indiana Association of Cities and Towns
Indiana Health Care Association
Indiana Health Industry Forum
Indiana Medical Device Manufacturers Council, Inc.
Indiana Neurological Society
Indiana Podiatric Medical Association
Indiana State Medical Association
Indpendent Womens' Voice
InterAmerican College of Physicians & Surgeons
International Franchise Association
International Institute for Human Empowerment
International Society for the Advancement of Spine Surgery
Institute for Liberty
Iowa Orthopaedic Society
Iowa Podiatric Medical Association
Kansas Medical Society
Kansas Podiatric Medical Association
Kansas Urological Association
Kentucky BioAlliance
Kentucky Medical Association
Kentucky Podiatric Medical Association
Kidney Cancer Association of Illinois
Kitchen Table Patriots
Large Urology Group Practice Association
Latino Diabetes Association
Let Freedom Ring
Licensed Professional Counselors Association of Georgia
Louisiana State Medical Society
Lupus Alliance of America - Hudson Valley Affiliate
Lupus Alliance of America - Queens and Long Island Affiliate
Lupus Alliance of America - Southern Tier Affiliate
Lupus Alliance of America - Upstate New York Affiliate
Lupus Foundation of America, DC/MD/VA Chapter
Lupus Foundation of Arkansas
Lupus Foundation of Florida
Lupus Foundation of Mid and Northern New York
Lupus Foundation of Pennsylvania
Lupus Foundation of the Genesee Valley
Mabel Wadsworth Women's Health Center
Maine Health Care Association
Maine Osteopathic Association
Maine Podiatric Medical Association
Maine State Council of Vietnam Veterans of America
Maryland Orthopaedic Association
Maryland State Medical Society
Massachusetts Association for Behavioral Health Systems
Massachusetts Association for Mental Health
Massachusetts Biomedical Initiatives
Massachusetts Medical Device Industry Council
Massachusetts Orthopaedic Association
Massachusetts Podiatric Medical Society
Medical Association of Georgia
Medical Association of the State of Alabama
Medical Society of Delaware
Medical Society of New Jersey
Medical Society of the District of Columbia
Medical Society of the State of New York
Medtronic
Men's Health Network
Mental Health America of Greater Houston
Mental Health America of Indiana
MichBio
Michigan Chamber of Commerce
Michigan College of Emergency Physicians
Michigan Orthopaedic Society
Michigan Podiatric Medical Association
Michigan Society of Anesthesiologists
Minnesota Podiatric Medical Association
Minnesota State Grange
Mississippi Arthritis and Rheumatism Society
Mississippi Orthopaedic Society
Missouri State Medical Association
Missouri Urological Association
Montana Orthopaedic Society
National Alliance on Mental Illness
National Alliance on Mental Illness Colorado
National Alliance on Mental Illness Florida
National Alliance on Mental Illness Georgia
National Alliance on Mental Illness Indiana
National Alliance on Mental Illness Maine
National Alliance on Mental Illness Michigan
National Alliance on Mental Illness NC
National Alliance on Mental Illness Texas
National Association for Home Care & Hospice
National Association for Home Care & Hospice - Indiana Chapter
National Association for Home Care & Hospice - Ohio Chapter
National Association for Uniformed Services
National Association of Manufacturers
National Association of Nutrition and Aging Services Programs
National Association of People with AIDS
National Association of Social Workers NC
National Association of Spine Specialists
National Coalition on Health Care
National Council for Community Behavioral Healthcare
National Council of Negro Women
National Council of Negro Women - Los Angeles View Park Section
National Health Foundation
National Hemophilia Foundation - Delaware Valley Chapter
National Kidney Foundation - Ohio Chapter
National Medical Association
National Minority Quality Forum
National Retail Federation
National Taxpayers Union
NCBIO
Nebraska Academy of Physician Assistants
Nebraska Medical Association
Nebraska Orthopaedic Society
Nebraska Urological Association
Neurofibromatosis Mid-Atlantic
Nevada Orthopaedic Society
Nevada Podiatric Medical Association
Nevada State Medical Association
New Hampshire State Grange
New Horizons Home Health Services
New Jersey Academy of Ophthalmology
New Jersey Mayors Committee of Life Science
New Jersey Podiatric Medical Society
New Mexico Podiatric Medical Association
New York Podiatric Medical Associtation
New York State Rheumatologists Society
New York State Urological Society
North Carolina Association on Aging
North Carolina Psychological Association
North Carolina Rheumatology Association
North Carolina Urological Association
North Dakota Chamber of Commerce
North Dakota Medical Association
North Dakota Policy Council
Northwest Urological Society
Ohio Association of Ambulatory Surgery Centers
Ohio Association of County Behavioral Health Authorities
Ohio Association of Medical Equipment Services
Ohio Hospital Association
Ohio Orthopaedic Society
Ohio State Grange
Ohio State Medical Association
Ohio Urological Society
Ohio Veterans United
Oklahoma Podiatric Medical Association
Oklahoma State Medical Association
Oklahoma State Orthopaedic Society
Oklahoma State Urologic Association
Old North State Medical Society
Oregon Medical Association
Oregon Podiatric Medical Association
Partners in Care Foundation
Partnership for Drug Free North Carolina
Pennsylvania BIO
Pennsylvania Chamber of Business & Industry
Pennsylvania Medical Society
Pennsylvania Orthopaedic Society
Personal Coaching & Psychotherapy for Women
PhRMA
Premier healthcare alliance
RARE Project
Restore America's Voice Foundation
RetireSafe
Rhode Island Medical Society
Rio Grande Foundation, New Mexico Rocky Mountain Stroke Center
Robert Powell Center for Medical Ethics at the National Right to Life Committee
Rural Health IT
Sanfilippo Foundation for Children
Scott and White Healthcare
Society for Cardiovascular Angiography and Interventions
Society for Vascular Surgery
Society of Gynecologic Oncology
Society of Urologic Oncology
South Carolina BIO
South Carolina HIV/AIDS Care Crisis Task Force
South Carolina Medical Association
South Carolina Orthopaedic Association
South Carolina Podiatric Medical Association
South Carolina Urological Association
South Dakota State Orthopaedic Society
South Jersey Geriatric Care PC
South Jersey Senior Networking Group
Southeastern Medical Device Association (SEMDA)
Southwest Michigan Pharmacist Association
Stockton Center on Successful Aging
Syndicus Scientific Services
Taxpayers Protection Alliance
Tea Party Express
Tea Party Nation
Team Sanfilippo Foundation
Tennessee Medical Association
Tennessee Orthopaedic Society
Tennessee Podiatric Medical Association
Texas Healthcare & Bioscience Institute
Texas Podiatric Medical Association
Texas Urological Society
The Center for Health Care Services
The National Center for Public Policy Research
The Seniors Coaltion
The G.R.E.E.N. Foundation
The National Grange
U.S. Chamber of Commerce
US Health Freedom Coalition
U.S. Pain Foundation
Urology Society of New Jersey
Utah Medical Association
Utah Podiatric Medical Association
Utah State Orthopaedic Society
Unite In Action, Inc.
Vascular Society of New Jersey
Vermont Medical Society
Vermont Podiatric Medical Association
Veterans Health Council
VHA Inc.
Vietnam Veterans of America
Virginia Biotechnology Association
Visiting Nurse Association of Ohio
Washington Biotechnology & Biomedical Association
Washington Free Clinic Association
Washington Osteopathic Medical Association
Washington Rheumatology Association
Washington State Medical Association
Washington State Podiatric Medical Association
Washington State Urology Society
WERAK Foundation
West Virginia Academy of Otolaryngology
West Virginia Chapter of the American College of Cardiology
West Virginia Manufacturer's Association
West Virginia Orthopaedic Society
West Virginia State Medical Association
William "Hicks" Anderson Community Center
Wisconsin Hospital Association
Wisconsin Medical Society
Wisconsin Urological Society
Women Against Prostate Cancer
Wyoming State Grange
60 Plus Association

Energy & Commerce Committee. More than 390 groups voice support for repeal of IPAB [Internet]. Washington, DC: Committee on Energy and Commerce: 2012 Mar 21 [cited 2013 Mar 23]. Available from: http://energycommerce.house.gov/brand/more-390-groups-voice-support-repeal-ipab Repeal IPAB
Restore Congressional authority over Medicare reimbursement Ask of Congress: GWU Urology Grand Rounds
March 27, 2013 Christopher Bayne, MD Introduction The idea for this type of presentation was born from my experience at the 2013 Urology Joint Advocacy Conference (JAC)





Admittedly, this is different than typical Grand Rounds





I think what I have to present today is just as important





I have no political ties to the information I am presenting I have aimed for objectivity Much of the information I'm presenting is in the public domain; it's difficult to cite one specific source. I have, however, leaned on the American Medical Association and American Urological Association, UROPAC, and my experience at the JAC Office of Representative Bobby Scott, VA-3


Office of Representative Gerald Connolly, VA-7 Will we have enough physicians?

Where will they come from? >390 groups Why is this important? Your profession Your Congressman doesn't know
what you know Your patients Call to action Take 15 minutes and write your Congressman Follow your Congressman on Twitter
Follow @AmerUrological
Follow @AACU, @UrologyUS, and other thought leaders Interact with your Congressman Read your emails!
Join AACU, UROPAC, or at least subscribe to their news feeds or email lists Meet with your Congressman
Plan to attend the 2014 JAC (it's free for residents and you're local) Read the rest: http://www.auanet.org/eforms/hpbrief/view.cfm?i=1777&a=3836 Section 2713 of the Affordable Care Act grants USPSTF rule of law (i.e., de facto mandates) Medpage Today. AMA bucks USPSTF on mammography. 2012 Jun 19 [cited 2013 Mar 25. Available from: http://www.medpagetoday.com/MeetingCoverage/AMA/33353 American Urological Association. Dr. John Lynch Speaks Out Against USPSTF Recommendations on PSA [video on the Internet]. 2011 Oct 11 [cited 2013 Mar 25]. Available from: vs. Office of Representative Robert Hurt, VA-5 Office of Senator Mark Warner, VA If IPAB fails to make recommendations on time, the Secretary of Health and Human Services gets unilateral decision-making authority Office of Representative James Moran, VA-8 Patient Protection and Affordable Care Act (ACA)
Full transcript