Edney MD FACS Peninsula Urology Associates Salisbury MD November 3 2011 AUA Legislative Affairs Committee Young Urologist Committee Liaison to AUA Health Policy Council President Maryland Urologists for Patient Access to Care ID: 935813
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Slide1
Health Policy Update
Mark T.
Edney
, MD, FACS
Peninsula Urology Associates, Salisbury,
MD
November 3, 2011
AUA Legislative Affairs Committee
Young Urologist Committee Liaison to AUA Health Policy Council
President, Maryland Urologists for Patient Access to Care
Slide2Overview
Joint Select Committee on Deficit Reduction
Independent Payment Advisory Board (IPAB)
Sustainable Growth Rate (SGR)
In-Office Ancillary Exception (IOAE)
PROSTATE Act,
Urotrauma
Bill
Other Legislation of Interest to Urology
UROPAC
Slide3Debt Ceiling Bill
Budget Control Act of 2011
Passed Aug 2, 2011, became public law 112-25
Establishes Joint Select Committee on Deficit Reduction
Slide4Committee Members
Senate Members
Finance Committee Chair
Max Baucus (D-MT)
Senate Foreign Relations Committee Chair
John Kerry (D-MA)
Democratic Senatorial Campaign Committee Chair
Patty Murray (D-WA)Minority Whip Jon Kyl (R-AZ)Pat Toomey (R-PA)Rob Portman (R-OH)
House Members
Energy & Commerce Committee Chair
Fred Upton (R-MI-6)
Ways & Means Committee Chair
Dave Camp (R-MI-4)
Jeb
Hensarling
(R-TX-5
)
Assistant Democratic Leader
James Clyburn (D-SC-6)
Budget Committee Ranking Member
Chris Van
Hollen
(D-MD-8)
Ways & Means Social Security Subcommittee Ranking Member
Xavier Becerra (D-CA-31)
Slide5Super Committee Process
Committee report due to Congress by November 23, 2011
Congress must either accept or reject the recommendations without changes by December 23, 2011
If successful, the debt ceiling can again be raised
Slide6What is on the Table?
EVERYTHING including but not limited to:
Graduate Medical Education cuts
Payment reductions (PC), and prior authorization for imaging services
Direct cuts to physician reimbursement
Loss of EHR incentive payments for meaningful use
Slide7Super Committee Process
If Congress fails to enact, debt ceiling would be automatically raised by $1.2 trillion and across-the-board cuts would be triggered (sequestration)- effective CY13
Half of the savings would come from defense spending
Social Security and Medicaid are exempt
Medicare is not
Benefits and benef
ic
iary cost sharing remains unchanged, 2 percent cut to providers Deep cuts possible for CDC, NIH, HIV treatment and disease prevention programs
Slide8Independent Payment Advisory Board
15 member appointed panel (<50% physician, non-practicing)
Broad authority to cut provider payments (hospitals and hospices exempt for 5 years)
Essentially no Congressional oversight
H.R. 452/S.668 – main repeal bills
David Roe MD (R-TN)- 209 cosponsors, currently in E+C subcommittee on health
President Obama is calling for a strengthening of IPAB
Senate shows no sign of willingness to repeal
Slide9Sustainable Growth Rate
29.6% Cut Looming on Dec. 31
If this is not addressed by the Committee, there will be little time to stop the cuts.
LATE BREAKING: CMS PFS CY12 final rule published 11/1- 27% cut
MedPAC
Recommendation to fix the SGR
Cut specialists 5.9 percent per year for three years, freezing payments for the remaining seven years. Primary care frozen for 10 years without reduction.
Collect data on service volume and work time to establish “more accurate” work and practice expense values Supplanting the extensive prior work of the RUCUse data to identify over-priced physician services and reduce their relative value units (RVUs)
Slide10In-Office Ancillary Exception
Urology has been and will continue to be under intense scrutiny from CMS and attack from organized radiology, radiation oncology and hospitals
Slide11In-Office Ancillary Exception
MedPAC
Recommendations at April Meeting
Encourage the RUC to
accelerate bundling
of discrete services often provided during one encounter
Reduce
payment rates for the professional component of multiple imaging studies provided during the same sessionReduce the professional component for imaging and other diagnostic tests ordered and performed by the same practitionerPrior authorization for physician outliers
Slide12In-Office Ancillary Exception
STATE ALERT
Maryland 2011- became 1
st
state to
prohibit
non-radiologists from owning and operating CT and MRI
American College of Radiology considers Maryland Patient-Referral Law “model legislation”Heretofore unsuccessful attempts at passing same language in Pennsylvania, Washington, and OregonBe vigilant in your state
Slide13PROSTATE Act
Prostate Research, Outreach, Screening, Testing, Access, and Treatment Effectiveness Act of 2011 – S. 1190/H.R. 2159
Establishes an Interagency Task Force, led by the VA and includes the
DoD
and HHS that will:
Aligns federal agencies’ prostate cancer research, healthcare delivery programs, educational & outreach efforts, and messages
Makes recommendations for future funding
Expands prostate cancer programs in research, telehealth, minority outreach, and education and awareness.Budget Neutral
Slide14Urotrauma – H.R. 1612
Commission (sunset) led by
DoD
and includes VA and HHS
Will develop and recommend a long-range plan for utilization of national resources to effectively deal with battlefield
urotrauma
Prevention, initial and subsequent/chronic management, public/private coordinated efforts
May get included in National Defense Authorization Act
Slide15Other Legislation of Interest to Urology
H.R. 5 (
Gingrey
, R-GA-11)/S. 218 (Ensign, R-NV) – the HEALTH Act – comprehensive liability reform
H.R. 816 (
Gingrey
, R-GA-11) – nothing in the ACA (guideline or standard) can create a new cause of action
Slide16Other Legislation of Interest to Urology
H.R. 674 (Herger, R-CA-2)/S. 164 (Brown, R-MA) – repeals the required withholding of 3% of government payments to contractors starting Jan 1, 2012
Tax Increase Prevention and Reconciliation ACT (2005), section 511
3% withholding on government payment for contracted services (Federal, State and any state political subdivision making payments >$100M annually) as down-payment on federal tax liability
Passed House 10/27/2011 405-16
Senate expected take it up this week
Slide17Other Legislation of Interest to Urology
H.R. 969 (Price, R-GA-6) -
Prohibits
the HHS Secretary or any state
from
requiring any health care provider to
participate in any health plan as a condition of licensure
of the provider in any stateSTATE ALERTThis issue being considered in a few states2011 – model legislation prohibiting participation-based licensure in Kansas, Virginia
Slide18Other Legislation of Interest to Urology
H.R. 1700 (Price, R-GA-6) - establishes a Medicare payment option for patients and physicians or practitioners to
freely contract, without penalty, for Medicare fee-for-service
Slide19Other State Issues
Insurance Exchanges- MD, DC, MA
Assignment of Benefits
Wins: MD, DE
Loss: WV
Scope of Practice- NJ, MD, WV, CT
MA Healthcare Act 2006- Dr. Hopkins
VT single payer system
Slide20Slide21What is UROPAC?
UROPAC is the only political action committee dedicated exclusively to advancing the public policy interests of urology.
Voluntary, nonpartisan political action committee that organizes urologists, residents and students who share an interest in electing and retaining pro-urology candidates in Congress.
UROPAC is co-sponsored by the American Association of Clinical Urologists (AACU) and the American Urological Association (AUA).
Slide22UROPAC Income 1992-Present
Slide23Specialty Physician PACS 2010 Election Cycle - Receipts
Specialty Association
Receipts for 2009-2010 Cycle
Percent of Eligible Members Donating
American Association for Justice
$ 34,715,804.00
American Association of Orthopaedic Surgeons
$ 3,791,270.00
27.7%
American Society of Anesthesiologists
$ 3,145,915.00
16.5%
American Medical Association
$ 2,345,490.00
---
American College of Radiologists
$ 2,345,140.00
13%
American College of Emergency Physicians
$ 2,245,822.00
29%
American College of Ophthalmology
$ 1,880,000.00
20%
College of American Pathologists
$ 1,621,634.00
21%
American College of Surgeons
$ 1,345,374.00
4.2%
American College of Cardiology
$ 1,257,476.00
10%
UROPAC
$ 1,027,662.00
18%
American College of Obstetrics & Gynecology
$ 934,000.00
4.0%
American Osteopathic Information Association
$ 914,323.00
4.3%
American Academy of Dermatology
$ 741,000.00
12.0%
American Academy of Family Physicians
$ 714,385.00 3.35%
UROPAC- 10
th
Largest Specialty Physician PAC
Slide24Physicians in Congress- 111
th
Congress (16)
Family Medicine
Vic Snyder (D- AR 2)
John Flemming (R- LA 4)
Paul Broun (R- GA 10)
Donna Christensen (D-VI)Psychiatry Jim McDermott (D- WA 7)OB/GYN Tom Coburn (R-OK) Michael Burgess (R –TX 26) Ron Paul (R- TX 14) Phil Roe (R- TN 1) Phil Gingrey (R- GA 11)
Allergist
Steve Kagan (D- WI 8)
GI
Bill Cassidy (R- LA 6)
CT Surgery
Charles Boustany (R- LA 7)
Radiation Onc
Parker Griffith (R- AL 5)
Orthopedics
John Barrasso (R- WY)
Tom Price (R- GA 6)
Slide25Physicians in Congress- 112
th
Congress (20)
Family Medicine
John Flemming (R- LA 4)
Paul Broun (R- GA 10)
Donna Christensen (D-VI)
Psychiatry Jim McDermott (D- WA 7)OB/GYN Tom Coburn (R-OK) Michael Burgess (R –TX 26) Ron Paul (R- TX 14) Phil Roe (R- TN 1) Phil Gingrey (R- GA 11)GI Bill Cassidy (R- LA 6)
CT Surgery
Charles Boustany (R- LA 7)
Larry Bucshon (R- IN 8)
Orthopedics
John Barrasso (R- WY)
Tom Price (R- GA 6)
General Surgery
Dan Benishek (R-MI 1)
Anesthesia
Andy Harris (R- MD 1)
Ophthalmology
Nan Hayworth (R- NY 19
Rand Paul (R-KY)
Emergency Medicine
Joe Heck (R- NV 3)
Slide26Ways to Get Involved
Leadership Program (sectional program)
Northeastern 2 South Central 3
New England 2
Western 3
New York 2 North Central 3
Mid Atlantic 2
Southeastern 3AACU States Society Network Annual Meeting Every September in ChicagoJoint Advocacy Conference AUA/AACU, annually in March in Washington DC
Slide27Ways to Get Involved
Gallagher Health Policy Scholarship
Annual award in its 7
th
year
Biannual HP meetings
Brandeis (ACS) Health Policy/Leadership course (1 week)
AMA RUC meetingSection Level ParticipationSection representatives to AUA BoardPractice Management CommitteeYoung Urologists CommitteeHealth Policy Council
Slide28Ways to Get Involved
State-level advocacy development
Critical unmet need
Opportunity for the motivated to immediately assume a leadership role
Assemble critical mass of practices
Mix of all practice models
Get experienced healthcare counsel
Get a lobbyistIncorporateStart making relationships with lawmakersAttend/host fundraisers
Slide29“
IF YOU ARE NOT AT THE TABLE YOU WILL SURELY BE ON THE MENU”
Slide30Ways to Get Involved
Contribute
Slide31THANK YOU
mtedney04@hotmail.com