State of Urology Discussed by Three Organization Leaders

Oncology Live Urologists in Cancer Care®April 2014
Volume 3
Issue 2

Richard S. Pelman, MD, Juan A. Reyna, MD, and David F. Penson, MD, all large urology organization leaders, cited managing bureaucracy, PSA screening, and in-office ancillaries as top priorities.

Richard S. Pelman, MD


An update on the state of urology and the 2014 legislative and clinical priorities for the profession was offered by three leaders in the field during a panel discussion at the Urology Joint Advocacy Conference. Richard S. Pelman, MD, president of the American Association of Clinical Urologists (AACU), David Penson, MD, MPH, Health Policy Chair for the American Urological Association (AUA), and Juan Reyna, MD, president of LUGPA, also provided brief summaries of the recent accomplishments of their organizations.Because urologists are faced with an enormous burden of existing and pending bureaucratic responsibilities—from HIPAA, electronic health records, and ICD-10 coding to health insurance preauthorization phone calls and pharmacy authorization letters—Pelman commended JAC attendees for being proactive about those issues by participating in the meeting.

“We’re not quite ready to be like Howard Beale [from the motion picture Network] throwing his head out the window and yelling ‘I'm mad as hell, and I'm not going to take this anymore!’ but we can band together to bring a voice for our patients, for our concerns, for the way we practice, and for our ability to take back medicine," he said.

In a call to action, he highlighted the kind of community efforts that start in one state and slowly spread to another. He emphasized the success associated with the issue of freedom of licensure. This goal ensures for fair and open contractual relationships between third-party payers and healthcare providers and prohibits tying healthcare provider licensure to participation in a third-party payer program. “We just recently protected ourselves in Washington State. We’ve already seen this in Alabama, Georgia, and Virginia,” he said.

Pelman also touched on the question of whether the Medicare Payment Advisory Commission (MedPAC) will advise Medicare to reimburse for prostate-specific antigen (PSA) screening in light of the recommendation against the practice 2 years ago by the US Preventive Services Task Force (USPSTF). There have been discussions indicating that this screening might not be reimbursed for Medicare patients, and the AACU has launched an educational campaign to reach primary-care physicians, patients, and the media about PSA testing and the importance it plays in treating prostate cancer. AACU has been critical about the way the USPSTF analyzed the data and the organization’s recommendation.

The AACU also plans to provide medical practices with a specialized log that will help them track the amount of uncompensated time their staff members spend on bureaucratic procedures, Pelman said, and is working on medical liability reform by moving to ensure that conflicts are resolved only by experts in the specialties at the heart of each case.

He urged attendees to fight for their profession by “developing data” on issues such as whether quality measures set as benchmarks for urologists are appropriate. In addition to joining the AACU and asking others to do the same, urologists can help by forming and joining state urology societies that can serve as resources for government as it makes decisions that affect the field, Pelman said.


“Those at the local levels who are active are sought out,” he said. “We can provide input, and we can win.”Penson discussed the allocation of the AUA’s lobbying resources and how the group plans to support the policy needs of its members.

David F. Penson, MD

“AUA has [had] a single Health Policy Division for some time, but we now have numerous objectives, so much so that the infrastructure has gotten extremely large,” said Penson.

As a result, the Health Policy Division has been broken out into two groups—the Public Policy and Practice Support (PPPS) group and the Science and Quality group. Penson explained that legislative affairs, coding and reimbursement, and practice management would fall under the PPPS group umbrella, with committees such as guidelines, quality improvement in patient safety, and data housed under the Science and Quality group. “It’s going to be one happy family, just with more structure and more resources to promote all the work we are doing,” he told the audience.

He highlighted, in particular, the efforts of the Legislative Affairs Committee (LAC), which recently distributed a survey to all North American AUA members and the leaders of other urologic organizations to take their pulse regarding what’s going on in urology and to see which legislative issues they consider important.

From those results, AUA compiled a top-10 list of hot issues that was approved by the board of directors. “It gives us some guidance, and it also helps us decide where we should put our resources,” said Penson.

Those issues include finding ways to appeal the sustainable growth rate formula; keeping PSA screening available to appropriate men; reforming the USPSTF recommendation process that led to the agency’s discouragement of PSA testing; preserving the in-office ancillary exception; opposing or deferring implementation of ICD-10 coding; addressing urologic workforce shortages; eliminating or modifying the Independent Payment Advisory Board, which is charged with making cost-cutting changes to Medicare; promoting medical liability reform; and promoting funding for urology and urologic cancer research.

The LAC “set up a system so these issues will be reviewed every 2 years with the new members of Congress moving forward. I think this is a more egalitarian approach to setting the legislative agenda than what we have had in the past,” he added.

The practice management committee, meanwhile, has focused on the transition to ICD-10, or International Classification of Diseases, Tenth Revision, the World Health Organization’s standard tool for capturing mortality and morbidity data, with the development of materials including web-based training and live workshops.

“That does not mean that some members of the AUA think ICD-10 should go forward, but you have to hedge your bets, as it were, and make sure that you have things in place if it does move ahead,” Penson said. Back in February, Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, said during her keynote address at the Healthcare Information and Management Systems Society convention that there will be no delay, with the system set to go live on October 1 this year.


Penson closed his portion of the presentation by emphasizing the need to collaborate with the leadership of the other organizations. “We have to take the strengths of the organizations and match them in such a way that will optimize our effectiveness,” he said.In an effort to meet the needs of all of its members, LUGPA is undergoing a change in logo and even name, Reyna told the audience. Formerly known as the Large Urology Group Practice Association, the organization has dropped that name but is keeping the acronym LUGPA. It has also added the tagline “Integrated Practices, Comprehensive Care.” The changes are meant to make it clear that urology practices of all sizes are welcome to join the organization, and can benefit from membership, Reyna has said.

Juan A. Reyna, MD

The group created its Communications Committee to inform people of the changes. Another responsibility of the new committee is to identify a key physician and administrator from each member practice to develop a Group Championship Network, said Reyna. The network members will reach out to state senators and representatives to educate them about important urologic issues.

On the federal level, the association’s advocacy groups have made “hundreds of visits to members of Congress,” Reyna continued. “We’ve educated congressional leaders about how urologists provide patient care, how urologists provide better access, and how urologists do this efficiently and for value. We have worked with at least 27 different physician specialty groups on behalf of hundreds of thousands of physicians to contact House and Senate members, opposing the president’s budget proposals and Representative [Jackie] Speier’s [D-California] bill that would eliminate the In-office Ancillary Services Exception” set forth in the Stark Law.

LUGPA includes more than 120 physician groups led by a number of practice administrators, according to Reyna. “By drawing on [the ideas of] a few of the practice administrators and members of the board, we have developed an initiative to help practice administrators as a whole to improve efficiency and productivity,” Reyna told the audience. Using multiple channels like the web and telephone, he said, “LUGPA will identify and share the best practices that are occurring in very successful groups that could be easily implemented by groups of all sizes going forward.” Those best practices are available on the organization’s website,

Dovetailing on the discussion of prostate cancer prevention via PSA screening, Reyna described LUGPA’s men’s health initiative, which has involved the creation and distribution of posters, tools, and a website that member urologists can download and use within their own practices at no cost. Reyna said the idea is for urology offices to market themselves as men’s health centers within their communities.

Pelman interjected that AUA and AACU will sponsor a separate men’s health initiative to “protect male cancer survivors who have had therapy in the pelvis…in a broad sense of sexual health and incontinence,” and that LUGPA is invited to participate.

Reyna concluded by emphasizing that LUGPA will continue to support collaboration between the three associations and the continuing efforts of the Joint Advocacy Conference on legislative issues confronting urologists.

“We are going to continue to advocate not only for our specialty and for our members, but more importantly, for our patients,” he said. “In the end, we think we [as community practitioners] provide a better form of medicine for our patients. We can provide a place where they can get all of their care done in one place, at a less expensive price, with high quality.”

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