NEAUA Highlighter Newsletter
April 2015 Issue
New England Section AUA Board Alternate Representative Process and Candidate

The New England Section has the privilege of nominating one of its Active or Senior members to become the Alternate Representative to the American Urological Association’s Board of Directors, and subsequently the Section's Representative to the AUA Board. The chosen Alternate’s term will officially begin after the AUA Meeting in 2015.

The following candidates have been certified by the Section Nominating Committee and Board of Directors.

E. Ann Gormley, MD
John A. Libertino, MD
Arthur E. Tarantino, MD

Candidate profiles and a ballot will be circulated to the voting membership for vote within the coming weeks. A majority of the vote is required for election. In the event a winner cannot be declared based on the ballots cast in the initial round of voting because two nominees have received an identical number of votes, the profiles of the two nominees ranked highest shall be resent to the voting members of the Section along with a subsequent ballot for a second round of voting. The candidate receiving a majority of the second round of balloting will be considered the Section’s Alternate Representative to the AUA Board of Directors.



NEAUA Financials in Summary: Dr. Arthur Tarantino, Treasurer


Colleagues, I am pleased to report that 2014 was a financially successful year for the Section and has helped position us for continued financial stability. The Section ended the 2014 calendar year for the first time with over $1.3 million in assets, a testimony to the thoughtful attention paid to the organization’s finances and investments by the leadership and the Finance Committee.

The success of the Newport meeting combined with a strong investment performance resulted in year-end Total Assets of $1,313,572 compared to $1,154,826 in 2013. The meeting netted a surplus of approximately $240,000 with 239 registered attendees. Our Investment Portfolio, managed by Joel Blau of Mediqus Asset Advisors, grew to a total of $762,041 as of the end of 2014. The Endowment Fund is starting off strong at $109,266. We hope to grow the Endowment Fund so as to provide us some independence in offering our Annual Meeting. We operated "on budget" in 2014 and the leadership has approved the 2015 budget with similar expectations.

We need to continue to grow our membership and support our Annual Meeting, which are the drivers of our balance sheet. I encourage all of our members to enroll their APRN’s and PA’s as members of the Section. Beginning in October 2015, the Section will break its Allied membership classification in two and will maintain a membership category for Advanced Practice Providers and a separate category for Allied Health Providers, including nurses, medical assistants and technicians. Also encourage your medical staff to attend the Joint Meeting with the Mid-Atlantic Section coming up this October in the Bahamas. If you plan to bring your family to the Bahamas, be sure to registry your spouse or guest. Registration for spouses and guests includes free breakfast in the spouse hospitality room, attendance at the Welcome Reception on Thursday, attendance at the Friday evening reception, and attendance at the Saturday evening dinner. This is a great value. If a spouse/guest is registered, children under 18 years of age can register for free and also access all the social events listed above.

Vendor support is critical to the financial success of our meetings and the Section leadership continues to work closely with our industry colleagues to ensure satisfaction from all Annual Meeting angles. I want to personally thank all of our members who made the effort to spend quality time with our industry colleagues in Newport this past fall; we need to carry that momentum forward this year for the joint meeting in the Bahamas. Industry support is an important financial component for the Section and helps to offset our organization’s expenses, so please make some time to visit our industry colleagues and thank them for their support while at the Atlantis this coming October.

In closing, I want to thank you for the responsibility entrusted to me as your Treasurer. I remain available for any and all questions. I can be reached by email at arthur.tarantino@hhchealth.org.

Art Tarantino, MD
Treasurer



Save the Date: Urology Care Foundation Gala, May 15, 2015

Please join the Urology Care Foundation for a celebration of friends and supporters united in advancing urologic health by attending the Care Gala on May 15, 2015 at The National WWII Museum in New Orleans. Individual tickets to the Gala are available along with sponsorship opportunities. Visit the Urology Care Foundation website for more information.


Joint Meeting with Mid-Atlantic Section – Important Information

  • Book accommodations at the Atlantis: Space is limited so book as soon as possible, but no later than September 11, 2015. meeting.maaua.org/index.cgi

  • Registration: Registration is currently available at meeting.maaua.org/registration.cgi

  • Getting to the Atlantis: meeting.maaua.org/getting-to-the-bahamas.cgi

  • Guest/Spouse/Child Registration: Please be sure to register guests and spouses and children in advance of the meeting. Registration for spouses and guests includes free breakfast in the spouse hospitality room, attendance at the Welcome Reception on Thursday, attendance at the Friday evening reception, and attendance at the Saturday evening dinner. If a spouse/guest is registered, children under 18 years of age can register for free and also access all the social events listed above. If you are bringing children to the meeting, please contact the Section offices to arrange for a children’s registration. Guests without badges will not be allowed into any social events and will not be able to participate in any meeting activities.

  • Atlantis Activities: meeting.maaua.org/atlantis-activities.cgi

  • Preliminary Program: Available summer 2015



Resident Participation in the 2015 JAC: Articles by Dr. Kevin Koo and Dr. Michelle Kim

Walking briskly past the U.S. Capitol as I hurried between visits with members of Congress during the Urology Joint Advocacy Conference (JAC), I had a sudden revelation: political advocacy is not unlike urolithiasis.

There’s a routine I go through with patients when they return to the clinic after surgery for kidney stones. I ask them about their experiences after surgery—how quickly they recovered, how well they tolerated their stents, whether their symptoms have improved. Most of the time, the outcomes are excellent, and the patients are relieved. Then I show them their stone composition analysis and remind them that the real work of managing their stone disease has begun. Diet modification and preventative medical therapy, I say, are a lifelong commitment. Making the commitment right after surgery is easy, but as we all know, keeping the commitment in the following weeks and months is what makes the difference.

Advocacy requires the same purposeful dedication. If legislative progress could happen as quickly as the weather changes in New England, then we as a urological community would simply solve one issue and move onto the next. But meaningful change takes time and sustained effort, and so each year we meet at the JAC to determine how we can continue improving the lives of our patients and fostering high-quality, evidence-based urology in our communities. I am grateful to have attended this year’s JAC with the generous support and mentorship of our Section.

Many of the issues discussed at this year’s conference are not new. We remained concerned about our patients’ future access to urological care due to federal caps on graduate medical education. We supported new efforts to bring transparency to the U.S. Preventive Services Task Force and ensure that its membership is aligned with its purview. And we renewed the call to federal action on the Medicare Sustainable Growth Rate, the perennial challenge facing practices and colleagues across all specialties of medicine.

But what happens now that the JAC is over and we’ve returned from Washington to our daily routines of patient care? The most powerful lesson I learned at this year’s JAC is that advocacy is not a single day or an annual meeting. Rather, the most impactful advocacy depends on longitudinal relationships with members of Congress and their staff that can start with an in-district meeting or a visit to see clinical care in action. The American Association of Clinical Urologists has launched a "JAC365" campaign with instructive resources on sustaining our advocacy year-round. I would encourage everyone, and especially those who may not have had the opportunity yet to visit Capitol Hill as urologists, to be part of the cause.

Finally, I was inspired to see so many of the national leaders in urological advocacy are from the New England Section and have integrated legislative activism in their professional lives. My fellow trainees and I must continue this legacy of leadership, not only to preserve the progress that has already been made, but to advance the voice of urology on behalf of our patients and our profession.

Kevin Koo, MD, MPH, MPhil
Dartmouth-Hitchcock Medical Center
Lebanon, N.H.


I was given the generous opportunity to attend the 10th annual Urology Joint Advocacy Conference through the New England AUA. This was a well attended meeting for UroPAC, the political action committee of the American Association of Clinical Urologists (AACU) and the American Urological Association (AUA). The New England section of the AUA was well represented by a very diverse group of attendees from private practice, academic, rural, and urban areas, each of whom had gathered to address legislative issues pertinent to the field of urology.

The conference was composed of several speakers including academic and private practice urologists, congressional staff members, special interest group representatives and Senators. Each addressed several important topics related to health economics, health care reform, and health information technology as well as other policy topics relevant to the field of urology. While a broad range of topics was covered, four main legislative issues were discussed in depth. These included improving the transparency and accountability of the recommendations made by the United States Preventive Services Task Force (USPSTF), increasing graduate medical education funding to meet the demands of the proposed physician shortage in primary as well as specialty care, repealing the Sustainable Growth Rate formula and maintaining the in-office ancillary services exemption of the Stark Law. The conference commenced with each participant going to Capitol Hill to discuss these four policy topics with the staff members of various Senators and Congressmen.

The conference was a wonderful opportunity to get exposure to the inner workings of the political process and to learn about the advocacy efforts of UroPAC in Washington D.C. on behalf of patients and urologists. Many of the issues have broad implications for patient care. For example, patients may not get the appropriate screening due to the USPSTF recommendations or may have to take more time out of their busy schedule and spend more money to get imaging or tests at an outside facility due to the Stark Law. Additionally, the lack of GME funding for additional residency spots in urology may leave many communities without proper urologic care as older urologists retire. As a result, we have a responsibility to our patients and their families to advocate against policies that may negatively affect patient care and start a more thoughtful, data driven dialogue to implement policies that will improve patient care.

Lastly, the conference was a great way to meet urologists from around the around the country and in different practice settings. Many had taken time out of their busy clinical schedules because of the challenges they were facing in their own practices. I hope that more residents will follow their lead and start getting involved in the advocacy process as many of the issues will be pertinent to us going forward. At the end of the conference, one very thoughtful attending noted “we have no right to complain if we do not do our part and get involved.” We are all responsible for shaping the future of urology and becoming advocates for our patients and our peers. I hope that we will all take advantage of opportunities such as the one presented by UroPAC and bring a larger presence to Washington D.C. next year.

Michelle Kim, MD



NEAUA Resident Bowl and Debate Teams to Compete at the AUA 2015 Annual Meeting

Support the Section’s Resident Bowl and Resident Debate Teams as they compete in New Orleans!

Resident Bowl Team:
Patel Chintan, MD (Lahey Clinic)
Andrew Leone, MD (Rhode Island Hospital)
Rachel Moses, MD (Dartmouth Hitchcock Medical Center)
Gregory Murphy, MD (University of Connecticut)
Bejamin Waldorf, MD (Lahey Clinic)
Joseph Yared (Dartmouth-Hitchcock)

Resident Bowl competition rounds will take place May 16-18, 2015 at booth #1401 in the Science & Technology Hall. www.aua2015.org/attendees/residents-bowl.cfm

Resident Debate Team:
Steven Kardos, MD (Yale School of Medicine)
Timothy Tran, MD (Brown University)

The Resident Debate will take place May 17, 2015 in room 348-349 of the New Orleans convention center. www.aua2015.org/attendees/resident-debate.cfm



New England Well Represented at the 2015 JAC

The New England Section was well represented at the 2015 AUA/AACU Joint Advocacy Conference in Washington, DC last month with at least 14 New England urologists advocating on Capitol Hill! All 6 New England states were represented and urologists in attendance included current and past members of the leadership, past Presidents, and residents. If you are interested in becoming more involved with the JAC in 2016, please contact the NEAUA administrative office.




AUA Interactive State Legislation Map

The AUA tracks state legislation that could impact the practice of urology in your region. View which bills the AUA is monitoring by visiting the interactive state legislation map.




Government Relations & Advocacy Update

The following articles are provided by the American Association of Clinical Urologists in partnership with the New England Section of the AUA. The AACU is pleased to update NEAUA members on socioeconomic issues affecting urologists. AACU staff may be reached via the NEAUA or by emailing info@aacuweb.org. Edited By: Ross E. Weber, AACU State Affairs Manager




Keep Current with MedPAC

MedPAC wants to increase payment rates for hospitals but eliminate an update for ambulatory surgical centers in 2016. Browse what to expect in the upcoming Annual March Report to Congress.




Amendments to 2015 Medicare Physician Fee Schedule Released

CMS has announced an emergency Change Request (CR) 9081 that updates the Medicare Physician Fee Schedule conversion factor. Unspecified fee schedule errors have been corrected, but result in slightly lower payment rates for urology services. For additional information, click here.




AACU State Government Relations and Advocacy Update – April 2015

Edited by: Ross E. Weber, AACU State Affairs Manager

The first several months of any year are filled with legislative and regulatory activity in Washington and state capitols across the country. 2015 is no different. Much attention is currently focused on the U.S. Senate, where the fate of permanent repeal of the Medicare physician payment Sustainable Growth Rate rests. New England Section of the AUA states have likewise considered thousands of bills that impact the practice of medicine. Many measures have been necessitated as a result of the Affordable Care Act. For instance, legislators in Massachusetts and Connecticut are wrestling with the power of state attorneys general and quasi-independent boards to review large health care industry transactions. What's more, with millions of newly-insured citizens seeking health care, states are struggling to adapt non-physician providers' scope of practice laws in a way that maintains patient safety, as well as professional standards.

Of more 11,000 bills introduced in New England Section states*, here are just a few to peak your interest. Details on each of these bills may be viewed online at the AACU State Action Center (www.aacuweb.org/states).

Medical Liability Reform

  • MA HB 865 – An Act to allow a medical malpractice insurer to decline to pay claims for negligence when a licensed provider fails to consult the prescription monitoring program prior to prescribing a medication to a patient; MA HB 986/1014 – An Act to include actions for wrongful death under medical malpractice damages, establish new burdens of proof on plaintiffs in medical malpractice cases and exempt peer review committees from the Public Records Law.

  • NH SB 37 – An Act to limit the requirements for live testimony by medical professionals in civil actions.

  • VT H 441 – An Act to establish a system of mandatory arbitration for medical malpractice claims; require a claimant to file a notice of intent to file a claim 182 days prior to filing a complaint for medical malpractice; establish 1imits on the amount of damages recoverable in medical malpractice actions; provide that a defendant's compliance with the State's health care cost containment initiatives is an affirmative defense in medical malpractice actions and establish screening panels for medical malpractice claims.

Private Payer Reform - 90-day Grace Period and Network Adequacy

  • CT HB 5916 – An Act to eliminate the difficulty individuals who purchased qualified health plans through the Connecticut Health Insurance Exchange are having finding health care providers to accept the plans.

  • ME LD 124 – An Act to require payment by a carrier for health care services provided to enrollees; ME LD 704 – An Act to require carriers to notify providers when an enrollee has not paid their premium.

  • MA HB 818 – An Act to prohibit carriers from dropping coverage of insured for late premium payments until payments are a full 90 days late.

  • RI H 5597 – An Act to establish criteria by which the office of the health insurance commissioner shall review and regulate the adequacy of health plan networks.

Certificate of Need, Medical Economics and Industry Consolidation

  • CT SB 191 – An Act to eliminate the requirement for a certificate of need for transfer of ownership of a physicians' group practice; CT SB 807 – An Act to promote the use of low-cost, high-quality health care providers, mitigate the anticompetitive effects of hospital consolidations and encourage administrative efficiency; CT SB 1120 – An Act to ensure that consumer access to health care is not adversely impacted by hospital mergers and acquisitions.

  • ME LD 45 – An Act to exempt capital expenditures that do not result in a net increase in MaineCare costs from the Maine Certificate of Need Act; ME LD 734 – An Act to repeal the Certificate of Need Requirement for hospitals.

  • MA HB 983 – An Act to require that when MassHealth enrollees have received prior approval for emergency and other services, health care providers not included in a managed care organization's network must accept a rate equal to the rate paid by Medicaid for the same or similar services; MA HB 1007 – An Act to expand the threshold for determination of need for hospitals and acute care centers by requiring that million (or million over five years) be expended on outpatient care.

  • NH HB 330 – An Act to establish an oversight commission for medical cost transparency to monitor and further develop the NH HealthCost Internet website.

  • VT H 179 – An Act to regulate health care professionals' rates and practice locations and establishing a health insurance market outside the Exchange

Public Health, Scope of Practice and Professional Standards

  • CT HB 5625 – An Act to establish a task force to recommend a definition of surgery.

  • ME LD 179 – An Act to direct the Dept. of Health and Human Services to provide coverage under the MaineCare program for routine male newborn circumcision.

  • MA HB 993 – An Act to allow the Health Care Policy Commission to review any/all alterations in the scope of practice of a licensed health care provider; MA HB 1994 – An Act to investigate and study robotic surgery in the Commonwealth; MA HB 2012 – An Act to authorize the board of registration to define the practice of surgery and limit surgery to physicians licensed by said board.

  • NH HB 251 – An Act to exclude circumcision from the state Medicaid plan.

*New England Section State Bill Introductions (as of April 8, 2015)
CT – 3,184
ME – 1,302
MA – 3,354
NH – 901
RI – 1,853
VT - 806



Telemedicine Compact Usurps State Authority to License Physicians

By: Ross E. Weber, AACU State Affairs Manager

More than three dozen states have introduced the Federation of State Medical Board’s (FSMB) Inter-state Medical Licensure Compact. The general view extolled by news outlets and medical associations belies the fact that if a sufficient number of states approve the measure, the authority of legislators and licensing boards would be questioned, if not compromised. When questioned about the authority of states to require benefit managers' decisions be made by a physician licensed in that state (WA HB 1471 / SB 5560), FSMB Senior Director for Legal Services Eric Fish responded:

The Compact is designed to facilitate the granting of a full and unrestricted medical license. Once granted, physicians are bound to the laws of the state where the patient is located. This applies both to standard of care issues as well as any other requirements for medical care necessitated by that state's laws.

While the legislation referenced in this piece may be of varying degrees of concern to urologists, there are a number of positive work force measures under consideration, including state-funded residency programs in Georgia and Idaho, as well prohibitions on tying licensure to meaningful use of electronic health records and maintenance of board certification.

The AACU is dedicated to bringing these issues to urologists' attention and developing resources that facilitate engagement in political and policy-making processes. Feedback from the diverse urologic community of providers, patients and partners is always welcomed.

Federal Regulatory Update
By: American Urological Association Staff



Open Payments Video Tutorial Now Available

The Centers for Medicare & Medicaid Services (CMS) has released an Open Payments (Physicians Payments Sunshine Act) 2014 Program Overview and Enhancements 20-minute video tutorial for the 2014 reporting year that includes: a 2014 timeline for Open Payments, enhancements made to the Open Payments portal and a review of the registration process for physicians and teaching hospitals. Physicians do not need to act unless they want to review and dispute their data in the Open Payments portal. Physicians already enrolled in the Open Payments portal do not need to re-enroll in the system; however, the Open Payments portal is undergoing system enhancements at the present time and will be unavailable through late January. For more information visit: CMS.gov/Open Payments and CMS Open Payments Fact Sheet.


New Emergency Regulation for Stricter Guidelines

The California Department of Insurance (DOI) recently issued an emergency regulation requiring health plan insurers to comply with stricter guidelines for provider network adequacy, out-of-network notifications and accurate provider listings. For additional information, click here.





The Fate of SGR Repeal Rests with the Senate

By: Daniel R. Shaffer, JD, AACU Associate Director

Congress can act quickly...When it wants to.

In early March, as urologists were preparing to attend the 10th annual Urology Joint Advocacy Conference (JAC), co-hosted by the AACU and AUA, the word on the street was that despite a great opportunity to repeal and replace the sustainable growth rate (SGR) formula in early 2015, Congress was likely going to enact another a temporary SGR patch or “doc fix” to address the March 31, 2015 expiration of last year’s temporary SGR patch.

Much has changed, however, in the weeks since urologists visited Capitol Hill at the JAC. Right after the JAC, there were reports that senior House staff from both parties had been meeting and discussing a plan to permanently repeal and replace SGR. Soon thereafter, the House Energy and Commerce and Ways and Means committees released a joint bipartisan statement announcing that both committees were actively working to follow up on the work that they had done on SGR repeal and replacement in 2014, which included the introduction of last year’s SGR repeal and replacement legislation, H.R. 4015/S. 2000.

Less than a week later, on March 19, 2015, leaders in the House and Senate introduced H.R. 1470/S. 810, the “SGR Repeal and Medicare Provider Modernization Act of 2015,” legislation very similar to last year’s H.R. 4015/S. 2000. Five days later, bipartisan leaders of the House Energy and Commerce and Ways and Means Committees introduced H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015,” which built upon the SGR repeal and replacement language of H.R. 1470/S. 810, adding offsets to help pay for SGR repeal and replacement as well as a number of other provisions not directly related to SGR repeal and replacement, like a 2-year extension of full funding for the Children’s Health Insurance Program (CHIP), set to expire September 30, 2015.

Continue Reading at UrologyTimes.com.