Health Policy in Urological Diseases

Ruchika Talwar | April 17, 2024

The recent cyberattack on Change Healthcare has been called the most pervasive and damaging of its type in U.S. history.1 Change is a third-party healthcare technology company that, by its own account, touches 1 in every 3 patient records and processes 15 billion transactions annually.2 After the attack, Change shut down its systems to prevent further breaches, which left tens of thousands of healthcare providers unable to electronically fill prescriptions, verify insurance eligibility, obtain prior authorizations, or submit reimbursement claims.

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Ruchika Talwar, MD

Ruchika Talwar, MD is a Urologic Oncology Fellow and a AUA Holtgrewe Legislative Fellow at Vanderbilt University Medical Center. She went to Medical School at Rutgers New Jersey Medical School in Newark, NJ and completed her residency at the University of Pennsylvania in Philadelphia, PA.

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Written by Ruchika Talwar, MD
Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN
Ongoing analyses of disruptions to care during the COVID-19 Public Health Emergency (PHE) continue to help identify important insights on how the healthcare system adapted to the pandemic, as well as how cancer patients may have been affected by the PHE. The PHE led to significant disruptions in clinical cancer care
Written by Ruchika Talwar, MD
Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN
In January 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This regulation mandates that Medicare Advantage (MA) organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities
Written by Ruchika Talwar, MD
Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN
The COVID-19 pandemic brought about a rapid expansion of telehealth services to ensure that patients were able to obtain necessary medical care without exposure to illness. Prior to this point, Medicare was very hesitant to cover telemedicine given lack of evidence regarding quality and cost, as well as effects on outcomes. As the Public Health Emergency (PHE) ended in May 2023
Written by Ruchika Talwar, MD
Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN
Over the past several years, Medicare Advantage (MA) insurance has been heavily criticized by health economists for the large degree of overpayments from Medicare, as well as by patients and physicians for restrictive networks, inconsistent coverage, and often high out-of-pocket costs for patients. Although one may think that MA plans fall under the Medicare/Medicaid umbrella based on the name of these plans, the MA program actually consists of private health plans.
Written by Ruchika Talwar, MD
Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN
The Centers for Medicare and Medicaid Services have maintained a focus on transitioning the American healthcare system from a fee-for-service payment model to a value-based payment model. Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reformed the Medicare payment system and created two new pathways to move towards value.
Written by Ruchika Talwar, MD
Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN
Although generic prescription drug shortages have been an ongoing problem over the past decade, the recent few months have brought about a severe chemotherapy shortage affecting many Americans with cancer. We explore the history and causes of this drug shortage in our last post.
Written by Ruchika Talwar, MD
Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN
Over the past decade, the United States has been facing ongoing issues regarding the supply and demand of generic prescription drugs. In general, generic drugs make up approximately 90% of prescriptions filled by American consumers.
Written by Ruchika Talwar, MD
Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN
On June 22, 2023, the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee hosted a hearing entitled, “MARCA Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors.”
Conference Coverage
Conference Highlights Written by Physician-Scientist
Presented by Ruchika Talwar, MD
(UroToday.com) The House of Delegates (HOD) convened at the American Medical Association (AMA) Annual Meeting in Chicago, IL, in June 2024. During the HOD, voting members of the legislative body of the organization deliberated, debated, and cast votes to finalize the healthcare policies
(UroToday.com) In June 2024, the House of Delegates (HOD) gathered at the American Medical Association (AMA) Annual Meeting in Chicago, IL. During this assembly, members of the legislative body engaged in discussions, debates, and voting to determine the healthcare policies that would be adopted as official directives.
Presented by Ruchika Talwar, MD
(UroToday.com) In June 2024, the House of Delegates (HOD) met during the American Medical Association (AMA) Annual Meeting, where they engage in discussions, debates, and voting processes to determine the healthcare policies that the organization will adopt as official directives.
Presented by Ruchika Talwar, MD
(UroToday.com) During the 2024 American Medical Association (AMA) Annual Meeting, the House of Delegates (HOD) convened to discuss, debate, and vote on healthcare policy that the organization will adopt as official directives.
Presented by Ruchika Talwar, MD
Since the inception of UroToday’s Health Policy Center of Excellence, our mission has been to spotlight critical health policy issues that resonate with the broader urology community. Physicians primarily use organized medicine to advocate for policy reforms impacting healthcare. Despite physicians' varied and often critical perspectives regarding the American Medical Association (AMA), it remains the most significant and powerful organization in this sphere.
Presented by Apoorv Dhir, MD
(UroToday.com) During the American Urological Association 2024 Annual Meeting in San Antonio, Texas, Dr. Apoorv Dhir from the University of Michigan delivered a podium presentation focused on the determinants of financial toxicity in patients with urologic cancer. Financial toxicity refers to the economic strain experienced by patients due to medical expenses, which can significantly impact their quality of life and access to care. This cross-sectional investigation aimed to explore the pervasive issue of financial toxicity that many patients face following a diagnosis of urologic cancer.
Presented by Divya Ajay, MD, MPH
(UroToday.com) During the 2024 American Urological Association’s Quality Improvement and Patient Safety session, Dr. Divya Ajay presented an analysis of institutional initiatives focused on the impact of surgery and operating room processes on climate change. This retrospective analysis of strategies employed during the 2022 “Greening the Operating Room” (GOR) initiative illustrated the potential for healthcare facilities to significantly reduce their environmental footprint and operational costs by adopting sustainable practices.
Presented by Khalid Alkhatib, MD, MMSc
(UroToday.com) During the COVID-19 pandemic, the rapid expansion of telemedicine brought virtual care delivery into the policy spotlight, particularly as a potential tool for addressing health equity. A study presented by Dr. Khalid Alkhatib from the University of Pennsylvania at the 2024 American Urological Association Annual Meeting, focused on how telemedicine has been utilized among cancer patients and survivors specifically focusing on prostate cancer.
Presented by Ruchika Talwar, MD
The 2024 SESAUA annual meeting featured a State of the Art Lecture by Dr. Ruchika Talwar discussing online tools to decrease out-of-pocket prescription costs for our urology patients. Dr. Talwar started by emphasizing that the objectives of this presentation are not to solve America’s problem of unaffordable prescription medication, nor is it to discuss why treatment prices are so high in America and figure out who is to blame, but rather to be able to provide guidance for when patients ask their provider “Doc, what will this prescription cost me?”
Presented by Ruchika Talwar, MD
(UroToday.com) The second day of the American Urological Association’s Annual Advocacy Summit included a panel focused on state advocacy related issues facing organized urology. Dr. Brian Duty opened the panel with an overview of the state-focused advocacy work undertaken by the AUA.
Presented by Ruchika Talwar, MD
(UroToday.com) The American Urological Association’s Annual Advocacy Summit in Washington, DC in late February 2024 featured a session focused on Telehealth in Urology. Dr. Helen Bernie began the session by outlining how the COVID-19 pandemic accelerated the widespread use of telehealth care.
Presented by Ruchika Talwar, MD
(UroToday.com) The American Urological Association’s 2024 Advocacy Summit included a session on Medicare Payment Reform. Dr. Jonathan Rubenstein began this session by outlining the history and current state of physician payment. In 1965, President Johnson signed Medicare into law.
Presented by Ruchika Talwar, MD
(UroToday.com) The first panel on the Urologic Workforce Shortage at the American Urological Association’s Advocacy Summit featured leaders in AUA census data, workforce research, and patient advocacy champions. Dr. Andrew Harris, chair of the AUA Workforce Task Force
Presented by Ruchika Talwar, MD
(UroToday.com) A critical component of the American Urological Association (AUA) Advocacy Summit, which takes place annually in Washington, DC, is the opportunity for urologists and patient advocates to meet with their Congressional representatives to discuss important legislative issues affected organized urology.
Presented by Ruchika Talwar, MD
During the Society of Urologic Oncology Annual Meeting in Washington, DC, several health policy posters were presented exploring the integral issue of financial toxicity in the care of urologic cancers. Dr. Benjamin Pockros from the University of Michigan presented a study, recently published in Urology Practice, exploring the impact of recent legislation on drug costs for prostate cancer patients.
At the 2023 Interim Meeting of the American Medical Association (AMA) held in National Harbor, MD, the House of Delegates approved a number of significant policy measures pertaining to Medical Service, Practice, and Insurance, which are significant for the field of urology.
(UroToday.com) During the 2023 American Medical Association (AMA)’s Interim meeting in National Harbor, MD, the House of Delegates adopted several important pieces of policy related to Medical Education that have implications for urologists. The ongoing rural workforce crisis has been a major advocacy priority of organized urology – according to the American Urological Association (AUA), over 60% of counties in America do not have a single urologist.
During the American Medical Association (AMA) Interim Meeting, Mr. Todd Askew, Senior Vice President for Advocacy, and Mr. Daniel Blaney-Koen, Senior Attorney for Advocacy at the AMA, presented an overview of the organization’s top advocacy priorities.
Through UroToday’s Health Policy Center of Excellence, we aim to inform the urologic community about pivotal health policy issues that affect our patients, practice, and profession. Despite urology being a smaller specialty within the broader healthcare field, the perspective of the urologist is critical.
Presented by Todd Askew
(UroToday.com) At the American Medical Association’s 2023 Annual Meeting in Chicago, Mr. Todd Askew, Senior Vice President for AMA Advocacy, provided a comprehensive overview of the AMA’s advocacy priorities.
Presented by Ruchika Talwar
(UroToday.com) Since the launch of UroToday’s Health Policy Center of Excellence, we strive to raise awareness about important health policy issues that are of interest to the broader urologic community.
Presented by Diana Magee, MD
(UroToday.com) The 2023 American Urological Association’s Annual Meeting included a session on Health Services Research: Value of Care, Cost & Outcomes Measures; this session featured a presentation by Dr. Diana Magee discussing the cost-effectiveness of CT scan of the chest versus chest x-ray
Presented by Song Jiang, MD, PhD
The 2023 American Urological Association (AUA) annual meeting held in Chicago, IL, hosted the late-breaking abstracts in cancer session. Dr. Song Jiang presented the results of a comparative study of newly diagnosed high-grade Ta (HG Ta) urothelial carcinoma of the bladder treated with intravesical chemotherapy versus Bacillus Calmette Guerin (BCG) during the BCG shortage.
Presented by Daniel Joyce, MD
(UroToday.com) The 2023 American Urological Association’s Annual Meeting included a session on Health Services Research: Value of Care, Cost & Outcomes Measures, which featured a presentation by Dr. Daniel Joyce discussing the impact of Medicare subsidies on access, treatment choices, and oncologic outcomes
Presented by Stephanie Kielb, MD, Suzette Sutherland, MD, Chloe Peters, MD, Christopher Corbett, MD, MS, Kurt McCammon, MD, & Aseem Shukla, MD
(UroToday.com) The 2023 American Urological Association Residents’ Forum included a panel with leaders in international surgery within urology, sharing their experiences integrating this unique global pursuit into their careers. Panelists included the following leaders
Presented by Pamela D. Tyner
(UroToday.com) During the Society of Academic Urology meeting, Pamela D. Tyner, Senior Legal Counsel at Houston Methodist Health System, presented an overview of physician non-compete clauses, which have been a media focus recently. She began by providing a background of the covenant to not compete, aka non-competes.
Presented by Christopher M. Gonzalez, MD, MBA, FACS
(UroToday.com)The 2023 American Urological Association’s Society for Academic Urology meeting featured a presentation by Dr. Christopher Gonzalez, highlighting the importance of and strategies to ensure retention of faculty in an academic department. According to the Association of American Medical Colleges’ 2022 data, there were 172,549 academic
Presented by James M. McKiernan, MD
(UroToday.com) During the Society of Academic Urology meeting at the 2023 American Urological Association’s Annual Meeting, Dr. James McKiernan led a panel discussion centered around supporting academic health system faculty in their pursuit of work that is not directly compensated by the health system, i.e. non-clinical, non-revenue generated work.
Presented by Erika Miller, JD
To conclude the 2023 AUA Summit, Erika Miller, JD provided a broad review of the changes to the Centers for Medicare and Medicaid services (CMS) prescription drug program contained within the recently passed “Inflation Reduction Act” (IRA).
Presented by Brian Duty, MD, MBA, Julie Riley, MD, FACS, Jonathan Kiechle, MD, & Beth Drzewiecki, MD
Dr. Duty, incoming chair of the AUA’s State Advocacy Committee (SAC) introduced the role of the SAC, which includes tracking relevant state level legislation that may have ramifications on the way urologists practice.
Presented by Arthur Burnett, MD, MBA, Adam Murphy, MD, MBA, MSCI, & Patrick Bingham, PhD
The 2023 AUA Summit included a session by Dr. Arthur Burnett, Dr. Adam Muphy, and patient advocate Dr. Patrick Bingham, entitled “Breaking Down Barriers to PSA Screenings.” Dr. Burnett began the talk provided a history of the PSA screening recommendation from the United States Preventative Screening Task Force (USPSTF),
Presented by Lisa Finkelstein, DO, & Kara Watts, MD
Dr. Lisa Finkelstein and Dr. Kara Watts provided a presentation on the utility of telehealth services, one of the focuses of the 2023 AUA Summit. The public health emergency declared during the pandemic expanded allowances for telehealth services, but these changes were temporary.
Presented by Denise Asafu-Adjei, MD, MPH
(UroToday.com) To kick-off the 2023 AUA Summit, Denise Asafu-Adjei, MD, MPH, the 2023 AUA Gallagher Scholar, provided an overview of this year’s main legislative priorities and Congressional “asks” that would be addressed during the Congressional Hill visits.
Presented by Anurag Das, MD, Mara Holton, MD, & William Reha, MD, MBA
(UroToday.com) During the AUA Summit, leaders in urology participated in a panel discussion reviewing several important aspects of physician payment reform that have placed significant strain on urologists and urology practices.