AUA Urology Advocacy Summit 2024: Overview of the 2024 AUA Advocacy Summit Legislative Priorities

( 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. This year, the legislative priorities, or “the asks,” focus on the physician workforce shortage, telehealth services and access, and Medicare reimbursement and physician payment.

The first ask centers on the critical issue of the shortage of urologists in the United States, exacerbated by an aging population's increasing demand for urologic services, which leads to significant concerns about access and delayed care. The “ask” requests congressional support to enhance the urologic workforce through specific legislative bills: the Resident Physician Shortage Reduction Act (H.R.2389/S.1302), which aims to expand residency positions with Medicare support, the Conrad State 30 and Physician Access Reauthorization Act (H.R.4942/S.665), which seeks to extend and increase J-1 visa waivers for international physicians, and the Specialty Physicians Advancing Rural Care (SPARC) Act (H.R.2761/S.705), which establishes a student loan repayment program to encourage specialty medical care in rural areas. These measures collectively aim to bolster the number of practicing urologists and improve access to timely urologic care.

The second priority focuses on the looming expiration of telehealth benefits and flexibilities that were temporarily extended through 2024. These provisions, initially introduced during the pandemic, have significantly reduced barriers to healthcare by allowing services to be delivered via telehealth. The expiration of these benefits could reintroduce obstacles to accessing healthcare services that telehealth had effectively mitigated. The specific “asks” requests support initiatives aimed at enhancing telehealth services accessibility, including the endorsement of the CONNECT for Health Act (H.R. 4189/S. 2016). This bill proposes a bridge program to facilitate providers' transition to Medicare and CHIP Reauthorization Act goals and the Merit-based Incentive Payment System through telehealth and remote patient monitoring (RPM). It also seeks to expand the use of telehealth and RPM within alternative payment models, for patients with chronic conditions, in community health centers, rural health clinics, and as basic benefits in Medicare Advantage. Moreover, it aims to clarify that providing telehealth or RPM technologies under Medicare by a healthcare provider should not be considered remuneration.

Finally, all physicians, including urologists, are confronting a significant challenge in CY 2024 with a proposed 3.37% cut to Medicare reimbursement rates. This reduction, coupled with outdated Medicare physician payment rules that fail to reflect the escalating costs of practicing urology, continues to diminish payments, jeopardizing the provision of essential urologic care. The last “ask” requests support for the "Preserving Seniors’ Access to Physicians Act of 2023” (H.R. 4189/S. 2016), which proposes for a 4.62% increase in payments under the Medicare Physician Fee Schedule (MPFS) for 2024, as opposed to the current law's 1.25% increase. Additionally, it calls for the introduction of an inflationary adjustment aligned with the Medicare Economic Index, highlighting that the MPFS is the only Medicare fee schedule lacking such an adjustment, which has led to a 26% decline in Medicare physician pay. The act also aims to revise the budget neutrality threshold to ensure more equitable adjustments across physician services and rectify flawed utilization estimates that affect payment rates. Furthermore, it seeks to reform the Quality Payment Program, which, despite its goals to enhance care quality and reduce Medicare costs, has primarily increased administrative burdens without significant improvements in care quality. 

Presented by: Ruchika Talwar, MD, Vanderbilt University Medical Center, Logan Galanksy, MD, Johns Hopkins University

Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center, during the 2024 AUA Advocacy Summit, Feb 26 to Feb 28, 2024