Health Policy 2012: A Urologist's Perspective

Jay Motola Health Pro
  • I have recently returned from a trip to Washington, DC for a urology advocacy meeting, where I participated in countless discussions regarding health policy. The trip culminated in a day of lobbying on Capitol Hill.  When I return back to work after a trip like this (this is the sixth year that I have participated), I am often asked by colleagues, “Why are you wasting your time?”  I don't agree that I am wasting my time; I feel that action is better than inactivity. I believe that participation by physicians in the health care debate is critical to the survival of health care in the US.  We addressed three important issues during my trip: the Affordable Care Act legislation, the anti-PSA sentiment by the United States Preventive Services Task Force and the Independent Payment Advisory Boards, created by ACA.

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    The future of health care in the United States is now in the hands of the Supreme Court.  Last week the court completed listening to arguments on the constitutionality of the Patient Protection and Affordable Care Act (ACA).  Much of the discussion centers on the law requiring Americans to purchase health care insurance, or the individual mandate. Numerous states have expressed opposition to this clause, claiming unconstitutionality, leading to the lawsuit that has been filed. 


    One question surrounding this debate is if the states that are opposed to ACA are able to sue at the present time, as the question remains whether or not the penalty that is going to be imposed is a tax. If it were deemed to be a tax, then the question of whether the lawsuit can occur prior to the tax being levied becomes a pertinent issue – this was the content of the first day of arguments, held March 26, 2012.  


    Another aspect of this bill that is being questioned is the affordability of this new legislation. The Republicans have hopes that the bill is completely overturned, however it does not seem likely that the Supreme Court would completely overturn the entire bill, but that they would instead repeal portions of it.  This ability to separate different parts of the law was the basis for the third day of arguments in the Supreme Court. 


    As part of the Republican campaign agenda, the leading presidential candidates have been discussing their plans to change the ACA. The debate over the ACA will certainly be a hotly debated topic while we are in the midst of a Presidential election year and regardless of the decision, this law will play a very large part in the upcoming election. The Supreme Court is scheduled to render their opinion in June….stay tuned!


    On October 7, 2011, the United States Preventive Services Task Force (USPTFS) issued a draft recommendation against PSA-based screening for prostate cancer for healthy men stating that there is “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits” and discourages the use of the test by issuing a Grade D rating.  This rating would result in PSA testing not being covered by insurance companies.  This recommendation is something that organized urology is contesting.


  • During my visit to the nation's capital, we were able to meet with the vice-chair of this committee. We discussed the rationale the committee used to make this. It became readily apparent that the scientific approach used by the committee is flawed, in my professional opinion, for several reasons including:


    1) The use of inappropriate studies to help support their decision,

    2) not focusing on morbidity data related to prostate cancer but rather on survival and mortality data

    3) not having any specialists involved in the treatment of prostate cancer on the committed


    We admit that PSA testing is not perfect, however a more effective test does not exist, thus we advocate responsible utilization of the PSA test. We have asked members of Congress to oppose the USPTFS recommendations against PSA screening and to support research necessary to improve the testing and treatment process by supporting the Prostate Research, Outreach, Screening, Testing, Access and Treatment Effectiveness (PROSTATE) Act (H.R. 2159/S. 1190). We have also asked for support for changes to the flawed USPTFS process and to make their deliberations transparent and therefore accountable to the public. This would require:

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    1) consultation with specialists that treat the specific diseases under review

    2) a formal response to invited public comments, patterned after the rule-making process engaged in by federal agencies before they issue final recommendations.


    I urge you as concerned parties to contract your representatives and express your dissatisfaction with the task force findings and ask for their support to help bring about change.

    The Independent Payment Advisory Board (IPAB), which was created by the Affordable Care Act (ACA), eliminates Congress’ ability to ensure access to the health care our seniors need and deserve by eliminating Congressional oversight of the Medicare program. The new board will consist of 15 members, fewer than half of which can be health care providers, and none are permitted to be otherwise employed (eliminating practicing physicians from the Board).  The Board is solely appointed by the President.  The IPAB will be responsible for recommending cuts based on targets set annually by the Centers for Medicare and Medicaid Services (CMS) in 2014.   Cuts recommended by IPAB exclude hospitals and hospice care until 2020, thereby directing cuts disproportionately on other providers.


    This Board limits congressional authority, and eliminates the transparency of hearings, debate and the opportunity for participants to have any meaningful input.  While we have recognized the need to lower health care cost and improve the quality of health care, the IPAB will not achieve these goals. We have asked support of H.R. 452, the Medicare Decisions Accountability Act of 2011, a bi-partisan bill introduced to repeal the Independent Payment Advisory Board as well as support of S. 2118, the Health Care Bureaucrats Elimination Act, another bill to repeal IPAB.

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    In this election year, it is crucial that you are heard from. Please contact your representatives, and express your support for these bills that will help you to continue to receive the outstanding health care that Americans deserve.

Published On: April 02, 2012