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Urologists!
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CUA Report - Fall 1999 IssueTable of ContentsThe President's Report: President-Elect's Report: The Treasurer's Report:
Disclaimer: The CUA report is published by the California Urological Association as a service to CUA members. Your comments are welcomed. The California Urological Association, Inc. ® (CUA) believes the information in this newsletter is as authoritative and accurate as is reasonably possible and that the sources of information used in preparation are reliable, but no assurance or warranty of completeness or accuracy is intended or given, and all warranties of any kind are disclaimed. This newsletter is not intended as legal advice nor is the CUA engaged in rendering legal or other professional services. Click here to see a library of selected past CUA articles
The
President's Report: Amid considerable turmoil in the economic situation facing California physicians last month, the CUA held its annual meeting in Monterey. Coming just after a CMA sponsored meeting that highlighted what may be a crisis in managed care conditions in California with 115 physician-managed groups failing in the past four years (FPA and MedPartners the most notable among them), the CUA met on a much more uplifting note. Led by Floyd Katske, M.D., who has done an outstanding job as President of the CUA for the past two years, the delegates from the CUA to Medicare's Carrier Advisory Committee have established remarkably good relations with the regional medical directors despite occasional disagreements. In view of this, the two directors (Gerald Rogan, M.D. from NHIC in Northern California and Arthur Lurvey, M.D. from TransAmerica Occidental Life in Southern California) presented talks at the Tuesday noon meeting and then spent another two and a half hours answering questions from members. The face-to-face gave CUA members and guests from throughout the Western Section a chance to better understand the dynamics behind Medicare policy decisions. We are indeed fortunate to have two directors favorably predisposed toward practicing physicians making decisions in implementation of HCFA guidelines here in California. Of course, as they pointed out, they may interpret, but are not responsible for the laws written by Congress or the budget set forth for payment of Medicare bills. Nonetheless, the meeting and the dinner that followed that night were excellent examples of how our efforts to communicate can pay off by creating a win-win situation for our members, their patients and the directors/managers who interpret and implement payor guidelines. There simply could not have been a better example of how organized medicine can work on our behalf or a better demonstration of how important it is to belong to the CUA. Among the discussions were:
Our next goal should be to bring the medical directors for other payors, such as Blue Cross and Aetna/U.S. Health Care/Prudential (the two groups about whom we received the most complaints) to the table for similar discussions. It's clear that it's far better to work with them and educate them than to remain adversaries. A vocal, well-funded, organized association representing all urologists is a good first step. Toward that goal the leadership has been meeting to focus on our plans for the next two years. We are continuing to emphasize our input to the Medicare Advisory Committee regarding reimbursement for new technology, improved logistics for payment and further clarification on the use of modifiers and appropriate use of E&M codes. I would like to establish disinterested panels of "expert" community-based urologists to provide impartial reviews to the larger insurance payors on questionable practices and charges rather than their proprietary in-house consultants who may be economically biased (similar to a program used by various county medical societies for many years). CUA needs to continue to interface with other specialty societies to accommodate changes that protect our areas of interest and service. These include primary care physicians who may assume the medical therapy for prostate cancer, BPH or erectile dysfunction; so called uro-gynecologists treating voiding dysfunction; general surgeons taking on retroperitoneal surgery because of their expertise with laparoscopic techniques; gynecologists taking over the treatment of male infertility without urologic input; and transplants, renovascular surgery and pediatric urology done by non-urologists. While many of these issues have national implications, California has often led the way and should remain an example of cooperation that protects our interests. As a socioeconomic organization the CUA should become a clearing house and source of advice regarding coding, new laws, CLIA regulation, appeals (for Medicare and private payors), Stark II regulations, private contract issues and business support (such as GNRH purchases, overhead costs and malpractice discounts). While the AACU and the AUA have done an excellent job, their emphasis has not always been tailored to California with its unique concerns. As a political organization the CUA will continue to work with the CMA and others regarding support for MICRA, enhancing opportunities for collective bargaining (such as Campbell HR 1304), HMO responsibility and reliability, state funding for Medi-Cal and CCS, and input on issues micromanaged by Sacramento (such as laws mandating warning patients about PSA and prostate cancer). With HMOs and IPAs failing at an alarming rate, with trial lawyers lining up to file suits against payors, with ever-increasing levels of government oversight and regulation, with threats continuing against MICRA and with Sacramento and Washington endeavoring to pass laws to protect patients from the fall out, the times demand vigilance and effort to protect our members. Your dues could not be better spent. Encourage your friends and colleagues to join the CUA.
President-Elect's
Report: It is an honor to serve you as the President-Elect of the California Urological Association. And I know that I can count on your help in bringing about higher reimbursement for all of California's urologists. For those of you who do not know me, I am in the private practice of urology in San Diego. I graduated from the University of Southern California in 1982, completed two years of general surgery and four years of urology residency at Baylor College of Medicine in Houston, Texas. I stayed to complete a fellowship in Male Reproductive Medicine and Surgery with Larry Lipshultz. I have been active in the local urological society, reproductive endocrine society, medical society, the state medical society and the national urological and fertility societies. I have been the representative to the California Medical Association's Commission on Legislation for the past three years. I was encouraged to serve on this committee by my predecessor, Robert Masters, a Past President who served for many years. In addition, I am on the board of directors of one of the local I.P.A.'s. My wife, Sue, and I have three children (boy, girl, boy; ages 6, 8, 10). My goals for the next two years are to help increase membership in the CUA, attend the Carrier Advisory Committee meetings and continue to represent you at the CMA's Commission on Legislation. Membership is vitally important. It is the first question asked to determine if the CUA has broad support from the urological community and really represents them. There is no other association that can give you the value that the CUA does. But for the intervention of the dedicated officers and representatives of the CUA, the Medicare carrier would have reduced the reimbursement for trans-rectal ultrasound directed needle biopsy of the prostate gland to below $100. This is only one example of the good work that we do on your behalf. The Carrier Advisory Committee sets reimbursement policies. The agenda is sent to all interested parties for the public comment period. There is a committee for the Northern California carrier and another for the Southern California carrier. Whereas some specialties are occasionally involved, there is almost always something of interest to the urological community presented. I have witnessed how the CUA's seasoned and diplomatic team has been influential in the outcome of these meetings from which all have benefited. The CMA's Commission on Legislation (COL) reviews legislation in the making and sends the very effective lobbying team to get our message across to those who make the laws. The COL depends upon articulate leaders from the various specialties to form opinions, responses and to put forward proposals for legislation. It is important for us to have the CMA in our corner. In solo private practice I have a particular view of urology. I would like to hear from you if you have a challenge to your practice. I can be reached through the CUA office in Santa Ana, (714) 550-9155, at my office in San Diego, phone: (858) 452-8845, fax: (858) 535-8364, email: pwise@ucsd.edu, or at home: (619) 224-2254. My address is 9850 Genesee Avenue, Suite 460, La Jolla, CA 92037.
The
Treasurer's Report: The CUA treasury is in sound condition and passed audit at the Monterey meeting. We have completed the initial asset allocation plan and have added an equity mutual fund and a value fund with 50% of the assets in money market funds. The CUA along with the California Medical Association (CMA) continue to effectively impact legislation and health care policy, but we need to do more. Please discuss the work of the CUA with your local industry representatives when they visit your office and ask for their support. Have them call Chris DeSantis at the CUA office to make a commitment (714) 550-9155. It was a great honor to take the gavel as President of the Western Section AUA at Monterey, September 29, as I hope this will give the CUA a strong link to the Western Section AUA and the national AUA. In addition Dr. Anthony Middleton, Jr. was named President-Elect and chair of the WSAUA Health Policy Committee. Tony has surveyed urologists for several years regarding the practices and socioeconomics and has amassed some very interesting data. If you have not read the latest report call the CUA office for a copy. Finally, kudos to Dr. Floyd Katske for organizing such a productive meeting in Monterey on September 28, 1999 with our Medicare intermediates and for the new, prestigious CUA membership certificates. (For details on this meeting read the President's Report)
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