Changes in federal legislative and regulatory policy can have profound impact on urology practices across the country. The AUA actively monitors federal activities, advocates for policies that protect and sustain the independent practice of urology, and collaborates with other physician organizations to ensure the voice of AUA members is heard on Capitol Hill.

The AUA Legislative Affairs Committee (LAC) consists of physician members who provide feedback to AUA staff about the impact of federal legislative and regulatory policy on the practice of urology. The AUA biannually surveys AUA members about the most pressing legislative concerns, and the LAC uses this feedback to guide the AUA’s legislative agenda and makes recommendations to the Public Policy Council. LAC members also personally represent the AUA in meetings with lawmakers and regulators throughout the year.

Medicare Physician Payment Reform

One of the LAC’s perennial legislative priorities is adequate Medicare physician reimbursement that allows for sustainable clinical practice and access to patient care. At the recent AUA Annual Urology Advocacy Summit, one of the 3 chief legislative requests was a permanent fix to the 3.37% cut to the 2024 Medicare Physician Fee Schedule that began on January 1, 2024. Summit attendees provided important education for lawmakers, highlighting that “physician” payments not only account for urologists’ salaries but also represent the revenue from which AUA members run outpatient offices and pay staff salaries. Maintaining adequate physician payments is key to preserving access to outpatient care for millions of Medicare patients nationwide. Furthermore, cuts to reimbursement continue to threaten the sustainability of urology practices and exacerbate the high turnover of staff, a key contributor to physician and staff burnout.

Following the Summit, the Consolidated Appropriations Act of 2024 was signed into law and implemented a provision to mitigate a portion of the Medicare payment cuts, reducing the decrease to the conversion factor by 1.68% for the remainder of 2024. Even with this partial fix, urologists are still effectively experiencing a 2% cut in Medicare reimbursements in 2024 relative to the prior year. This exacerbates a decades-long trend: since 2001, physicians have seen their Medicare payments decrease by nearly 30% after adjusting for inflation. Medicare physician payment reform is likely to remain a top advocacy priority for the AUA advocacy team.

Strengthening the Urology Workforce

The LAC also prioritizes legislative solutions to preserve and strengthen the urology workforce. According to the Association of American Medical Colleges, the United States will face an overall shortage of up to 124,000 physicians by 2034. Given the increased demand for urologists’ services due to a continually aging population and expanded insurance coverage, the LAC recognizes the urgency of legislative action to ensure a fully trained specialty physician workforce for the future.

The LAC has supported the Resident Physician Shortage Reduction Act in the past several sessions of Congress to improve the nation’s graduate medical education system and preserve access to specialty care. This legislation would increase Medicare-supported graduate medical education residency slots by 14,000 over the next 7 years, specify priorities for distributing the new slots (eg, states with new medical schools), and study strategies to increase the diversity of the health professional workforce. The AUA, along with dozens of other physician groups, support these measures to improve the acute shortage of specialty physicians.

The LAC has also prioritized access to care as a top legislative issue. Rural and underserved areas in particular have been a focus of recent federal legislative activity. One avenue to strengthen rural access to care is to encourage physicians with specialty expertise to practice in communities that have the greatest need. The Specialty Physicians Advancing Rural Care (SPARC) Act is a bipartisan bill that establishes an educational loan repayment program for specialty physicians, including urologists, who practice in rural and underserved areas. The LAC will continue to prioritize passage of this legislation to incentivize specialty-care clinicians to practice where they are needed most and decrease the barriers to establishing urology practices in rural communities.

Sustaining Telehealth in Urology

Finally, the LAC has focused on telehealth as a key federal legislative priority following the COVID-19 pandemic, which accelerated virtual care in urology. Prior to 2020, the regulatory restrictions on performance of telehealth services were costly and onerous, effectively making it impractical for most urologists to offer in their practices. The pandemic necessitated the ability to perform virtual visits, which, alongside advances in technology, such as secure electronic health communication platforms, led to federal exemptions to the prior regulations that dramatically increased the provision of telehealth services. For instance, these exemptions allowed for billing for visits originating in almost any location convenient for the patient and physician.

Telehealth has now become a considerable part of many physician practices and has gained irreversible traction among patients, with no demonstrable decrease in quality of care. However, telehealth exemptions are set to expire at the end of 2024. The LAC is actively pursuing legislative and regulatory solutions to make these exemptions permanent, which would enable urology practices to continue to offer virtual care as seamlessly as possible. The LAC also coordinates with the AUA Telehealth Task Force to organize ongoing advocacy efforts.