Synopsis: AUA Advocacy Summit 2020

By Dr. John Lam, CUA Secretary

The following is a comprehensive summary of the Annual Advocacy Summit hosted by the AUA from Aug. 31 to Sept. 4, 2020.

Dear Members and Colleagues

This year’s American Urological Association (AUA) Annual Advocacy Summit was hosted virtually from August 31 through September 4 due to the COVID-19 pandemic. The agenda was amended to include 10 keynote/educational sessions with 4 nights of programming and live Q&A. On-demand content on the AUA Advocacy Meeting website is available for those who want hear the sessions. An update on the priorities of the AUA Political Action Committee (AUAPAC) were presented, which includes federal quality reporting, medical liability reform, Medicare physician fee schedule, prior authorization, prostate cancer screening, quality clinical data registries (QCDRs) and quality measures, research funding, and urology workforce shortage.

After welcoming remarks from Drs. John Lynch and Chris Gonzalez, Margaret Brennan, Moderator of CBS’ Face the Nation, welcomed us from the TV studio in her basement to give the Keynote speech. Ms. Brennan reminded us that there are political appointees and career scientists/professionals at federal agencies and it is important to have a public facing health official people trust. She says that”if the public does not trust information, that is a threat to their health and security,” so there is a need to develop skills on how to critically review information, in print, online, or within conversations. Ms. Brennan states that,”If you only hear things you agree with, you’re not doing it right. Don’t only seek out affirmation, seek out information.” She advises to “look back at your sourcing” when it comes to information on politics and COVID as misinformation supports partisanship. With regards to the upcoming election, “It’s not going to be Election Day. It’s going to be election week. States are varied with mail-in and hybrid approaches.”

Day 1 of the Advocacy Summit comprised of educational sessions on this year’s asks, which center around increasing access to care by expanding telemedicine services and increasing the urology (and other medical specialties) workforce in underserved areas via loan repayment programs.

Dr. Eugene Rhee, Chair, AUA Public Policy Council, moderated the session on “Telemedicine: Expanding Services in a Pandemic” and key opinion leaders and members of the AUA Urology Telehealth Task Force provided a panel discussion on this topic led by Chair Dr. Aaron Spitz. Dr. Chad Ellimoottil from the University of Michigan and a member of the AUA Telehealth Task Force presented on why telehealth had small utilization prior to COVID, which was due the originating site requirement. Medicare started paying for video visits and telehealth back in 2001, but less than 1% of patients and providers have ever used telemedicine because it was initially intended for rural care. The originating site requirement, which meant that patients could not connect to their physician at home, but had to travel to a medical facility, such as a medical office or hospital, in order connect to the physician. This requirement made telehealth difficult to logistically set up. Some commercial insurers and Medicaid have removed the originating site requirement and in March 2020, Medicare finally allowed patients to connect from home due to the public health emergency. The removal of the originating site is critical to change legislatively so it is permanently fixed.

The AUA Telehealth Task Force recommends supporting HR 7663 that focuses on removing this originating site requirement. Dr. Jonathan Rubenstein, Chair, AUA Coding and Reimbursement Committee, member of the AUA Telehealth Task Force, and Compliance Officer for United Urology Group presented on reimbursement for telephone visits and telemedicine vists by Advanced Practice Providers (APP). Dr. Rubenstein discussed technology as the first gap to access to care. Telemedicine requires the need to smartphone/computer and ability to use technology, but many patients may be excluded. Most patients have telephone access, but may be less effective without visual and there is a risk of mis-use. Prior to the public health emergency, CMS had “virtual check-in” that used G2012 “brief communication technology-based service,” which was patient initiated and only charge for it if the physician could handle it on the phone if not related to a recent E/M service <7 days nor leading to E/M service or procedure within next 24 hours or soonest available appointment, which was useful, but limited. Telephone E/M visits have CPT codes 99441-99443 by a physician provided to an established patient, parent, or guardian not originating from a related E/M service <7 days nor leading to E/M service or procedure within next 24 hours or soonest available appointment based on how much time spent with the patient, which are also limited.

CMS allowed telephone services during the public health emergency on March 31, 2020, which also allowed access to new patients. A study from the Atlanta VA medical center evaluated the experience and preferences of 450 patients undergoing hematuria consultation via teleurology compared to a conventional face-to-face clinic visit. Patients preferred teleurology to face-to-face clinic visits for the initial evaluation of hematuria, and it positively impacted compliance and access as well as improved efficiency, convenience and flexibility. Due to the concern of telephone service mis-use, the encounter must be medically necessary, must obtain consent to receive these services, and must describe medical discussion.

Telephone E/M services are considered telehealth services for the duration of the public health emergency. Budget neutrality is being maintained as phone services are taking place instead of office/outpatient E/M visits (either in-person or video visits). The AUA supports the continued use of telephone E/M services because it improves access (transportation and technology issues), as effective as in-person visits being used, budget neutral (1:1 substitution with in-person E/M), payment neutral (same physician time/expertise), include new patients (as effective) and no next visit in-person limitations, and virtual check-in is not enough. The second gap to access to care is workforce as the projected physician shortage of 46,900 to 121,900 by 2032 both in primary care and specialty care. Urology is second oldest surgical subspecialty with the average age of 52.5 years and >18% are age 65 years or older. The supply of AAPs is increasing and the AUA strongly endorses the use of APPs using a supervision/collaboration model. Typically, direct supervision (in office) is needed, but due to the public health emergency, CMS allows direct supervision to be provided using real-time interactive audio and video technology without the physical presence of a physician. Dr. Kara Watts from the Montefiore Medical Center and member of the AUA Quality Improvement and Patient Safety Committee presented on launching telemedicine in the Bronx during the COVID-19 pandemic. Many patients are unable or unwilling to access video visits due to limits of infrastructure or other barriers. Telephone only visits have been proven to provide quality access to care and must be preserved to bridge the gaps to our most vulnerable population.

Dr. Amanda North, Chair, AUA Workforce Workgroup moderated the session on “Urologic Workforce: Preparing for the Next Pandemic” with Dr. John P. Smith representing the Society of Academic Urologists and Dr. Una Lee representing The Society of Women in Urology. Over half of the rural urologists reported difficulty filling positions compared to less than a third of urban urologists reporting that recruitment difficulty. Most of the difficulty in filling these rural vacancies was not having candidates available. Around 10% of urologists were in rural areas compared to 19.3% of the US population there. Urology residents have high levels of student loan debt and urology residency is long. American Board of Urology mandates a minimum of 5 years of postgraduate medical training (residency). 64.3% of urologists are between 31-33 years old when they complete residency. 51.3% of urology residents have either already matched for or plan to pursue a fellowship after completing residency, which adds additional years to training. More than half of urology residents have >$150,000 in student loan debt and 86.1% of urology residents with student loan debt say that payment of student loans will impact their decision to accept a practice offer, whereas 87.8% of urology residents without student loan debt say that it will not impact their decision to accept a practice offer. Dr. Smith is a family medicine physician who did a fellowship in genitourinary medicine who practices at the University of Utah.

Some of the challenges to improving access to rural (<50,000 people) urologic care include limited academic affiliation, limited exposure, and no incentive program to recruit graduating urology residents into rural programs. Management solutions to improve access to rural urology include telemedicine, increase numbers of advanced practice clinicians, genitourinary medicine fellowship trained physicians, and outreach clinics. Access to urologic care in rural areas is lacking and with the average age of most rural urologist being >65 years of age, this problem is only going to expand. There are many challenges facing the improvement of rural urologic access to care. There are quality management options that have been and can be implemented to improve this issue, but they all require increased funding and commitment from many parties and have the potential to make a substantial improvement in rural urologic care across the country. Dr. Lee from Virginia Mason Medical Center identified barriers and highlights solutions for gender diversity in AUA workforce. The most recent data on females in urology shows that it has been slowly increasing for years, now up to 26% of graduating residents are female, 10% of practicing urologists are females. The number of women urologists has increased, but meaningful change within organizational structures needed. Women urologists benefit trainees, the urologic community, healthcare organizations and patients. The first myth to debunk is that gender bias unique to a few individuals, but on the contrary research on the human brain show that we are all biased and cognitive bias are needed survival skills and allow us to interact meaningfully with the world. When we encounter a person, our brain rapidly engages in a series of calculations in order to interpret that person’s relevance to you and place them in social categories. The first automatic calculations are age, race, and gender. So gender frames the way we see the world and provides a foundation. Myth #2 is the key to controlling bias and controlling how people think. This can have intended and negative consequences. Although educating people about these biases an providing education on how to recognize them is a first step, we must go further to create systems and environments in which bias and stereotyping are less likely to result in discrimination. Myth #3 is that the under-representation of women is a pipeline problem. Women perform equal to or better than men in STEM and are interested in pursuing STEM. The pipeline is healthy, but the problem is that there are multiple compounding factors and pressures that push women out. Research shows that discrimination exists against women at each stage of professional life from recruitment and selection, to recommendation, evaluation, promotion, training, and compensation. Myth #4 is that promoting diversity violates our meritocracy. An abundance of research shows that a signal of female gender leads to devaluation and our underlying biases are causing us to pass up highly capable women and members of other minority groups. Myth #5 is that we have to fix the women. While this is not universally true, many solutions are themselves high biased, in that they train women to act more like men because the actions of men are more valued and perceived as the correct way to succeed. However, what is neglected in this approach is the backlash women often experience when engaging in these behaviors.

Next Dr. Lee discussed the solutions based on management research on improving the experience of women in medicine. Solution 1: Treat gender equality as an innovation challenge. The most promising solutions are behavioral and systemic changes that focus on creating a climate for change, an approach widely supported by the nudge theory. Nudge theory is identifying easy to implement and economical ways to change people’s behaviors by structuring their choices. No quick fix solution, but rather the repeated application of commitment, courage, and innovative experimentation. Solution 2: Change institutional norms. Norms are the conventional patterns of behavior that are considered acceptable by a social group. The most important source of such normative change is that of a group’s leader. The leader must show a commitment to diversity for others to follow suit. Solution 3: Create a culture in which people feels personally responsible for change. Better results are seen with diversity programs that capitalize on people’s need for autonomy, increase contact between diverse groups, and encourage personal engagement. It is also important to include all members of the organization rather than only those who are part of the group targeted for intervention. Solution 4: Implement behavioral guidelines and action plans. Organizations can clearly lay out the specific steps that will be taken to enact their values and goals, specify the indicators that will be used to measure success. Guidelines might include: at least % of hiring committee members are women, with success being identified as a steady state of men and women on committees within 3 years, using standardized questions and structured interviews, or examining the increase in the number of women hired over a 3-year period as an indicator of success. Solution 5: Create organizational accountability for change. Organizational efforts should be embedded within larger systems that support and monitor progress toward diversity and inclusion goals so “what gets measured gets done.” Take home messages include the number and percentage of women urologists are increasing, gender diversity consists of meaningful change, and gender diversity will benefit not only women urologists and trainees, but also our urologic community, healthcare organizations, and patients.

On Day 2, virtual Capitol Hill meetings were held with lawmakers that included the offices of Senators Kamala Harris and Dianne Feinstein as well as Representatives Brad Sherman, Doris Matsui, and Ro Khanna to discuss the two legislative asks. My fellow California urologists that joined me included: Drs. Eric Biewenga, Jungwan Choi, Robert Lurvey, Irene McAleer, Polina Reyblat, and Eugene Rhee.

The first request was that House members cosponsor H.R. 7663, the Protecting Access to Post-COVID-19 Telehealth Act. The legislation seeks to make permanent some of the telehealth flexibilities implemented in response to COVID-19. H.R. 7663 is a bipartisan bill introduced by Telehealth Caucus members, Representatives Mike Thompson (D-CA), Peter Welch (D-VT), Bill Johnson (R-OH), Dave Schweikert (R-AZ), and Doris Matsui (D-CA). The bill does not address all of AUA’s telehealth priorities, but it does propose a number of important changes to support the expanded use of telehealth. The bill eliminates the restrictions on the location of the patient, grants the Secretary of HHS authority to waive Medicare telehealth requirements during future public health emergencies, and authorizes Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FHQCs) to be eligible telehealth providers.

The second request was to urge House members to cosponsor H.R. 5924, a bill that would encourage urologists and other specialty medicine physicians to practice in rural communities by creating a student loan forgiveness program for these important providers. The bill authorizes the HHS to provide urologists and other qualified specialty medicine physicians the opportunity to have a portion of their eligible student loans repaid by the federal government in exchange for practicing in a rural community experiencing a shortage of specialty medicine physicians. The required period of service is six years of full-time employment with no more than one year passing between any two-year period of employment. The loan repayment for each year of service would be 1/6 of the principal, and interest on each eligible loan (which is outstanding on the date the service started). The remaining principal and interest on any loans is paid upon completion of the sixth and final year of service. The total amount of repayments cannot be more than $250,000.

Following the meetings on the hill, Dr. Brian McNeil welcomes urologist Congressman Rep. Greg Murphy, MD (R-NC-03) to provide insight on being in office. Dr. Murphy states that “If we are to be heard, if we are to be counted, we have to be at the table!” It will be important to preserve patients’ access to telehealth. He also stated that “as physicians, we are heroes; we are on the front lines during COVID-19. I’m addressing this as we look at the Medicare Physician Fee Schedule and as we look at telehealth.” Dr. Murphy stated that “as a physician, I have a love for the work we do caring for our patients. Even on Capitol Hill, I never take off my white coat.

Dr. Ruchika Talwar, a resident from the University of Pennsylvania and delegate to AMA House of Delegates for introduced Mr. Wendell Primus, senior policy advisor to House Speaker Nancy Pelosi. Mr. Primus talked about where we stand with regards to the virus, the pandemic response that Democratics would like to negotiate with the administration, about the drug pricing bill that passed Congress in late June and where we go from here. He stated that “One of the things that will result from the pandemic is that telemedicine is here to stay. We need to encourage it; it should be used wisely.”

The AUAPAC keynote address was given by Mr. Charlie Cook who gave his analysis on the upcoming election.

Day 3 of the AUA Advocacy Summit started with presentations sponsored by Janssen Biotech, Inc. from Dr. Jacqueline Roche, Senior Director, Coverage and Reimbursement Policy, and Global Policy Planning Worldwide Government Affairs and Policy and Mr. Michael Barnard, Director of Federal Affairs from Johnson & Johnson on “A Manufacturer’s Perspective on 2020: Progress toward a Vaccine and Response to Policy Environment.”

Dr. David Penson, Chair, AUA Science & Quality Council moderated a session on “Prostate Cancer Disparities: The Pandemic’s Impact on the African American Community and the Role of Urology” with Dr. Keith Crawford from the Prostate Health Education Network (PHEN) and Dr. Tracy Downs representing the R. Frank Jones Urological Society. Dr. Crawford introduced PHEN’s primary mission, which is to increase participation of African American men in prostate cancer clinical trials through education, awareness, support and collaborations. Programs include lectures about clinical trials called “Clinical Trials 101” with Dr. J. Jacques Carter, clinical trial E-newsletters, a Broadway-style stage play Daddy’s Boys, which is a show that focuses on the prostate cancer crisis in the African American community, talk with your doctor webinar series, and the Annual African American Prostate Cancer Disparity Summit during September. Dr. Downs from the University of Wisconsin spoke on diversity, equity and inclusion in urology. He quoted a colleague, Ms. Binnu Palta Hill at the University of Wisconsin Business School that “an inclusive culture is vital to innovation and growth of an organization as well as the professional and personal growth of individual members of the organization. He discussed differences in health equality versus health equity. Diversity and inclusion are the range of human qualities that impact and influence how people are perceived, treated, and behave as well as a sense of belonging, feeling respected, valued, and seen for who you are and valued as a contributing member of the team, work group, or organization. These values serve as a catalyst for change resulting in health equity. Dr. Downs proposes a strategy to increase recruitment of African Americans is to go to those undergraduate institutions with high rates of African Americans applicants applying to MD programs, “Go to where those students are graduating.”

Following the day’s sessions, Dr. Kevin Koo (@kvnkoo) hosted a networking event to discuss advocacy on telehealth and workforce for medical students, residents, and fellows.

On Day 4 of the Summit, Dr. Aria Olumi (@AriaOlumiMD), Chair of the AUA Research Advocacy Committee, kicked off the evening with a session on “Urologic Research and COVID-19: What We Need Moving Forward” with Drs Dolores Lamb representing the Society for Basic Urologic Research, Dirk Lange representing the Endourological Society, and Polina Reyblat representing the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) to advocate for urology research in COVID-19 era.

The pandemic has caused site closures, furloughs, travel limitations, and 10% decreases in enrollment each month of National Cancer Institute clinical trials. Dr. Olumi announced the need to embrace telehealth to assess study subjects and to bring study subjects into our clinical trials more easily by using telehealth to assess study subjects, drive-thru visits, easing restrictions for remote laboratory/radiology sites, collection of bio-samples remotely, and shipment of experimental therapies directly to patients. Dr. Lamb from the Weill Cornell College of Medicine talked about why we need to train the next generation of urologic researchers and with specific emphasis on benign urologic diseases. Dr. Lamb stated the key areas of urologic investigation needing support include insights into urinary tract infections to lead to potential new treatments; new treatments for kidney stones in adults and children; more studies of development of the genitourinary tract to aid in correcting birth defects and treated acute injuries; improved understanding and treatments of lower urinary tract systems and related conditions in males and females, adults and minors; understanding the causes, diagnostic options and treatment of the pelvic pain and inflammatory conditions of the urogenital tract; improving sexual and reproductive health in men and women; and defining genetic and genomic causes of benign urologic disease, as well as the complex impacts of co-morbid diseases such as diabetes, obesity, pelvic floor disorders on urologic diseases. Training and career development in benign urologic disease research is important due to problem of the decreasing workforce of urologist-scientists and urology has witnessed a more dramatic decline in training physician-scientists due to lack of mentors, role models, nurturing environments, financial support for additional training and education, institutional focus on primary care rather than sub-specialization, and less financial reward then private practice. Support is needed to train the next generation of urologic researchers and it is an investment in the future of discovery and improved diagnosis, prognosis, treatment, and outcomes for patients with benign urologic disease. She also highlighted how COVID-19 pandemic created new challenges for researchers due to laboratory shutdowns, job opportunities for early career investigators are limited/rescinded, and trainees may be unable to complete work for publications critical to future successes.

Furthermore, benign urologic diseases are common with significant morbidity and mortality. Dr. Lange from the University of British Columbia talked about the state of research on kidney stone disease. He points out that kidney stones are highly recurrent, painful and debilitating, costly to society and health care system, yet only gets a fraction (0.3%) of prostate cancer funding. Pandemic revealed critical areas needing attention to improve patient treatment/outcomes in face of pandemics to prevent significant increase in systemic costs due to treatment delays leading to acute kidney injury and damage. Increased NIH support for ongoing and future cross-disciplinary translational research will revolutionize diagnostics and prevention. Research will ultimately improve response in the face of future pandemics and decrease incidence of recurrent kidney stone disease and decrease associated Medicare costs. Dr. Reyblat from Kaiser Permanente Los Angeles Medical Center talked about bladder health in women and the need for research in this area. The current gaps and need for funding include understanding the contribution of the bladder and urethra to lower urinary tract function, mechanisms that allow the female urethra to be functionally competent, better understanding of the pathophysiologies that underline outlet obstruction, bladder sensory signaling, what makes bladders contract, and understanding bladder mucosa and the lamina propria as functional centers of the bladder. In addition, there is a need to investigate women who can void, despite not being able to generate sufficient detrusor contraction pressures, need for alternatives to catheters for those patients who cannot void/empty their bladder, home uroflow and pvr technology to enhance telehealth capabilities, home UTI testing, and understanding UTIs as well as the urobiome. Dr. Reyblat stated that a complete state of physical, mental, and social well-being related to bladder function and not merely the absence of symptoms. Healthy bladder function permits daily activities, adapts to short-term physical or environmental stressors, and allows optimal well-being.

Dr. Arthur Tarantino, Chair, AUA State Advocacy Committee, moderated the next session on “State Advocacy: COVID-19 and the Impact on Urology” with Drs. William Reha, Chair, American Association of Clinical Urologists (AACU) State Advocacy from AACU, Mark Fallick, Member, AUA State Advocacy Committee, Chair, AUA Legislative Affairs Committee from the Mid-Atlantic Section, Ms. Kimberly Horvath, Senior Legislative Attorney, American Medical Association (AMA), and Peter Bretan, Member, AUA Public Policy Council and President, California Medical Association (CMA). Ms. Horvath started session and presented an overview of medical liability at the state level in the current COVID environment and what laws are in place as well as what actions states have taken to provide additional immunity to physicians across the country.

During the pandemic, the AMA worked on additional layers of protections for physicians in states, including Uniform Emergency Volunteer Health Practitioners Act (19 states) and granting immunity from civil liability for out-of-state licensed practitioners. There is also the Emergency Management Assistance Compact, which all 50 states have adapted and is focused on easing the deployment of resources from one state to another when there is a declared emergency including protections to physicians being transferred from one state to another state to help provide assistance. The AMA created two important documents to promote civil immunity. One was a policy options document that included recommendations for civil liability both for physicians providing care to COVID-19 patients and for physicians that may have been impacted by COVID-19 directives and regulations. The second was a state-level guidance document that provided detailed recommendations for states and how they can go about adopting civil immunity and highlighting the important provisions that should be included such laws. The AMA have been working on liability protections at the federal level. In addition, a letter was sent out to the National Governors Association to encourage Governors to adopt emergency response protection for physicians. During the pandemic, for telehealth, there has been a temporary waiver of requirement for licensure in the state in which the patient resides and going off of this, Dr. Fallick from New Jersey Urology gave a presentation on the Interstate Medical Licensure Compact, is a voluntary, expedited pathway to license, which was designed to facilitate the growth of telemedicine while preserving state regulation of medical practice to help increase access to health care for patients in underserved or rural areas. It makes it easier to physicians to obtain licenses to practice in multiple states, but it is felt that is also strengthens public protection by enhancing the ability of states to share investigative and disciplinary information.

Some of the issues are that the location of medical practice is state where patient is located, all laws, regulations of patient’s state apply, coverage of services by insurers varies from state to state, and physicians must negotiate contracts with private payers, if not covered by Medicare. In addition, you need malpractice insurance in each state the patient resides where you’re practicing. For additional information, go to Dr. Reha, a private practice urologist from Woodbridge, Virginia gave a presentation on virtual advocacy during the pandemic and beyond. He showed the various virtual platforms available that we should be familiar with and stressed at the preparation for the meeting is of paramount importance such as testing the set up and making sure internet connection works as well as other virtual meeting conduct and etiquette. The meeting should be treated like this is a in-person meeting. If you are running the meeting, make sure your participants are using video when meeting with legislators and try to get everyone to participate. Dr. Reha also presented some tips for engaging your legislator whether it be virtual or in-person.

These include having all the appropriate information at hand before you meet, including key talking points; identify yourself as a constituent, if possible; define the issue in the beginning and provide support; ask for their support and be clear about what action you like the legislator to take; outline your concerns and explain the negative impact an adverse decision could have on your patients, your business, and the community; share your opinion in a polite, positive way; thank the legislator for their time; afford staff the same respect and courtesy you would give the legislator if meeting with them; and follow up with a thank you note restating your position.

Dr. Bretan, a private practice urologist from Watsonville, California talked about the CMA COVID response. The CMA provides resources for all physicians in need with the latest and most current confirmed information on the pandemic as well as updated toolkits on telehealth, financial assistance, employer considerations, reopening practices, employment, staffing and medical staff issues, advocacy letters to our state and federal legislators, and dealing with delay of care. California began 2020 with a strong bill of financial health, a strong economy, historic reserves, and a structurally balanced budget. In May, there was 54.3 billion dollar shortfall and projected 18% jobless rate, which is a stark difference between 21 billion dollar surplus and 3.9% unemployment from a year ago.

To cover deficit, the Governor plans to: cancel expansions/other reduction: $8.4B, dip into reserves: $8.8B, borrow/transfer/defer: $10.4B, new revenue: $4.4B, Federal funds:  $8.3B, federal trigger: $14B (no guarantee on this if Feds pass $1T relief bill) = $54.3B; trigger cuts, with the state facing its first deficit in eight years after being blindsided by the coronavirus pandemic. The trigger cuts go back to the last recessionary playbook, proposing significant reductions in everything from schools to health care and the safety net. Governor Newsom also proposed “solutions” in healthcare that include taking $1.2 billion in Prop 56 from providing supplemental payments that include adult dental and all optional benefits for a total General fund savings of $54.7 million and elimination of special carve outs for Federally Qualified Health Centers (FQHC): $100 million; taking $272 million in Prop 56 Loan Repayment program; and taking $33.3 million from ongoing funding for Song-Brown primary care residency slots.

Due to CMA advocacy and thousands of physicians calling in, CMA was successful at influencing the Senate budget, which rejected the Governor’s proposal to cut funds from Prop 56 and included supporting increased provider payments in the Medi-Cal program & supporting the federal Heroes Act, which would give $100B in federal aid to physicians and hospitals. In addition, the CMA partnered with State of California and to provide free medical-grade personal protective equipment (PPE) to small and medium sized medical practices across the state to ensure California physicians can continue to provide care to patients during the COVID-19 outbreak.

Lastly, Dr. Bretan stated when we share information from state to state, other opposition groups share those types of information. “United we are strong if we share all our knowledge together. All politics are local and all politics need to be united. This organization within the AUA has incredible amount of potential to help organize medicine at the level of the AUA and support each other at the state level and because of that will be a better federal representation for advocacy for our patients and all physician practices, not just urologists”