Urologists Applaud Senators for Strong Support of Patient Access to Coordinated Care

Today, the American Association of Clinical Urologists (AACU), American Urological Association (AUA) and LUGPA applauded the Physician’s Caucus of the United States Senate who joined their physician colleagues in the United States House of Representatives in demonstrating their commitment to preserving patient access to independent, integrated medical services.

In a letter to Senate Majority Leader Harry Reid and Senate Minority Leader Mitch McConnell, Sens. Tom Coburn (R-Okla.), John Barrasso (R-Wyo.), Rand Paul (R-Ky.) and John Boozman (R-Ark.) expressed their support for the in-office ancillary services exception (IOASE) to federal self-referral regulations (the “Stark” law), which permits physician practices to provide critical services including radiation therapy, diagnostic imaging, pathology and physical therapy in an integrated and coordinated fashion within their respective practices.

“Providing comprehensive services to patients through the integration of ancillary services at the point of service improves communications between physicians of different specialties, facilitates the development of coordinated clinical pathways and enhances the development of disease specific clinical expertise, all of which lead to improved quality at reduced cost,” said Dr. Juan A. Reyna of San Antonio, Texas, President of LUGPA.

The IOASE is considered the cornerstone by which physicians in private practice provide an alternative to less convenient and more expensive sites of service. The letter affirmed that the utilization of certain ancillary services has actually decreased in recent years.

“It’s important to note that the letter stated that the volume of advanced imaging services has slowed significantly, from 13.4 percent growth in 2006 to 5.4 percent in 2007,” said Dr. David Penson, Health Policy Council Chair for the AUA and Professor of Urology at Vanderbilt University. “Research shows that the utilization of intensity modulated radiation therapy, or IMRT, to treat prostate cancer from 2007 to 2011 increased by only 2.2 percent, notwithstanding the approximately 160 percent increase in the number of urologists in practices with ownership of IMRT.”

The leadership of physician members of Congress on this issue is particularly timely as both parties work toward modification of the deeply flawed Sustainable Growth Rate (SGR) formula. Repeal of the IOASE provision for radiation, advanced imaging and physical therapy would make it illegal for physician practices to integrate these ancillary services into their practices and ultimately force more patients to receive these services in a hospital setting, thereby reducing access and increasing costs. In the letter, the Senators point out that hospitals typically mandate that employed physicians use the more expensive hospital services – a trend that is increasing as more physicians are becoming hospital employees. The Senators also note that those advocating for repeal of the IOASE stand to gain financially from such a change.

“Shifting patients to less convenient, more expensive sites of service is not a solution,” said Dr. Richard Pelman of Belleville, Washington, President of the AACU. “We need to focus on delivering high quality, cost effect care – not on where that care is delivered.”

Dec. 3, 2013, Senate Physician Caucus to Majority Leader Reid and Republican Leader McConnell re: IOASE


LUGPA represents 121 large urology group practices in the United States, with more than 2,000 physicians who make up more than 20 percent of the nation’s practicing urologists. LUGPA and its member practices are committed to best practices, research, data collection and benchmarking to promote quality clinical outcomes. For more information, visit lugpa.org.

About AUA
Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association (AUA) is a leading advocate for the specialty of urology, and has more than 18,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it fosters the highest standards of urologic care through education, research and formulation of health policy.

About AACU
The American Association of Clinical Urologists (AACU) is the only national organization to serve urology with the sole purpose of promoting and preserving the professional autonomy and financial viability of each of its members. AACU’s resources are dedicated to inform members of the issues affecting their practice and profession, and then to work directly to influence the resolutions of these issues. Forty-five percent of all urologists nationwide are members of the AACU.