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Has the American Urological Association made a Difference?
0022-534 7/92/1483-0772$03.00/0 THE JOURNAL OF UROLOGY Copyright© 1992 by AMERICAN UROLOGICAL ASSOCIATION, INC.
Vol. 148, 772-774, September 1992 Printed in U.S.A.
Special Article HAS THE AMERICAN UROLOGICAL ASSOCIATION MADE A DIFFERENCE? JAY Y. GILLENWATER* The years 1991 and 1992 have been interesting, busy and threatening for urology. When the time came to decide the subject for my Presidential Address, the logical choice was to report to the membership on what organized urology is doing in response to the problems facing us this year. In this report I am including the accomplishments of the American Urological Association (AUA), American Foundation for Urologic Diseases (AFUD) and American Lithotripsy Society. I am happy to report to you that the AUA has made a difference. The work of the AUA is performed by several dozen urologists who have worked hard in many areas with no compensation. Much has been accomplished, although we have failed to modify some Medicare changes and there is still a lot to do. In visiting the sections and talking to the members, I have noted 2 overwhelming concerns: 1) the effect of health care reform and 2) recertification. As Senator Dole said, trying to stop health care reform is like trying to stop a hurricane or a tidal wave. That does not mean we cannot have an influence. Health care changes started because Medicare administrators, the Department of Health and Human Services, the Office of Management and Budget, and Congress all want to reduce health care costs. The American Medical Association and the American Society of Internal Medicine pushed for changes to increase money for cognitive procedures at the expense of surgical procedures. Dr. William Hsiao, a Harvard economist, developed a system of resource-based relative work values. In 1984 the AUA hired independent health policy consultants to study the methodology. Drs. Alan H. Bennett, Wallace A. Gerrie and Robert D. Wickham (nominated by the American Association of Clinical Urologists) also participated in the evaluation. In 1985 the AUA testified against the changes before the Physician Payment Review Commission (PPRC) and Congress. In 1986 the AUA hired Multinational Business Services, Inc. to do a study on the impact these changes would have on urologists. The study showed that transurethral resection of the prostate accounts for 25% of urologist income. In that same year the AUA succeeded in stopping a proposed 36% reduction in prostatic transurethral resection reimbursement. The AUA membership was informed of the proposed Medicare changes through speeches by the AUA Section Presidents and by articles published in AUA Today. The AUA has provided oral testimony and written responses at every opportunity. The Medicare physician payment reform plan was mandated by Congress in 1989. In 1990 a committee was formed (Drs. Lawrence E. Allen, H. Logan Holtgrewe, Richard G. Middleton, Gregory A. Slachta and Robert D. Wickham) to analyze the new Medicare fee schedule. Urologists sent more than 500 letters to Dr. Gail Wilensky, Health Care Financing Administration (HCFA) administrator, concerning the proposed changes. The most contentious issue in the proposed rule was the 10.5% "behavioral offset" that was calculated into the fee schedule conversion factor. After the protests of all medical * Presidential Address presented at annual meeting of American Urological Association, Washington, D. C., May 10-14, 1992. 772
organizations and Congress, the behavior offset was changed to 6.5%. An issue of more concern to urologists was the proposed definition of global surgical services, which was changed from a proposed 30-day preoperative period to a 24-hour preoperative period. The proposed inclusion of return trips to the operating room in the global fee was changed. In the final version reoperations for complications that require a return trip to the operating room are removed from the global surgical service. Multiple operations on different parts of the body at 1 time (as in trauma) will be considered for separate global fees rather than the proposed 100% of the global fee for the most expensive operation, 50% for the second most expensive procedure and 25% for the third, fourth and fifth procedures. Medicare's policy of paying new physicians less than the fee schedule amount for their services during the first 5 years has been vigorously opposed by most medical societies. New physicians have the same practice and malpractice costs as older physicians. The 16% payment of the global surgical fee for assistants at surgery is imposed legally by statute. New legislation will be needed to make changes. Changes can be made by individual efforts of AUA members. Dr. Jeffrey H. Cohn of Birmingham, Alabama served on a Centers for Disease Control panel evaluating office laboratory fees of Medicare, and he was instrumental in getting some fees changed. Included in the moderate complexity tests were bacteriology-urine cultures and sensitivities, urinalysis and semen analysis. Semen analysis was later put into a more complex category and the AUA is working to get it reclassified. Dr. Steve Wilson of Arkansas complained to Medicare on February 12, 1992 about the 50% reduction of Code 54405 (implantation of an inflatable penile prosthesis) and 67% reduction of Code 54407 (revision of an inflatable penile prosthesis). On March 30, 1992 Medicare notified him that Medicare payments would be modified to a transitional payment schedule (15% reduction in 1992). The American Lithotripsy Society took HCFA to court and won! A United States District Court barred HCFA from implementing a new shock wave lithotripsy facility fee of $1,150, which would have been below cost. Fees for lithotripsy must return to the old rates and methodology (100% of the lesser of facility charges or costs paid only through a hospital). The AUA has contracted with the Gallup Organization to evaluate the effects of the new Medicare changes on the practice of urology. The success of this poll will depend on your willingness to participate if selected. In the last several years there have been studies suggesting that patients have more cardiovascular accidents within 10 years of transurethral resection than those having open prostatectomy. There is no explanation for this apparently valid observation. Since transurethral resection is the most common urological surgical procedure the AUA thought that this observation needed to be evaluated in a prospective randomized study. In addition, the newer methods of relieving prostate
HAS AlViERICAN UROLOGICAL ASSOCIATION MADE A D[FFERENCE
obstruction need to be evaluated. Toward that end the AUA has committed $1 million for the pilot studies and submitted grants to the Agency for Health Care Policy and Research (AHCPR). The AHCPR has funded 50% of the pilot study and the National Institutes of Health (NIH) may be funding some of the proposed research. As a byproduct of this study a symptom score sheet for benign prostatic hyperplasia has been developed. Other socioeconomic activities of the AUA include 1) continued work with the PPRC and HCFA to modify the proposed regulations, 2) educating our members about Medicare reimbursement issues, 3) identifying individuals with negotiating skills and 4) striving to improve urological codes in the CPT. BOARD RECERTIFICATION
There have been many complaints from our membership about the proposed Board of Urology recertification in 1995. The AUA has vigorously acted as the spokesperson for urologists to the Board. The American Board of Urology is a separate and distinct entity not answerable to the AUA. Its members are nominated by the AUA, American Association of GenitoUrinary Surgeons, Society of University Urologists, American Association of Clinical Urologists, American College of Surgeons and the American Academy of Pediatrics Section on Urology. The Board selects the person from a list of submitted names. Voluntary recertification started in 1980, and 10-year limited certificates were first issued in 1985, In 1991 it was proposed that the examination be closed book, surgical logs were required and a $1,800 fee was assessed. On April 25, 1992 the American Board of Urology agreed to modify the recertification process. The fee has been decreased to $900, the surgical case log requirement has been reduced to 100 cases, and the examination will be open book and can be taken at any site that gives the in-service test. These modifications make it a fair recertification process in my opinion. WHAT HAS THE AUA DONE FOR UROLOGICAL PATIENTS?
One of the main goals of the AUA is to improve the quality of health care for patients with urological diseases. The AUA helped to obtain approval for the use of bacillus CalmetteGuerin in bladder carcinoma in situ. The AUA is working on access to quality care (manpower) and defining underserved areas. The AUA and AFUD supported Mr. Ed Kaps in setting up "Us Too," which is a prostate cancer support group. They have endorsed and helped sponsor Prostate Awareness Week. The AUA has also worked on guidelines for benign prostatic hyperplasia and incontinence with the idea of improving the quality of care. Nm
A great deal of time and effort have been invested during the last year in procuring better funding for urological disease research. Urology has been the victim of a system that sends grants to 23 study sections and 11 institutes. Urology is represented by only 1 person on council and 3 on study sections. With Dr. David McLeod's help we have gotten the assistance of Senators Dole and Stevens to obtain more money for urological research. We have not been successful in getting Congress to mandate a urological and renal institute because of the politics involved in the Fetal Research Amendment that was appended to the NIH appropriation bill. We have a chance of getting a center. This year Senator Stevens received $28 million for prostate research, and Senator Dole has gotten the Senate to approve $100 million for prostate research. Many good things have happened at NIH this year to help research in urological diseases. AUA OFFICE OF EDUCATION
The AUA Office of Education was approved by the Executive Committee in 1976 and organized by Dr. Russell Scott. Twelve years ago the office was moved to Houston to be led by Dr.
Eugene Carlton. There are 18 staff members in the Office of Education, handling a variety of educational projects. The Office of Education is charged with operating at a break-even point, which includes a yearly allocation from AUA membership dues of $121,000. The rest of the budget is earned primarily through registration fees and subscription income. Increased educational activities have caused the budget to increase by more than 38% in the last 5 years. One of the most well known projects is the seminar programs. An average of 11, 2-day seminars are held each year, along with 4 to 7 smaller hands-on meetings, and they have taught more than 7,700 urologists in the last 5 years. In this same 5 years the Office of Education has held almost 300 instructional and postgraduate courses at the AUA annual meetings with an attendance of more than 27,700. At the 1992 meeting they were responsible for 79 instructional/postgraduate courses. The most popular Office of Education publication is the "AUA Update Series." This yearly publication of 40, 8-page lessons is now averaging more than 2,000 full subscriptions, as well as more than 1,200 resident subscriptions annually. Many urology training programs are using the Update as a teaching tool. One of the more recent introductions is the videotape series, "AUA Video Digest," which has been popular with urological surgeons. A series of 4 videotapes each year displays many surgical techniques in vivid and realistic color. The newest program of the AUA Office of Education is the "Surgical Learning Center," using the facilities of the Texas Medical Center. The first of these limited enrollment courses was on laparoscopy and it was held only 6 months agoo These hands-on courses offer teaching of surgical techniques and the use of instruments that may have been developed since many urologists were in residency training. The initial popularity indicates to us that these programs will quickly become one of the most successful offerings of the Office of Education. The Office of Education provides many services to the urological profession. It works closely with the American Board of Urology in their examination programs and it provides a residency match program for students wishing to enter the field of urology. These matches are made by computer in a secret and impartial manner. The Office has sponsored several workshops on how to train residents better and a well attended "Basic Science Course" each summer. From comments made by our members as well as comments made by leaders in other medical specialties, we think that the AUA Office of Education is far ahead of the educational programs of most other medical societie,t We are proud of the educational programs they offer. When the office was first established, it was given the goal of providing quality continuing medical education for practicing urologists. They meet that goal in an outstanding way! A major benefit of the AUA to urologists is free registration at our annual meeting. This meeting is the largest and best educational meeting of urnlogists in the world. AFUD
This has been a great year for AFUD. Hovey Dabney, a prominent Virginia banker, has been elected Chairman of the Board. Art Keeney, a banker from Baltimore, has been recruited as Chief Executive Officer. Ed Kaps, a retired vicepresident of General Motors, has started the first prostate support group and has now established 58 chapterso Stan Musial has been recruited to record public service announcements about prostate cancer. The successful scholars program has been expanded. Searle is going to donate $1 million for 2 years for urological research grants for practicing and academic urologists. Councils for prostate, bladder and pediatrics have been established. AFUD also has moved into new headquarters in Baltimore.
774
GILLENWATER JOURNAL OF UROLOGY
Our members receive the Journal of Urology for $75 of their dues, which is a real bargain. This year there will be 4 special issues, with an increased number of pages and articles. Dr. John Grayhack has done an outstanding job as Editor. YOUNG UROLOGISTS
During the last several years the AUA has made a special effort to help recruit young urologists into national membership by requesting all sections to speed up and simplify section membership procedures. Special luncheons for young urologists were held at the 1991 and 1992 AUA meetings, at which a variety of issues were discussed in an open forum. The AUA is working to get Medicare payments to Jll'QlQgil!j;!! in lhf:l firsj; 5 years of practice increased to equal the amount paid to the more senior urologists for the same procedures. OTHER AUA ACTIVITIES
The AUA believes that in the future we will be paid for our services what we are able to negotiate, not necessarily what those services are worth. Thirteen urologists have been trained in negotiating to help deal with these problems. A group of speakers has been organized to discuss socioeconomic issues for state urological societies. The AUA has funded a new socioeconomic scholar, Dr. Mark Litwin, and hired Mr. Bill Glitz to increase our media relations activity. The AUA has developed a strategic planning committee, and
reviews its objectives and goals at each Executive Committee meeting. The AUA has tried unsuccessfully to have the lithotripsy machines put in safe harbors and be exempt from self-referrals. A UA Today changed from a quarterly newsletter to a monthly newspaper, improving the quality of the publication. Dr. William W. Scott spent the last year organizing the William P. Didusch Museum, which is on the third floor of the Baltimore AUA headquarters. This museum is an important and fascinating contribution to urological history. The centennial history of the AUA has also been started. Drs. Paul Peters and Harry Lichtwardt are the Editors. Doctors Peters and Lichtwardt have assembled a "History of Transurethral Resection" exhibit for this meeting. The future problems facing urologists mostly relate to socio-
ecoriomics. We a.re fortunate to have Dr. Logan Holtgrewe as
our next President, since he has done a great deal of work on socioeconomic issues and will be a great asset to the organization as we face health care reform. I feel comfortable turning over the reins of this organization to Doctors Holtgrewe and Cockett. The AUA has made a difference and will continue to make a difference. It has been successful in modifying some aspects of the Medicare health care reform. We have been effective spokespersons for urological patients and urologists, particularly young urologists in trying to modify the recertification process, which has been changed. The AUA also has been effective in getting more research money for urological diseases at NIH: $28 million this year and possibly as much as $100 million for prostate research next year.
Vol. 148, 772-774, September 1992 Printed in U.S.A.
Special Article HAS THE AMERICAN UROLOGICAL ASSOCIATION MADE A DIFFERENCE? JAY Y. GILLENWATER* The years 1991 and 1992 have been interesting, busy and threatening for urology. When the time came to decide the subject for my Presidential Address, the logical choice was to report to the membership on what organized urology is doing in response to the problems facing us this year. In this report I am including the accomplishments of the American Urological Association (AUA), American Foundation for Urologic Diseases (AFUD) and American Lithotripsy Society. I am happy to report to you that the AUA has made a difference. The work of the AUA is performed by several dozen urologists who have worked hard in many areas with no compensation. Much has been accomplished, although we have failed to modify some Medicare changes and there is still a lot to do. In visiting the sections and talking to the members, I have noted 2 overwhelming concerns: 1) the effect of health care reform and 2) recertification. As Senator Dole said, trying to stop health care reform is like trying to stop a hurricane or a tidal wave. That does not mean we cannot have an influence. Health care changes started because Medicare administrators, the Department of Health and Human Services, the Office of Management and Budget, and Congress all want to reduce health care costs. The American Medical Association and the American Society of Internal Medicine pushed for changes to increase money for cognitive procedures at the expense of surgical procedures. Dr. William Hsiao, a Harvard economist, developed a system of resource-based relative work values. In 1984 the AUA hired independent health policy consultants to study the methodology. Drs. Alan H. Bennett, Wallace A. Gerrie and Robert D. Wickham (nominated by the American Association of Clinical Urologists) also participated in the evaluation. In 1985 the AUA testified against the changes before the Physician Payment Review Commission (PPRC) and Congress. In 1986 the AUA hired Multinational Business Services, Inc. to do a study on the impact these changes would have on urologists. The study showed that transurethral resection of the prostate accounts for 25% of urologist income. In that same year the AUA succeeded in stopping a proposed 36% reduction in prostatic transurethral resection reimbursement. The AUA membership was informed of the proposed Medicare changes through speeches by the AUA Section Presidents and by articles published in AUA Today. The AUA has provided oral testimony and written responses at every opportunity. The Medicare physician payment reform plan was mandated by Congress in 1989. In 1990 a committee was formed (Drs. Lawrence E. Allen, H. Logan Holtgrewe, Richard G. Middleton, Gregory A. Slachta and Robert D. Wickham) to analyze the new Medicare fee schedule. Urologists sent more than 500 letters to Dr. Gail Wilensky, Health Care Financing Administration (HCFA) administrator, concerning the proposed changes. The most contentious issue in the proposed rule was the 10.5% "behavioral offset" that was calculated into the fee schedule conversion factor. After the protests of all medical * Presidential Address presented at annual meeting of American Urological Association, Washington, D. C., May 10-14, 1992. 772
organizations and Congress, the behavior offset was changed to 6.5%. An issue of more concern to urologists was the proposed definition of global surgical services, which was changed from a proposed 30-day preoperative period to a 24-hour preoperative period. The proposed inclusion of return trips to the operating room in the global fee was changed. In the final version reoperations for complications that require a return trip to the operating room are removed from the global surgical service. Multiple operations on different parts of the body at 1 time (as in trauma) will be considered for separate global fees rather than the proposed 100% of the global fee for the most expensive operation, 50% for the second most expensive procedure and 25% for the third, fourth and fifth procedures. Medicare's policy of paying new physicians less than the fee schedule amount for their services during the first 5 years has been vigorously opposed by most medical societies. New physicians have the same practice and malpractice costs as older physicians. The 16% payment of the global surgical fee for assistants at surgery is imposed legally by statute. New legislation will be needed to make changes. Changes can be made by individual efforts of AUA members. Dr. Jeffrey H. Cohn of Birmingham, Alabama served on a Centers for Disease Control panel evaluating office laboratory fees of Medicare, and he was instrumental in getting some fees changed. Included in the moderate complexity tests were bacteriology-urine cultures and sensitivities, urinalysis and semen analysis. Semen analysis was later put into a more complex category and the AUA is working to get it reclassified. Dr. Steve Wilson of Arkansas complained to Medicare on February 12, 1992 about the 50% reduction of Code 54405 (implantation of an inflatable penile prosthesis) and 67% reduction of Code 54407 (revision of an inflatable penile prosthesis). On March 30, 1992 Medicare notified him that Medicare payments would be modified to a transitional payment schedule (15% reduction in 1992). The American Lithotripsy Society took HCFA to court and won! A United States District Court barred HCFA from implementing a new shock wave lithotripsy facility fee of $1,150, which would have been below cost. Fees for lithotripsy must return to the old rates and methodology (100% of the lesser of facility charges or costs paid only through a hospital). The AUA has contracted with the Gallup Organization to evaluate the effects of the new Medicare changes on the practice of urology. The success of this poll will depend on your willingness to participate if selected. In the last several years there have been studies suggesting that patients have more cardiovascular accidents within 10 years of transurethral resection than those having open prostatectomy. There is no explanation for this apparently valid observation. Since transurethral resection is the most common urological surgical procedure the AUA thought that this observation needed to be evaluated in a prospective randomized study. In addition, the newer methods of relieving prostate
HAS AlViERICAN UROLOGICAL ASSOCIATION MADE A D[FFERENCE
obstruction need to be evaluated. Toward that end the AUA has committed $1 million for the pilot studies and submitted grants to the Agency for Health Care Policy and Research (AHCPR). The AHCPR has funded 50% of the pilot study and the National Institutes of Health (NIH) may be funding some of the proposed research. As a byproduct of this study a symptom score sheet for benign prostatic hyperplasia has been developed. Other socioeconomic activities of the AUA include 1) continued work with the PPRC and HCFA to modify the proposed regulations, 2) educating our members about Medicare reimbursement issues, 3) identifying individuals with negotiating skills and 4) striving to improve urological codes in the CPT. BOARD RECERTIFICATION
There have been many complaints from our membership about the proposed Board of Urology recertification in 1995. The AUA has vigorously acted as the spokesperson for urologists to the Board. The American Board of Urology is a separate and distinct entity not answerable to the AUA. Its members are nominated by the AUA, American Association of GenitoUrinary Surgeons, Society of University Urologists, American Association of Clinical Urologists, American College of Surgeons and the American Academy of Pediatrics Section on Urology. The Board selects the person from a list of submitted names. Voluntary recertification started in 1980, and 10-year limited certificates were first issued in 1985, In 1991 it was proposed that the examination be closed book, surgical logs were required and a $1,800 fee was assessed. On April 25, 1992 the American Board of Urology agreed to modify the recertification process. The fee has been decreased to $900, the surgical case log requirement has been reduced to 100 cases, and the examination will be open book and can be taken at any site that gives the in-service test. These modifications make it a fair recertification process in my opinion. WHAT HAS THE AUA DONE FOR UROLOGICAL PATIENTS?
One of the main goals of the AUA is to improve the quality of health care for patients with urological diseases. The AUA helped to obtain approval for the use of bacillus CalmetteGuerin in bladder carcinoma in situ. The AUA is working on access to quality care (manpower) and defining underserved areas. The AUA and AFUD supported Mr. Ed Kaps in setting up "Us Too," which is a prostate cancer support group. They have endorsed and helped sponsor Prostate Awareness Week. The AUA has also worked on guidelines for benign prostatic hyperplasia and incontinence with the idea of improving the quality of care. Nm
A great deal of time and effort have been invested during the last year in procuring better funding for urological disease research. Urology has been the victim of a system that sends grants to 23 study sections and 11 institutes. Urology is represented by only 1 person on council and 3 on study sections. With Dr. David McLeod's help we have gotten the assistance of Senators Dole and Stevens to obtain more money for urological research. We have not been successful in getting Congress to mandate a urological and renal institute because of the politics involved in the Fetal Research Amendment that was appended to the NIH appropriation bill. We have a chance of getting a center. This year Senator Stevens received $28 million for prostate research, and Senator Dole has gotten the Senate to approve $100 million for prostate research. Many good things have happened at NIH this year to help research in urological diseases. AUA OFFICE OF EDUCATION
The AUA Office of Education was approved by the Executive Committee in 1976 and organized by Dr. Russell Scott. Twelve years ago the office was moved to Houston to be led by Dr.
Eugene Carlton. There are 18 staff members in the Office of Education, handling a variety of educational projects. The Office of Education is charged with operating at a break-even point, which includes a yearly allocation from AUA membership dues of $121,000. The rest of the budget is earned primarily through registration fees and subscription income. Increased educational activities have caused the budget to increase by more than 38% in the last 5 years. One of the most well known projects is the seminar programs. An average of 11, 2-day seminars are held each year, along with 4 to 7 smaller hands-on meetings, and they have taught more than 7,700 urologists in the last 5 years. In this same 5 years the Office of Education has held almost 300 instructional and postgraduate courses at the AUA annual meetings with an attendance of more than 27,700. At the 1992 meeting they were responsible for 79 instructional/postgraduate courses. The most popular Office of Education publication is the "AUA Update Series." This yearly publication of 40, 8-page lessons is now averaging more than 2,000 full subscriptions, as well as more than 1,200 resident subscriptions annually. Many urology training programs are using the Update as a teaching tool. One of the more recent introductions is the videotape series, "AUA Video Digest," which has been popular with urological surgeons. A series of 4 videotapes each year displays many surgical techniques in vivid and realistic color. The newest program of the AUA Office of Education is the "Surgical Learning Center," using the facilities of the Texas Medical Center. The first of these limited enrollment courses was on laparoscopy and it was held only 6 months agoo These hands-on courses offer teaching of surgical techniques and the use of instruments that may have been developed since many urologists were in residency training. The initial popularity indicates to us that these programs will quickly become one of the most successful offerings of the Office of Education. The Office of Education provides many services to the urological profession. It works closely with the American Board of Urology in their examination programs and it provides a residency match program for students wishing to enter the field of urology. These matches are made by computer in a secret and impartial manner. The Office has sponsored several workshops on how to train residents better and a well attended "Basic Science Course" each summer. From comments made by our members as well as comments made by leaders in other medical specialties, we think that the AUA Office of Education is far ahead of the educational programs of most other medical societie,t We are proud of the educational programs they offer. When the office was first established, it was given the goal of providing quality continuing medical education for practicing urologists. They meet that goal in an outstanding way! A major benefit of the AUA to urologists is free registration at our annual meeting. This meeting is the largest and best educational meeting of urnlogists in the world. AFUD
This has been a great year for AFUD. Hovey Dabney, a prominent Virginia banker, has been elected Chairman of the Board. Art Keeney, a banker from Baltimore, has been recruited as Chief Executive Officer. Ed Kaps, a retired vicepresident of General Motors, has started the first prostate support group and has now established 58 chapterso Stan Musial has been recruited to record public service announcements about prostate cancer. The successful scholars program has been expanded. Searle is going to donate $1 million for 2 years for urological research grants for practicing and academic urologists. Councils for prostate, bladder and pediatrics have been established. AFUD also has moved into new headquarters in Baltimore.
774
GILLENWATER JOURNAL OF UROLOGY
Our members receive the Journal of Urology for $75 of their dues, which is a real bargain. This year there will be 4 special issues, with an increased number of pages and articles. Dr. John Grayhack has done an outstanding job as Editor. YOUNG UROLOGISTS
During the last several years the AUA has made a special effort to help recruit young urologists into national membership by requesting all sections to speed up and simplify section membership procedures. Special luncheons for young urologists were held at the 1991 and 1992 AUA meetings, at which a variety of issues were discussed in an open forum. The AUA is working to get Medicare payments to Jll'QlQgil!j;!! in lhf:l firsj; 5 years of practice increased to equal the amount paid to the more senior urologists for the same procedures. OTHER AUA ACTIVITIES
The AUA believes that in the future we will be paid for our services what we are able to negotiate, not necessarily what those services are worth. Thirteen urologists have been trained in negotiating to help deal with these problems. A group of speakers has been organized to discuss socioeconomic issues for state urological societies. The AUA has funded a new socioeconomic scholar, Dr. Mark Litwin, and hired Mr. Bill Glitz to increase our media relations activity. The AUA has developed a strategic planning committee, and
reviews its objectives and goals at each Executive Committee meeting. The AUA has tried unsuccessfully to have the lithotripsy machines put in safe harbors and be exempt from self-referrals. A UA Today changed from a quarterly newsletter to a monthly newspaper, improving the quality of the publication. Dr. William W. Scott spent the last year organizing the William P. Didusch Museum, which is on the third floor of the Baltimore AUA headquarters. This museum is an important and fascinating contribution to urological history. The centennial history of the AUA has also been started. Drs. Paul Peters and Harry Lichtwardt are the Editors. Doctors Peters and Lichtwardt have assembled a "History of Transurethral Resection" exhibit for this meeting. The future problems facing urologists mostly relate to socio-
ecoriomics. We a.re fortunate to have Dr. Logan Holtgrewe as
our next President, since he has done a great deal of work on socioeconomic issues and will be a great asset to the organization as we face health care reform. I feel comfortable turning over the reins of this organization to Doctors Holtgrewe and Cockett. The AUA has made a difference and will continue to make a difference. It has been successful in modifying some aspects of the Medicare health care reform. We have been effective spokespersons for urological patients and urologists, particularly young urologists in trying to modify the recertification process, which has been changed. The AUA also has been effective in getting more research money for urological diseases at NIH: $28 million this year and possibly as much as $100 million for prostate research next year.