2026 Annual Urology Advocacy Summit Recap

By John S. Lam, MD, MBA, FACS, Los Angeles, CA
AUA State Advocacy Committee Rep
WSAUA Health Policy Committee District 6 Rep
Past-President California Urological Association

 

Thank you to all that joined us for the 2026 AUA Summit in Washington, DC, Feb 23-25. The ninth Annual Advocacy Summit of the American Urological Association (AUA) was held at the JW Marriott Washington, DC from February 23-25, 2026 with more than 360 attendees that included physicians; 115 medical students, residents, fellows; 43 patient advocates; members of the AUA Leadership Class; 38 AUA FUTURE Program mentees; and others.

AUA Advocacy Summit Summary – February 23-25, 2026

The 119th United States Congress convened last year with the promise of unified government and the possibility of swift legislative action. Yet the reality inside the U.S. House of Representatives and the U.S. Senate has been far more fragile due to slim majorities, ideological fractures, and procedural hurdles that have slowed what might otherwise have been an ambitious agenda. But for urologists, the turbulence inside Washington, D.C. is not abstract politics — it is economic reality.

 

The summit opened up with Welcome remarks from AUA President, Dr. Lane Palmer and AUA Public Policy Chair, Dr. Mark Edney who provided highlights of this year’s summit that includes 11 general sessions, 200 planned Hill visits, face-to-face interactions with 24 members of Congress, and 3 legislative asks supporting 5 bills.

Following this, Montell Jordan, a Grammy Award winning songwriter, artist, author, speaker, 2X cancer survivor gave the Opening Keynote Address. Best known for his 1995 hit, This Is How We Do It, Mr. Jordan has become an advocate for men’s health after publicly sharing his battle with prostate cancer and saving lives through promoting early detection of this disease. Mr. Jordan and his wife, Kristin Hudson Jordan also co-founded Marriage Medicine Ministry, which is a faith-based nonprofit dedicated to helping couples build and maintain healthy, long-lasting relationships. Mr. Jordan shared how music heals hearts, how ministry saves souls, how marriage preserves family legacy, and how medicine saves lives by promoting early detection of prostate cancer. From a patient perspective, he stressed that there needs to more direction and data shared from practitioners to patients regarding where medical treatment and holistic healing intersect. Lastly, he introduced his forthcoming documentary film titled Sustain that chronicles his personal health journey as he confronts prostate cancer—including his diagnosis, treatments, and reflections on identity, faith, perseverance, and masculinity. The film reveals his openness and vulnerability in the hopes of encouraging early detection and health conversations, especially among men who are at high risk.

The rest of the afternoon were comprised of educational sessions that included the three issues we were going to Hill to advocate for this year: Medicare Physician Payment Reform; Burden of Prior Authorization (PA); and Establishment of a Federal Office of Men’s Health. The first general session, Prior Authorization Burden: One of the Barriers to Restoring Joy in Work, was led by Drs. Amanda North and Andrew Harris. Joy in medicine, or its loss, is a popular topic of conversation. Though safe, effective, and patient-centered care requires adequate resources and an engaged workforce, over half of U.S. physicians report emotional exhaustion, depersonalization, dissatisfaction, distress, and a sense of failure or reduced personal accomplishment, which have been labelled as “burnout.” The ramifications produce serious negative consequences for physicians, patients, and healthcare organizations and systems. Beyond individual impacts, physician burnout poses a public health threat, affecting the quality of care and quantity of physicians who provide it. Burnout negatively impacts patient care and delivery via decreased performance, increased medical errors, and increases in physicians changing jobs or abandoning medicine altogether.

To increase joy, the Institute of Healthcare Improvement (IHI) focuses on identifying “pebbles in your shoe,” those small daily frustrations decreasing satisfaction. Fixing these requires team communication and mutual respect. As a resource, the AUA Quality Improvement and Patient Safety Committee has developed a Quality Improvement Project Guide illustrating how to change processes. Potential targets include clinic efficiency and operating room delays. Dr. North talked about reframing work-life balance to work-life integration, and also discussed how artificial intelligence (AI) can help, but warns of potential risk on whether a decrease in administrative burden will really lead to increased time with patients? Or are we just asked to then “do more?” One large administrative burden is PA and the process is often lengthy and can lead to significant delays in providing necessary care. In fact, physicians typically spend two or more days a week negotiating with insurance companies for PAs, which can exacerbate administrative burdens and physician burnout. Administrative burden is a silent tax and PA, quality reporting mandates, and evolving value-based payment models continue to expand the non-clinical workload of urologists. Every hour spent navigating payer requirements is an hour not spent treating stones, managing BPH, or counseling a newly diagnosed prostate cancer patient. There is bipartisan rhetoric about reducing red tape. But rhetoric does not hire additional staff. Legislation does. If this Congress wishes to demonstrate seriousness about small business and patient access, reducing administrative friction would be a meaningful place to begin. PA protocols are particularly common in Medicare Advantage (MA) and evidence suggests they’ve been overly deployed and indiscriminately applied. Furthermore, the Centers for Medicare & Medicaid Services (CMS) recently introduced PA requirements to traditional Medicare for the first time ever with the launch of the Wasteful and Inappropriate Service Reduction – or WISeR – model.

The program went into effect earlier this year in six states – Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington – and applies to several services, including those to treat common urological conditions like urinary incontinence and erectile dysfunction. Our congressional asks related to PA were:

• Cosponsor The Improving Seniors’ Timely Access to Care Act (S. 1816/H.R. 3514), which imposes new transparency requirements to shore up PA practices in MA plans to improve turnaround time, require electronic submission process, and require insurance plans to publish denial rates. The bill codifies regulatory changes previously enacted in 2024 and reflects similar legislation that passed the House of Representatives unanimously by voice vote during the 117th Congress. S. 1816 was introduced in the Senate by Sen. Roger Marshall (R–KS), with bipartisan support, and H.R. 3514 was introduced in the House by Rep. Mike Kelly (R–PA-16), also with a bipartisan group of cosponsors.

• Cosponsor The Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act (S.3484/ H.R.5940), which prohibits CMS from implementing the WISeR model or any similar model in traditional Medicare, thereby preserving and protecting timely access to care for enrollees. Rep. Suzan K. DelBene (D-WA-1) is primary sponsor for H.R. 5940 and Sen. Patty Murray (D-WA) is the primary sponsor of S. 3480 companion bill.

The second general session, Medicare Physician Payment Reform: A New Hope or the Empire Strikes Back? was led by Drs. Kevin Koo, Logan Galansky, and Joshua Broghammer. This Congress has been defined by narrow margins, partisan strategy, and uneven legislative output. While headlines focus on investigations and ideological battles, physicians are left navigating a far more immediate question: Who is protecting the stability of medical practice? Medicare physician reimbursement has become an annual cliffhanger. Temporary patches. Last-minute fixes. Across-the-board adjustments driven by budget neutrality rules. This isn’t a market force — it’s a congressional design flaw that has gone unrepaired for years. Congress regularly debates trillion-dollar fiscal packages. Yet stabilizing physician payment — a cornerstone of patient access — remains perpetually deferred. For urologists, whose practices often depend on procedural revenue and in-office ancillary services, unpredictability isn’t just inconvenient. It is corrosive. It discourages investment in new technology, expansion into underserved communities, and recruitment of young partners. Medicare payments to physician offices have declined 33% from 2001 to 2025 when adjusted for inflation. In addition, CMS made arbitrary cuts for 2026 that unfairly target specialty providers, which implements an across-the-board 2.5% reduction in work Relative Value Units (RVUs) for most non-time-based codes. With regards to this issue, we asked members of Congress to:

 

• Cosponsor The Strengthening Medicare for Patients and Providers Act (H.R. 6160), which would adjust fees by inflation for practice costs. Rep. Raul Ruiz (D-CA-25) is the primary sponsor with bipartisan support.
• Cosponsor The Efficiency Adjustment Delay Act (H.R. 7520), which would delay the efficiency adjustment until 2030 and require CMS to produce a study on the issue. It would also prevent any future adjustments from being calculated with similar productivity metrics. Rep. Ron Estes (R-KS-4) is the primary sponsor of the bill with Rep. Thomas R. Suozzi (D-NY-3) as a cosponsor.

 

The third general session, Needs for and Benefits of a Federal Office of Men’s Health, was led by Drs. Ira Sharlip, Hossein Sadeghi-Nejad, Jason Jameson, and Tobias Kohler. The status of men’s health in the U.S. is alarming and getting worse. Men face unique health challenges, including shorter lifespans, higher rates of disease, and higher suicide rates. The health challenges men face often go unaddressed due to stigma, reluctance to seek care, lack of awareness, or inaccessibility. Rationale for establishing a dedicated Office of Men’s Health within the federal government to develop and implement national strategies that aim to improve men’s health includes: addressing life expectancy gaps, mental health and suicide crisis, preventative care utilization gaps, workforce and economic impact, fatherhood and family outcomes, health equity and targeted subgroups, and policy coordination gaps. Preventable deaths among men cost us $420B annually. The Office of Men’s Health looks to implement a national strategy in order to coordinate research, raise public awareness, advance policies, and support innovative programs that advance men’s health. Importantly, the goal of the Office of Men’s Health is to complement — not compete with or take away resources — the Office on Women’s Health or women’s health initiatives and to highlight gaps in care for men with the hope to simultaneously enhance care for men and women. We asked members of Congress to:

 

• Cosponsor The State of Men’s Health Act (H.R.7602), a bill with bipartisan support with Rep. Troy Carter (D-LA-2) as primary sponsor and Rep. Greg Murphy, MD (R-NC-3) as co-sponsor, which would establish an Office of Men’s Health under the Office of the Assistant Secretary of Health seeking to: coordinate research, raise public awareness, advance policies, and support programs that advance men’s health.

Following these educational sessions to prepare us for our Hill visits, there were general education sessions. General Session 4 - Balancing Innovation and Affordability in the New Frontier of Bladder Cancer Care, was chaired by Drs. Ruchika Talwar, Stephanie Spence and Matthew Mossanen. There is significant economic burden associated with bladder cancer care as bladder cancer is one of the most expensive cancers to treat, with high direct costs that also lead to substantial indirect costs. These indirect impacts include patient anxiety over care-related expenses, stress about treatment decisions, lost workdays, caregiver strain, lifestyle changes, and an overall decline in quality of life, collectively contributing to what is termed "financial toxicity." Financial toxicity is a combination of two key components: financial burden and financial distress. Financial burden refers to objective, out-of-pocket costs borne by patients, including payments to doctors, hospitals, and pharmacies, as well as co-payments, co-insurance, and deductibles. In contrast, financial distress represents the indirect, subjective impact of this burden, encompassing factors such as travel time, lost wages, decreased work productivity, early retirement, the toll on loved ones, and emotional stress or anxiety.

In the U.S., up to 75% of bankruptcies are due to medical expenses. Around 40% of cancer patients report financial hardship, and in bladder cancer specifically, up to 1 in 4 patients experience financial toxicity. These individuals are more likely to delay care and report poorer mental and physical health. There have been various models to estimate surveillance costs for non–muscle-invasive bladder cancer and estimates vary by risk category. For example, $52,125 for low-risk disease versus $366,143 for high-risk disease. Each disease state is dynamic, and patients may shift between categories due to progression. However, these models risk becoming outdated as treatment costs and care options evolve over time. From a payer perspective, a pharmacist working within a health plan plays a key role in managing high-cost drugs by monitoring spending trends and identifying unexpected spikes. In the context of utilization management, PAs are typically the first mechanism employed to control access to high-cost therapies. Another key strategy involves site-of-care management.

Moreover, the cost of a drug can vary significantly depending on where it is administered. The price is influenced by negotiated contracts between payers and providers, and these rates can differ substantially across regions. For example, the cost of administering a drug in Florida may differ from that in Washington, DC, highlighting the geographic variability in reimbursement structures. In addition, site-of-care programs aim to steer drug utilization toward specific settings such as outpatient facilities or provider offices that may offer more cost-effective care. There are also emerging risk management models, where manufacturers acknowledging the high costs of drug development may price therapies with built-in warranties tied to clinical efficacy. These models are designed to share financial risk and reinforce value-based care. In 2023, the U.S. health system crossed a staggering $4.8 trillion in total spending, and projections show that by 2032, we could be looking at $7.7 trillion, nearly a fifth of the nation’s GDP. A closer look at who’s footing the bill reveals a steady expansion in the role of government-sponsored insurance, including Medicare and Medicaid, which together now make up nearly half of all healthcare expenditures.

The recent Executive Order aimed at slashing pharmaceutical costs by 59% highlights this need to rein in spending and reduces costs. Several provisions are now being proposed: requiring Medicaid to pay no more than the lowest global price for a given drug, applying “most favored nation” pricing standards to pipeline therapies (particularly relevant for high-cost agents in bladder cancer), and mandating that drug manufacturers repatriate overseas revenues. Perhaps most striking is the proposal to allow direct-to-consumer drug sales at those same benchmark prices. However, a critical nuance often missed in the pricing debate: the reason other countries pay less than the U.S. is that they negotiate aggressively, setting caps on what they’ll pay, sometimes below the cost of development. Pharmaceutical companies rely on U.S. pricing when that happens in order to recoup losses and generate a net profit thereby placing the financial burden of global R&D on the American healthcare system.

The Inflation Reduction Act marks a significant policy shift by enabling Medicare to directly negotiate prices for select high-cost drugs, aiming to lower patient out-of-pocket expenses.

The No Surprises Act, originally passed under the Trump 1.0 administration, protects patients from unexpected medical bills when receiving care from out-of-network providers, often during emergencies or in hospitals where certain clinicians aren't in-network, even if the facility is. Looking ahead, several proposed federal bills could significantly impact financial toxicity for patients with bladder cancer and other urologic malignancies.

Legislation such as the Cancer Drug Parity Act, Prescription Drug Affordability Act, and the Improving Seniors’ Timely Access to Care Act aims to reduce out-of-pocket (OOP) costs, ensure fair access to oral vs. IV therapies, and streamline prior authorizations issues, particularly relevant for patients navigating complex, multimodal bladder cancer treatment. The evolving landscape of bladder cancer care is pushing a shift away from traditional fee-for-service models toward value-based arrangements. These models aim to bundle all services related to a condition into a single payment, rewarding quality over quantity.

Lastly, advocacy plays a critical role in shaping policy to improve access and affordability in bladder cancer care. Building these relationships helps influence meaningful legislation that supports patients and the future of bladder cancer treatment.

 

General Session 5 - Aligning Incentives through Urologic Value-Based Care: the Past, the Present, and the Future, was chaired by Drs. Ruchika Talwar, Avinash Maganty, and David Johnson. The rise in health care expenditures in recent decades has created an impetus to reconsider how care delivery should be financed. In response to increasing costs, the Affordable Care Act, passed in 2010, created the Center for Medicare and Medicaid Innovation (CMMI) and tasked it with pioneering payment models that prioritize value rather than volume of health care services, thereby attempting to curtail spending while maintaining or enhancing care quality. Value‑based care shifts healthcare incentives away from volume (fee‑for‑service) toward quality, efficiency, and outcomes that matter to patients — essentially rewarding better care at lower or appropriate cost. The concept is well established in health policy literature, including pay‑for‑performance systems where clinicians are rewarded for meeting defined performance measures rather than sheer procedure volume. One of the tough areas when we talk about value-based payment is understanding and defining what value is, which is aligning financial incentives with the goal of achieving higher quality care. Urology has been slower than some other specialties to adopt robust alternative payment models.

Currently, the value-based payment models relevant to urologists are the merit-based incentive payment system (MIPS) within Medicare fee-for-service, episode- or condition-based bundled payments, and population-based models. Bundle payments may be the easiest to understand and probably the one where the most progress in adapting as a specialty. Bundle payments can be thought of as two big categories: procedural bundle payments that are focused on a surgery (e.g., robotic prostatectomies or kidney transplants) and condition or clinical condition-based bundle payments that are focused on an entire disease process. The Large Urology Group Practice Association (LUGPA) developed a specialty-specific alternative payment model (APM) for newly diagnosed, localized prostate cancer that differed from traditional fee-for-service. The model was designed to: create episode-based payments for care starting at diagnosis, encourage active surveillance for low-risk patients rather than immediate intervention, and pay a monthly care management fee for active surveillance and a performance-based incentive tied to cost and quality metrics. This type of model was intended to qualify as an Advanced APM under Medicare’s Quality Payment Program (QPP) so practices could participate in value-based care with downside risk.

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) reviewed LUGPA’s APM proposal in 2018 and recommended that it not be tested at that time because although it agreed that promoting active surveillance is important, it did not support the APM’s reliance on “total cost of care” as defined in the model. Urology practices face several challenges that make bundled/APM participation difficult: episode definition and cost attribution for prostate cancer care is complex (especially when care spans surgery, imaging, follow-up, complications), practices may face financial risk if actual care costs exceed benchmark payments, and administrative burdens for tracking quality metrics and costs are high — especially compared with fee-for-service billing. Without adequate risk adjustment for patient complexity or practice structure, some practices view bundled/APM participation as financially unstable. Furthermore, ACOs and health systems have waivers that allow physicians and hospital systems to receive financial incentives on shared savings that don't really exist for independent practices. The second umbrella of value-based payment models are ACOs, which was discussed above including some of its limitations.

Most ACOs (such as the Medicare Shared Savings Program run by the Centers for Medicare & Medicaid Services) are structured around primary care attribution and total cost of care benchmarks. The large issue is how CMS and CMMI will be dictating how Medicare patients receive care with a goal to have all Medicare patients in some sort of accountable care relationship by 2030. The third bucket is on the far end of the spectrum of value and it's called global payment model. In this setting, urologists or the provider would receive an upfront payment called a PM or per member, per month payment to take care of a population of patients so the global payment is totally uncoupled from volume. Future incentive alignment likely involves: integrating urologists into broader population‑based models like ACOs or global payment arrangements, developing specialty‑specific quality metrics and better risk‑adjusted benchmarks, and leveraging data, payment design, and policy reform to move beyond “volume” metrics toward meaningful quality improvement. MIPS Value Pathways (MVPs) is more specialty focused, but is explicitly designed to fix the “topped-out measure optimization” with MIPS in order to maximize payment. Under MVPs: measures are bundled into specialty- or condition-specific sets, quality measures are pre-defined, cost measures are embedded, and improvement activities are aligned to the pathway. This reduces the ability to rely solely on topped-out measures.

 

The last session of the day was led by AUA Political Action Committee (PAC) Chair Dr. Grace Hyun to provide an update and why it is important to donate to the AUAPAC. AUAPAC is proudly non-partisan and strives to protect and advance the urology specialty and urologic patients by supporting federal candidates from both parties.

Day 2 of the summit started with the Public Policy Forum and another general session before heading to Capital Hills to meet with our lawmakers. Nischal Ada, medical student, reported that fertility preservation is an important aspect of survivorship. Yet many men do not receive counseling, thus inequity and inconsistency lead to care gaps. Telemedicine & mail-in collection kits can improve access. Need insurance coverage too! Dr. Gregory Mansour reported that financial toxicity affects many, thus identifying at-risk populations is  to developing mitigation strategies. Dr. Kevin Parham reported that drug shortages have a significant impact on our patients. Main drivers include: raw ingredient scarcity, sole supplier dependency, regulatory delays, DEA quota limits, and low market incentives. Dr. Katie Schultis reported on the legislative priorities facing practices with the most important being Medicare payment reform, which impacts patient access to care.

 

General Session 6 – Telemedicine in Male Reproductive Health: Policy Barriers in a Hybrid Model of Care was given by Dr. Niki Parikh. Telehealth is a vital modality for urological care and how it lowers barriers to high-quality male reproductive care. Telemedicine provides critical access but needs: permanent coverage, payment parity, licensure compact and addressing technology gaps.

 

Day 3 of the summit started with the Closing Keynote Address with Chuck Todd, Former Chief Political Analyst at NBC, Moderator of Meet the Press from 2014-2023. Mr. Todd talked about concerns about erosion of political norms and role of the press and democratic guardrails, criticism of repeated false or misleading statements, growing partisan divides and the upcoming mid-term elections. Following this, Dr. Cameron Britton gave General Session 7 - Economic Impact of Tariffs on Healthcare Costs in Urology. A 10% universal tariff on all imported goods occurred April 2025 with country-specific tariffs (China, Canada, Brazil, UK). Approximately 13% of the non-U.S.-manufactured products are imported from China and a tariff of 55% on Chinese-manufactured products was implemented June 2025. This is important as urology is a device-intensive specialty (e.g., foley catheters, implantable prosthetics, ureteral stents, surgical instruments and OR materials). Increases in manufacturing costs lead to increases in device prices. Supply chain delays lead to product shortages. If costs exceed reimbursement, this can lead to barriers to access. Tariffs also impact the drug supply chain and manufacturers may halt production of lower-margin generics, exacerbating shortages and price increases. There is a gap problem in that sharp tariff-driven cost increases occur today, reimbursement adjustments come next fiscal cycle, and providers absorb margin pressure in between. Market dynamics show that tighter margins lead to reduced investment in innovation, higher institutional costs lead to increased insurance premiums, and uninsured/underinsured patients lead to higher out-of-pocket costs. Furthermore, patient outcomes are at risk as deferral of implants/devices due to cost lead to reduced quality of life widening health equity gaps. Domestic manufacturing is not a quick fix as there are structural barriers: raw materials remained sourced globally, increasing domestic capacity has associated lag time, and capital investment uncertain amid volatile trade negotiations. In addition, it takes 18-36 months (or longer) to scale manufacturing compared to the immediate tariff impact. It is important to advocate for policy solutions.

 

General Session 8 - Hormonal Health is Mental Health: Routine Testosterone Screening and Treatment Access for Men’s Mental Wellness was presented by Alison Meling, medical student. Low testosterone is connected to rising rates of depression, fatigue, and suicidality in mid‑life men and outlined how routine screening, stigma reduction, and policy reform could save lives. Testosterone replacement therapy (TRT) enhances mood, vitality, and quality of life. Safety evidence shown in the TRAVERSE trial (2023, NEJM) showed no increase in heart attacks or strokes on TRT versus placebo.

 

General Session 9 - Bridging the Gap in PSA Screening: How Telehealth and Strategic Partnerships Drive Equity was chaired by Dr. Vikas Desai and Mr. Anthony Minter, patient advocate. PSA screening rates remain far behind other cancers, with only 30–40% of eligible men that are screened, and system‑level barriers are to blame. Workforce shortages, geographic disparities, and fragmented follow‑up delay prostate cancer diagnosis. Virtual specialty care and strategic partnerships can close the gap from screening to imaging to biopsy.

General Session 10 – Maximizing Meaningful Summit Attendee Engagement Advocacy Across the Career Spectrum was led by Nancy Quintanilla, medical student and Drs. Benjamin Pockros, Christine Van Horn, and John Myrga explored how advocacy restores meaning, agency, and community across every career stage. From medical school to independent practice, the message was clear: advocacy strengthens resilience and builds the future workforce. An advocacy summit toolkit is available through the AUA, and it includes key resources, templates, and guidance to support meaningful, year-round advocacy, practical tools for Hill preparation, storytelling, legislator research, and follow up, and is designed for all career stages to strengthen the advocacy pipeline.

 

General Session 11 – Bridging the Urology Gap: Expanding Access to Urology Care in Underserved and Rural Communities was given by Jerome Wilson, Co-Founder and CEO of First Call Urology. Mr. Wilson showed how both urban and rural communities face the same access crisis, one shaped by systems, distance, and delay. From Chicago’s West Side to Pulaski, IL, he illustrated how miles turn into missed diagnoses, and how families like his own pay the price. His call to action: digital‑first triage, team‑based care, telehealth access, workforce incentives, and infrastructure investment to close the gap for good.

 

Lastly, we were able to speak with Dr. Brian McNeil during our Hill visit. Dr. McNeil is working in the office of Senator Adam Schiff as part of his Robert Wood Johnson Foundation Health Policy Fellowship. This placement situates him directly in federal legislative work where he can contribute his medical and policy expertise to work on federal legislative and regulatory health policy issues.