Insight from the recent AUA Western section video. Stay tuned.

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Welcome to episode 310 of the Urology Coding Reimbursement Podcast. I'm your host, Scott Painter, my co-host Mark Painter, Dr. Ray Painter. And on today's episode, we wanted to share a little bit about what some of the hot discussions were at the AUA Western section. Mark attended it and he's bringing it back to us and sharing us, sharing with us his insights and what he's learned at the AUA and also his thoughts and kind of where he kind of leaves or where his trends are going, at least his opinion. So Mark, what happened and where were you? All that good stuff.

The section meetings as I've gone to them over the years have been a wonderful place to connect, talk about the future of urology, and really see where everybody's fitting. And of course, life has changed over the years. I mean, when we started doing this stuff, we were predominantly talking to private practice urologists. And now, as we know from the figures, we've got a lot more folks that are employed. Practices have consolidated. So there's been a big market shift in the way urology is practiced over the years. And uh and ultimately I've been going to the Western section meeting, and they have a day that they dedicate at the beginning of the meeting to health policy. And so I usually start off the day there updating everybody on the changes in Medicare, which unfortunately recently have been I've become the doom and gloom guy because Medicare hasn't really been all that friendly to urologists over the years. So we talked a little bit about what everybody needs to do and how to prepare for those and had a lot of great audience participation in that particular section. And then for the afternoon, I participated in a pan in a panel moderated by Dr. James Stenson, who is really working at the AUA level to and at the AMA level to figure out how to help physicians understand the impact of AI and provide some guidance, leadership, governance. We all know that the AMA is working on new codes for AI in particular. They are on the pathway of setting up three different sets of AI categories, augmentative and assistive, and then actually basically a consolidator of everything that's there. So that's a piece of what they're trying to do is really figure out how to make sure that people implementing AI have potentially a pathway to get paid for those things. And in the panel, which we I was joined with by Al Borhan and Dr. Brian Duty was kind of a piece of this as well. So, and then we had a representative from the AMA there who is working on HIPAA policy and some other issues related to AI. So we had a robust discussion after James kind of presented what they're working on, which will be, I'm sure, produce some information fairly quickly guiding physicians around the country as to what they need to look for relative to the implementation in AI. We found out some areas that, as you would expect, we don't have the answers to yet. We're still working on and evolving. Ask some questions about HIPAA and kind of where that fits within the AI world and how that needs to be worked with and need to answer more questions there. As you might expect, it's new enough. Everybody's trying to figure out what they think they should do. And then, of course, until it actually gets challenged in the legal system, we won't know the interpretation of all of this. So that's going to be another consideration that's out there. And of course, you've got some general protections and interpretations going in with BAAs and protection that we need to take with any particular software tool that we're using in our urology practices that we are all following right now. And we'll see if there's any shift or push now to make some changes relative to what's happening in AI. And that was so that was one of the discussion points was making sure that everybody understood that standard AI, like Claude and Chat GPT and those types of things, is not HIPAA compliant. I mean, you can set it up so your data is removed from the system after the session, but it went in to a potentially unsecure environment. So that was one of the things that we discussed. And of course, we know that there are a number of vendors out there that are going through the process of making sure their AI is HIPAA compliant. So it's one of those things that ultimately you've got to check with your vendors as you go through this and really understand the tools you're using and how that all works. But a couple of the things that they really that we focused on on long-term implementation beyond just HIPAA was that AI isn't your standard software tool. It is designed to be a system that starts working on a problem, has some parameters, and then learns as it goes and makes improvements for you. And ultimately, of course, the question of hallucination or drift, depending on how you want to label those particular issues, came up. And that means that any AI that goes in needs to be monitored. And that's going to be, I think, something that practices are going to have to figure out how to do really well. But before that, vetting, making sure that the AI does what it does, that the vendor is going to stand behind what they're doing, that you have contractual agreements and those types of things that provide those protections, but even from the basics, trying to figure out what AI actually delivers or is supposed to deliver, and making sure that whatever your vendor partner is bringing to the table is what you really want and will get you where you want to go. So I think there's some valid concerns that are out there. A lot of excitement, obviously. There are some great AI tools that were discussed during the during the program, and utilization of ambient scribes is fairly high. The number of urologists dabbling in AI was fairly high. People are looking at what can artificial intelligence do to streamline their workflow and augment the patient experience. And of course, Al has his product out there that's focused on patient education, which is another area that we're seeing done. We've seen a lot of document consolidation programs and potential phone calls and booking. So there's all sorts of implementation. And of course, what we're working on with revenue cycle management. So, and then there was discussions about where it is, what's it going to be relative to clinical. Of course, there's a lot of discussion around robotic augmentation of surgical skills, clinical decision making. Utah's experiment in their sandbox with prescription drug or prescribing of drugs in the sandbox, getting that's being an AI process. So I think the overall conclusion that we came up with was it's all TBD. And right now the federal government is number one, uh, kind of through their actions, taking a position that's not as physician-friendly as we would like them to be. And they are really taking a hands-off approach to AI. And that then leaves the states to step in and try and come up with guardrails, guidelines, or parameters for what AI can or cannot do in healthcare and how it can or cannot do what it's supposed to do. And there was a comment overall from the AMA representative that the AI was one of those areas where it's maybe not ideal to have 50 different regulations to deal with, but it may be where we live at this point in time for at least the near future. And so that's gonna make things interesting, I think, for companies and for physicians as we monitor what gets implemented, how it gets implemented, how each practice deals with AI. So we came away with a lot of excitement. I don't want to put a damper on everything, but we did come away with a fair number of concerns. And one of the last ones, of course, that I focused on was one of the things that I brought up in the whole process was the uh the focus on what's gonna happen on the reimbursement side. And in our race to getting AI paid for separately, one of my concerns is what is that gonna do to reimbursement for those services that physicians provide now that are now made easier by AI? We already saw that CMS recently took 2.5% off the work values because physicians are more efficient in what they do. Is this yet another avenue that they can focus on there? So a lot of questions came up, a lot of concerns, as we do with technology disruptions, but again, a lot of excitement that is out there as to what AI is going to be able to do to support the practice of medicine and urologists in general.

So, Mark, how much of the discussion was for clinical AI versus non-clinical AI? And is it do you think it's being hampered by the fact that there is no clear reimbursement? Is that stunting clinical AI?

I mean, I would say that clinical AI was a big part of the discussion. Obviously, I I view it through my lens of the reimbursement side, which is where my focus is. So I'll put that bias out there. But there was a lot of discussion of the clinical. I mean, the clinical piece that Al was talking about is educating the patient on what the options are and making sure that the patient gets the right information. Because as there's plenty of Reddit YouTube and everything else there that can leave patients down rabbit holes that all of a sudden they're coming in with information that number one, they don't understand. But number two, and I think one of the things that physicians, and they talked about this, was not being derailed, physicians cut or patients coming in talking like they've had 20 years of medical school with some of the terminology that they use, but clearly reading from a script that came from Chat GPT or some AI, that ultimately the physicians had to drop back and explain what those terms were. So it's it was clinical in that regard in the patient interaction. And then, of course, they talked about clinically the fact that Da Vinci, which is the their robot, has been recording surgeries for years. And ultimately it's learned surgeries from physicians around the country. And Da Vinci now has all of that data. How that's now that's not accruing to the urologists that actually perform those surgeries. So there's discussions about how things accrue, where credit is, or where should credit go, credit due. And I think that's a piece that is going to be debated again and again as we go through all of this. So, yeah, there was a lot of clinical. There's a lot of discussion of what the reimbursement pathway is and what it should be, and ultimately, do we focus on the short term of trying to get paid for these things that we implement on a piece-by-piece basis, or do we actually consider that part of this and protect what we've got now? I mean, these are all conundrums that need to be resolved over in the next few years. And unfortunately, I think one of the issues we are going to face is that AI and its implementation is evolving faster than policy. So as custodians at the AMA and the AUA level, they're kind of the official or unofficial custodians and mouthpieces for individual physicians at this point in time. So the custodians and the stewardship that needs to be addressed at that level. There's a lot of discussion, there's a lot of different opinions, and ultimately so many people are jumping into the deep end and trying to implement these things, companies and physicians alike. What is that stewardship? What is the cus what are the custodians? When are they going to come out with guidance that actually makes sense and ultimately can we then backfill that if we implemented something? So I it is interesting in how fast things are going. And we've dealt with this before with the internet and everything else, and we've seen that sometimes and oftentimes our technology and our options outpace where we are from how we want to make sure it's done appropriately. So I I did walk away thinking that number one, you definitely want, as you're jumping into AI, to pick good partners. Or if you're picking a partner that's developing with you, really take the time to act as a custodian and a steward to really drive these tools into positions that are beneficial and considerate of everything that's out there, looking at all sorts of possibilities and where the intellectual property and where your efforts should accrue. And it's gonna be something over the next few years to watch all of this occur. And it is. And CMS has already weighed in on this, right? They they basically have started it down the pathway, and this was in the both the OPPS and the Medicare fee schedule for physicians this year, talking about software as a medical service. So it everybody's dabbling into this and trying to figure out how AI should be remunerated. And that's so that is real, and the coding is real in pursuing that. And what we don't know in the end is what that's going to do, because the CMS approach was the a physician service is work in each particular encounter. It's a resource based consumption that you can measure. Whereas the software tool, and this was kind of CMS's language, and we talked about this in one of our webinars. Recently is software is an investment in a tool that can then be used over and over again with incremental cost increase, but with a big investment up front. So it's a different resource consumption model as time goes by. And they, I don't think they have really taken into account kind of the overall monitoring that's going to need to be taken into account, the stewardship of that clinical advice that's there, who's going to take the risk. I think those are all discussion points and things that they're trying to figure out. And like who owns the liability? Where is that service? And that's kind of the AMA coding structure is really starting to come into play. Like ultimately, if this is a final end clinical decision, then they're providing advice on how to a patient should proceed to treat their problem, then the liability and the decision making is with the company that has the AI. If the information is summarized and provided to the physician, and the physician's making the final decision, that shifts liability, right? So I think those are discussions that are being had, and those are at the foundational level of the codes that the AMA has or is sort of developing in that regard. So those discussions are definitely happening. There's focus on those things. And so, yes, reimbursement is there. I again raise the question: what does that do to what we have right now as far as our reimbursement? Does that lower the time in the operating room? Does that do the stuff? And what happens when that happens? We've already seen that physicians haven't really gotten a raise for years and years. All the way back to 2002, we're about on the same reimbursement fee schedule. Like, what why does efficiency penalize production is a question I think we have to keep asking and see what what can be done. And that's gonna take legislative and action, and it's gonna so I think these are all parts of the equation that are out there that we've gotta continue to monitor and argue.

Real quick final question for you. Circling back to HIPAA.

Yeah. What was there any insight or any discussion about why this hasn't happened faster to get a HIPAA an attainable HIPAA compliant version of these this AI out there? There wasn't a lot of discussion there.

I think the general sense was that we do have HIPAA rules and regulations that should apply generally to this. But like so many of our rules and regulations, HIPAA was in '96. The general parameters that were part of HIPAA didn't have AI to consider as a real option. And so uh it's more about the application of the general rules of HIPAA that we're, I think, up against that really needs to be discussed. And of course, we all know when it comes to legal, the devil's rules in the detail and the arguments can be made in interpretation of the general rule. And so I think it hasn't come up yet because there hasn't been a big exposure. So that may be the real significant emotional event tomorrow, one of the those things that I was taught by Ray that actually drives change. So it may take something along those lines, but I know it's on people's minds, and they are talking about it. And but I also think that one of the the representative from the AUA was, of course, a lawyer, and she had some ideas, but couldn't at this point in time give us a definitive because nobody's taking a position. So she's working in a in an environment where as a custodian or speaking for a custodian of all of this, she isn't yet in a place that she has a position that she can speak from. And I think that's kind of the chicken and egg issue that we're up against. The the chicken exists, the egg exists, but ultimately do we know what those things are going to be, how they're going to produce, all those things? We don't. So that's kind of where we are.

Well, it's obviously without the the HIPAA compliant version of Chat GPT or Collod. Well, I know you can get them, but they're cost prohibitive for a lot of individuals. But without that, there's a lot of reluctance to experiment with something that might take might be easier to not have to worry about that those HIPAA compliance issues. And so I think a lot of the physician side of things or the individual side of experimentation is curtailed at the current moment because of that. Whereas a lot of the if you look at the payer versus physician, if you look at that, the payer certainly has the advantage with being able to implement AI on an enterprise level versus the individual practice.

Yeah. Ray, comments? A couple of things. I agree, Mark, you something you alluded to that if you receive payment for AI, they're gonna take it out of the total payment from the physician for the service rendered. So to me, it looks like the the vendors would like to get AI paid, but I don't see uh uh an advantage for the docs. I'd like to have your comments on that. And the second thing is, you know, when the internet first came out, we always said high tech, high touch. I don't know where I've heard that, but I thought it was really true. And boy, I think it's really true with AI as it begins to do more and more function. Each one needs the expertise to monitor what the AI is doing. And without that, why it'll be dangerous for a practice to implement. But with it, it looks like they'd be adding expertise to what they're doing.

Man touch, I think is the other one that with AI avatars and things like that, it's amazing what can be done and and also, again, scary a little bit on what can be done that's out there. So I I as you look at all of this, I think there is an argument either way, and I think this is where we're slow on all of this, is getting AI paid for so that physicians can implement it and maintain their financial viability and leverage AI to see more patients and provide better care is a real possibility. And that may be the right way to go. The on the other side, there is that fear that ultimately this ends up incrementally adding and then coming back and biting us by subtracting to the value that's already been, or the payment that's already undervalued for the services positions provide. So whether or not the time value of money offsets and that really comes to fruition as level and it works well, that that will be time that takes for those things. And ultimately, I think it's we just have to think ahead, play a couple racks ahead as we're going through all of this and consider all the possibilities and see if we can come up with the best pathway moving forward because it's coming, like it or not, and it is gonna get used, like it or not. Yeah, it's gonna be abused, like it or not. Um, so we just need to be as good as we can be and considerate as we can be, and maintain, I would say, in the end, maintain the dual focus of patient responsible clinical services, which is the end product of every physician group. And at the same time, understand that this is a business environment, and the way the system is set up right now, you've got to balance what I can do, what makes sense, and ultimately what is responsible to do as we approach this implementation. So it was a great discussion, and it was it's one that we've been having in the background with a lot of folks in the development side, and we'll continue to have, and encourage everybody else to do the same. It's uh I've been using the phrase it takes a village a lot lately, and it's really I think this is an area where it's gonna take all of us, including the AUA and the AMA, and the government side of the equation and the vendors, and it's gonna it's gonna take everybody coming to the table to do this responsibly and equitably.

Very true.

All right. Let's wrap this episode up here. We want to thank ModMed for supporting this episode. If you're in the market for an EHR or a practice management system, you can go to modmed.com forward slash PRS network for specials for our listening audience. Also, if you're headed to Lugpa on November 4th, 2026, Mark, you want to share what you're hosting?

So we we are having a for our our audience, our clients at a venue near the Marriott. We're having a happy hour. Certainly come by. We are we've we have a new partner in AI in the RCM space, and I'm inviting everybody to come meet those folks as we also wrestle with all this stuff for responsible, equitable implementation of AI.

All right. And if you're on the PRS email list, you should see uh email with an invite send an RSVP on the invite. So we'd love to see you there. If you're in Chicago at the Ludpa meeting November 4th, 2026. We have more of those discussions. Yes. This this will sure we'll definitely follow this conversation up with many more like it at the Love PA meeting. Yeah. All right. Any final thoughts, Mark?

I would have to say I pretty much was giving you my thoughts throughout the day today. So I'm gonna my final thought is thank you for letting me ramble on and download this while it was still fresh in my head. And please, I this I've by no means come to any conclusions. I've got guidance, I've got ways to go, I've got where I am now, but I am constantly gathering information as we go through, and I think we're all gonna need to do that. So if you have thoughts, let us know and track me down, whatever. I'm interested in everybody's thoughts. We've got to figure out how to do this.

Ray, final thoughts.

Exciting times.

What about scary?

Uh be scared you're not keeping up, but enjoy the true position.

The original position. There you go. There it is.

That's right. I am looking at it from a little different vantage point, but from my vantage point, I I see good things ahead.

Yeah, from the patient side as well. That's true. For sure.

Absolutely.

All right. Well, that's all we have for today's episode. Thank you all for listening. Take it out, right?

Thank you for listening to the LG Coding and Members the podcast, where we help Uralities and their staff maximize income and efficiency so there's time and energy for patient care and a happy life. Special thanks to all of Inter for the meeting today. You can find Dick on Spotify under its record label.