Integrated Practices | Comprehensive Care
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In this issue we feature:
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Bipartisan Legislation Reintroduced: Protecting Access to Life-Saving Therapies
The Protecting Patient Access to Cancer and Complex Therapies Act has been reintroduced by Reps. Greg Murphy, M.D. (R-NC), Adam Gray (D-CA), and Neal Dunn, M.D. (R-FL). This bipartisan bill, developed with LUGPA’s input, addresses unintended consequences of the Inflation Reduction Act (IRA) that risk limiting access to physician-administered treatments.
Key Provisions Include:
- Preserving ASP+6% reimbursement for Medicare Part B drugs.
- Implementing a manufacturer rebate model that avoids shifting costs to providers or patients.
- Safeguarding access to advanced therapies in community-based and independent practices.
- Maintaining budget neutrality for Medicare and its beneficiaries.
Without this legislation, many practices may be forced to stop offering critical and highly-used therapies once the new model takes effect in 2028, pushing patients toward more expensive hospital care and reducing access in rural and underserved areas. LUGPA remains committed to advocating for this bill and continues to elevate member stories to illustrate the real-world impact of these policy decisions.
Your support is crucial in urging Congress to act, and now is the time to act to avert this looming threat before it affects patients and providers, click below to send personalized letters to your lawmakers, urging them to endorse this vital legislation:
TAKE ACTION NOW
It only takes a moment, but your advocacy can have a lasting impact. By speaking up, you're helping to preserve timely, affordable, and high-quality care for your patients, while supporting the future of independent urology.
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Major Advocacy Victory: Medicare Reimbursement Fix Secured for 2026
A key policy win for independent practices has been secured: the recently passed reconciliation bill includes a 2.5% increase to the Medicare Physician Fee Schedule (MPFS) conversion factor for calendar year 2026. This critical adjustment provides short-term financial relief at a time when rising costs and operational pressures are placing immense strain on community-based providers.
Without this fix, looming reimbursement cuts would have jeopardized care delivery, intensified staffing challenges, and threatened the financial stability of many independent practices. The 2.5% increase offers a much-needed temporary safeguard to help stabilize the care environment and preserve patient access while we continue to push for long-term reform
This success reflects LUGPA’s sustained advocacy and strong member engagement, particularly during our 2025 Washington fly-ins. Our direct collaboration with Rep. Greg Murphy, M.D., was instrumental in elevating this issue and securing its inclusion in the final legislative package.
While this is a critical step forward, LUGPA continues to push for long-term, structural Medicare reimbursement reform, anchored to the Medicare Economic Index (MEI), to reflect the true cost of delivering high-quality urologic care in independent settings.
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CMS Releases Proposed CY 2026 Medicare Physician Fee Schedule
On July 14, 2025, CMS released its proposed Medicare Physician Fee Schedule (PFS) rule for 2026. LUGPA is closely analyzing the rule and will submit formal comments before the September 12 deadline. Key elements include:
- Conversion Factor Increases: $33.59 for APM participants (+3.83%) and $33.42 for non-APM providers (+3.62%). While welcome, these increases remain insufficient in the face of inflation and rising practice costs.
- Practice Expense Updates: CMS proposes incorporating OPPS data to better reflect indirect costs in office-based settings. LUGPA supports this direction but will advocate for greater transparency and urology-specific accuracy.
- Specialty Impact: Urology is projected to see a 1% net payment increase—driven by a 5% gain in non-facility services and a 9% decline in facility-based services.
- Telehealth Expansion: CMS would make audio-only telehealth visits permanent for patients lacking video access and extend flexibility for FQHCs and RHCs. LUGPA strongly supports the expansion of telehealth options for urologists.
- 340B Policy Changes: Proposals include excluding 340B units from Part D inflation rebates and creating a voluntary claims repository. LUGPA will assess the potential impact on independent practices.
LUGPA continues to advocate for MEI-based updates, simplified documentation, and policies that strengthen practice sustainability and patient access.
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HHS Proposes Shifting 340B Program Oversight to CMS
The Department of Health and Human Services has proposed moving oversight of the 340B Drug Pricing Program from HRSA to CMS. This shift aims to modernize administration, but it could dramatically reshape how the program operates.
LUGPA supports the mission of 340B but has long raised concerns about its uneven implementation. Current rules disproportionately benefit large hospital systems, often to the detriment of independent providers.
LUGPA’s Reform Priorities:
- Expand eligibility to include independent practices serving high-need populations.
- Increase transparency through public reporting of 340B savings and how they are used.
- Strengthen oversight with consistent audits and compliance standards.
- Maintain upfront discounts to ensure timely access to therapy.
- Preserve the safety-net intent of the program during any transition.
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PBM Reform Introduced in Congress
On July 10, Rep. Buddy Carter (R-GA) and 11 bipartisan cosponsors introduced the PBM Reform Act, responding to concerning findings in the FTC’s 2025 report on PBM practices. The legislation targets anti-competitive behavior that raises drug prices and undermines the autonomy of providers.
Key Reforms Include:
- Banning spread pricing in Medicaid and mandating transparent reimbursement.
- Delinking PBM compensation from drug prices in Medicare Part D.
- Requiring detailed transparency reports on rebates, formularies, and pricing.
- Enhancing CMS oversight and enforcement of fair contracting terms.
LUGPA fully supports this legislation as a necessary step toward restoring balance, lowering costs, and protecting access to medications in community-based care. LUGPA’s advocacy helped this issue gain momentum last Congress, and because of these efforts, a number of members of Congress are expected to push for its passage this year.
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CY 2026 OPPS/ASC Proposed Rule Released
CMS has released its CY 2026 OPPS and ASC Proposed Rule, with important implications for urologic care delivery in outpatient settings.
Key Provisions Include:
- Payment Update: 2.4% increase for facilities meeting quality reporting benchmarks (3.2% market basket, less 0.8% productivity adjustment).
- Inpatient-Only (IPO) List Phase-Out: CMS proposes removing 285 procedures from the IPO list in 2026, with complete elimination over three years.
- ASC-Covered Procedures: 547 additions, including 276 new codes and 271 moved from the IPO list.
- Price Transparency: New requirements for hospitals to disclose negotiated rate percentiles by January 1, 2026.
- 340B Payment Adjustments: OPPS conversion factor reduction increased to 2% for non-drug services; ASP minus 22.5% payment for 340B drugs maintained.
- Site-Neutral Policy Expansion: Applies to drug administration services at excepted off-campus departments, excluding rural Sole Community Hospitals.
- Non-Opioid Pain Management Payments: CMS proposes separate payments for five drugs and six devices used for pain relief in HOPDs and ASCs.
While supportive of transparency and expanded outpatient access, LUGPA is concerned about the adequacy of the payment update, increased administrative burdens, and continued inequities in the 340B program. Comments will be submitted before the September 13 deadline.
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LUGPA Joins Coalition Supporting the Clinical Trial Modernization Act
LUGPA has joined a broad coalition led by the American Cancer Society Cancer Action Network (ACSCAN) in support of H.R. 3521, the Clinical Trial Modernization Act. This bipartisan legislation aims to expand access to clinical trials by removing non-medical financial barriers, such as travel and lodging costs, and enabling remote participation.
These reforms are particularly important for underserved populations and those in rural areas. By increasing flexibility and reducing logistical burdens, the bill promotes more inclusive trial participation and faster access to emerging therapies.
LUGPA strongly supports this effort as part of its broader commitment to equitable, patient-centered care. Community-based practices play a critical role in research, and policies that support decentralized trials will benefit urology patients nationwide.
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New Federal Price Transparency Legislation Introduced: The Patients Deserve Price Tags Act (S. 2335)
Congress is considering a bipartisan transparency bill, S. 2335, the Patients Deserve Price Tags Act, introduced by Senators Roger Marshall (R-KS) and John Hickenlooper (D-CO), both members of the Senate Health, Education, Labor, and Pensions (HELP) Committee. The bill seeks to codify and expand existing federal price transparency requirements for hospitals, health plans, and intermediaries. By requiring upfront disclosure of actual prices, S. 2335 aims to empower patients, increase competition, and bring down healthcare costs.
Why This Matters
Unlike nearly every other industry, healthcare remains opaque in pricing, leaving patients with limited insight into their financial obligations until after services are rendered. This lack of transparency leads to higher costs, inefficient care, and eroded trust. With 96% of Americans supporting access to pricing information before treatment, this bill addresses a clear public demand and corrects ongoing shortcomings in enforcement and compliance with current rules.
Key Provisions of the Bill:
- Hospital Price Transparency: Requires providers to publicly disclose real, dollar-based prices (not estimates) for all services and procedures. These requirements are expanded beyond hospitals to all care settings and backed by increased penalties for noncompliance.
- Transparency in Coverage (TiC): Strengthens TiC rules by requiring health plans to ensure that posted pricing data is accurate and verified by a senior executive.
- Accountability for Third Party Administrators (TPAs) and PBMs: Mandates full disclosure of financial data related to claims, including subcontractor and PBM arrangements, to expose hidden markups and middlemen costs.
- Improved Patient Billing Practices: Requires commercial health plans to provide clear explanations of benefits and mandates that providers issue itemized bills to eliminate opaque “blank check” billing.
Independent urology practices can benefit from reforms that promote transparency, enabling patients to compare costs and the quality of care across different settings. As site-of-service payment disparities continue to distort market dynamics, this legislation could help to level the playing field and support consumer-driven, value-based care.
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