August 2026

     In this issue we feature:

• Advancing Independent Urology Through Federal Advocacy
• New Proposed Rules Released by CMS
• Recognition & Awards 
• State Advocacy Update
• Congressional Advocacy
• Legislative Advocacy 
• Medicare & Regulatory Advocacy 
• Coalition Advocacy 

Advancing Independent Urology Through Federal Advocacy

July was another productive month for LUGPA's advocacy efforts. We continued advancing policies that protect independent physician practices, improve patient access to high-quality specialty care, and reduce unnecessary administrative burdens. Highlights included our second Congressional Fly-In of the year (July 21–22), continued engagement on Medicare payment reform, leadership on 340B reform, successful coalition advocacy, and national recognition for the Community Practice Coalition.

At a Glance

Medicare & Regulatory Advocacy

• Analyzed CMS's CY 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule.
• Reviewed the CY 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule.
• Continued discussions with AbbVie regarding LUPRON Depot pricing changes affecting independent practices.

Federal Advocacy

• Hosted LUGPA's second Congressional Fly-In of 2026 (July 21–22), with physician leaders conducting nearly 30 meetings on Capitol Hill.
• Secured Rep. Raul Ruiz, M.D. (D-CA), as a new cosponsor of H.R. 4299, the Protecting Patient Access to Cancer and Complex Therapies Act.
• Following LUGPA's advocacy, Rep. Greg Landsman (D-OH) signed onto H.R. 9693, and Rep. Kevin Hern (R-OK) became a cosponsor of H.R. 4299, the Protecting Patient Access to Cancer and Complex Therapies Act.
• Submitted comments supporting H.R. 9504, the Tax-Exempt Hospital Transparency Act.
• Continued advocacy regarding CMS's WISeR prior authorization model.
• Engaged with the House Energy & Commerce Committee during its July legislative markup.

Legislative Advocacy

• Monitored introduction of the bipartisan Patients First Act (H.R. 9693) to modernize Medicare physician payment.
• Continued support for the SECURE 340B Act and broader 340B reform efforts.

Coalition Advocacy

• Supported expanded biomarker testing coverage in Delaware.
• Joined NCODA and other national organizations opposing inappropriate insurer step therapy policies.

New Proposed Rules Released by CMS

CMS Releases CY 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule

On July 14, CMS released the CY 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule, which proposes another reduction in Medicare physician payments following the expiration of the temporary 2.5 percent statutory payment increase enacted for CY 2026.

CMS proposes the following conversion factors for 2027:

Additional proposals include:

• Converting HCPCS code G2211 from a standalone add-on code to a payment modifier beginning in 2028.
• Reducing payment by 50% for the lower-paid same-day service when a separately identifiable Evaluation and Management (E/M) visit is billed with modifier 25.
• Updating practice expense methodologies, including indirect cost allocations.
• Refining policies governing remote physiologic and remote therapeutic monitoring services.
• Updating Quality Payment Program (QPP) and Merit-based Incentive Payment System (MIPS) policies.
• Continuing implementation of payment reforms supporting value-based care and Advanced Alternative Payment Models (APMs).

LUGPA is preparing formal comments urging CMS to withdraw the proposed modifier 25 payment reduction and urging Congress to enact permanent Medicare physician payment reform tied to the Medicare Economic Index (MEI) to reflect rising practice costs better and ensure continued patient access to physician-led specialty care.

CMS Releases CY 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule

CMS also released the CY 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule, proposing several significant policy changes affecting hospitals, ambulatory surgery centers, and physician practices.

Among the proposal's most significant provisions is a reduction in reimbursement for separately payable drugs acquired through the 340B Drug Pricing Program from ASP +6% to ASP -33.4%. CMS estimates this policy would reduce Medicare spending on 340B drugs by approximately $5.7 billion in CY 2027. Because the OPPS is budget neutral, CMS proposes redistributing those savings through an estimated 8.44% increase in payments for non-drug services furnished in hospital outpatient departments (HOPDs). This redistribution does not apply to Ambulatory Surgical Centers (ASCs), which are reimbursed under a separate payment system.

The proposed rule also includes:

• Annual payment updates for hospital outpatient departments and ambulatory surgery centers.
• Continued implementation of site-neutral payment policies required under existing law.
• Updates to quality reporting programs for hospitals and ASCs.
• Revisions to payment classifications and ambulatory payment classifications (APCs).
• Additional changes affecting outpatient service reimbursement and quality measurement.

LUGPA continues evaluating the proposal's impact on hospital acquisition incentives, competition between hospitals and independent physician practices, Medicare spending, and patient access to community-based specialty care. We will submit formal comments to CMS and continue advocating for policies that support physician-led independent practice while promoting fair competition across sites of care.

Recognition & Awards

Community Practice Coalition Receives ASAE Gold Award

LUGPA is proud to announce that the Community Practice Coalition received a 2026 ASAE Power of Associations Gold Award from the American Society of Association Executives (ASAE) in recognition of its innovative advocacy efforts to protect physician autonomy and preserve patient access to independent, community-based care.

Established under the leadership of former LUGPA President Evan Goldfisher, M.D., the Coalition brings together organizations representing multiple physician specialties—including OrthoForum, the U.S. Women's Health Alliance, Community Oncology Alliance, and the American Academy of Otolaryngology–Head and Neck Surgery—to advance shared policy priorities and strengthen physician-led advocacy.

The award recognizes the Coalition's success in demonstrating how collaboration across medical specialties can influence federal policy, protect independent practices, and improve patient access to high-quality care.

State Advocacy Update

As of late July, forty state legislatures have adjourned their 2026 sessions. Alaska, Mississippi, and South Carolina are currently in special session, while California, Massachusetts, Michigan, North Carolina, New Jersey, Ohio, and Pennsylvania remain in session. LUGPA continues to monitor legislative activity and engage where proposals affect independent urology.

Current Legislative Priorities

Biomarker Testing

Delaware's SB 120 has passed both chambers and has been transmitted to Governor Matt Meyer for consideration. The legislation would align insurance coverage for biomarker testing with nationally recognized evidence-based clinical guidelines. LUGPA also continues monitoring biomarker legislation in Massachusetts.

340B Reform

Illinois HB 2371 has passed the General Assembly and awaits action by Governor J.B. Pritzker. LUGPA opposes the legislation because it would codify and expand the current 340B contract pharmacy model before the state has evaluated whether the program is improving care for underserved patients.

Looking Ahead

State advocacy efforts over the coming months will focus on:

• Monitoring legislation in states that remain in session.
• Identifying emerging policy priorities for the 2027 legislative cycle.
• Strengthening early-warning systems for legislation affecting independent physician practices.
• Expanding engagement with state urological societies and member practices.

Congressional Advocacy

Second Congressional Fly-In of 2026

LUGPA welcomed physician leaders from independent urology practices nationwide to Washington, D.C., on July 21–22 for our second Congressional Fly-In of the year. Over two days, participants conducted nearly 30 meetings with Members of Congress and congressional staff, sharing firsthand experiences caring for Medicare beneficiaries and highlighting how current payment policies increasingly favor hospital systems over independent practices.

Key meetings included discussions with Rep. Greg Murphy (R-NC), Sen. John Barrasso (R-WY), Rep. John Joyce (R-PA), Rep. Scott Peters (D-CA), Rep. Greg Landsman (D-OH), Sen. John Hickenlooper (D-CO), and many others (see the full Fly-In recap for a complete list).

Advocacy Priorities

Physicians urged lawmakers to support:

• Permanent Medicare physician payment reform tied to the Medicare Economic Index (MEI), including advancement of the Provider Reimbursement Stability Act (H.R. 8163) and the newly introduced Patients First Act (H.R. 9693).
• Site-neutral payment policies to reduce incentives for hospital consolidation.
• Meaningful 340B reforms—including the SECURE 340B Act and 340B ACCESS Act—to improve transparency and accountability.
• Passage of H.R. 4299 to protect access to physician-administered cancer therapies under the Medicare Drug Price Negotiation Program by providing rebates that prevent Medicare reimbursement from falling below acquisition costs.
• Policies that reduce unnecessary administrative burden while promoting healthcare competition and price transparency.

Physicians emphasized the growing financial pressures created by declining Medicare reimbursement, rising practice costs, and continued healthcare consolidation that threaten patient access to physician-led, community-based specialty care.

Major Legislative Victory: H.R. 4299 Gains Key Democratic Support

Following the May Fly-In and continued engagement with congressional offices, Rep. Raul Ruiz, M.D. (D-CA), agreed to cosponsor H.R. 4299, becoming the eleventh Democratic cosponsor and only the second Democratic member of the House Energy & Commerce Committee to support the legislation. His support further strengthens bipartisan momentum behind this important legislation.

A full Fly-In recap is available on the LUGPA website.

Legislative Advocacy

Patients First Act Introduced

Representatives John Joyce, M.D. (R-PA), Greg Murphy, M.D. (R-NC), and Kim Schrier, M.D. (D-WA) introduced the bipartisan Patients First Act (H.R. 9693). The legislation would provide annual Medicare physician payment updates tied to the Medicare Economic Index, replace MIPS with a physician-led quality improvement program, reduce administrative burden, improve payment stability, strengthen independent practices, and expand opportunities for value-based care.

LUGPA welcomes this bipartisan effort to establish a more sustainable Medicare physician payment system.

Supporting the SECURE 340B Act

LUGPA continues supporting the bipartisan SECURE 340B Act, which would improve transparency, strengthen oversight, establish a uniform federal patient definition, and restore accountability within the 340B Drug Pricing Program.

Supporting H.R. 9504

LUGPA submitted comments supporting H.R. 9504, the Tax-Exempt Hospital Transparency Act, which would improve public reporting on tax-exempt hospitals' community benefit activities and financial practices.

Medicare & Regulatory Advocacy

HRSA Launches 340B Rebate Pilot
HRSA has announced a 340B Rebate Model Pilot Program that will allow qualifying manufacturers to provide 340B ceiling prices through rebates rather than upfront discounts for certain drugs. Manufacturer plans are due August 24, 2026, with an effective date of January 1, 2027. LUGPA is assessing potential impacts on independent practices and will keep members informed as additional details become available.

Continued Engagement on LUPRON Depot Pricing

LUGPA remained engaged with AbbVie regarding recent LUPRON Depot pricing changes affecting physician office dispensing and buy-and-bill practices. We continue working to ensure patients maintain access to essential prostate cancer therapies while protecting the financial viability of independent practices.

CMS Responds to LUGPA WISeR Advocacy

CMS responded to LUGPA's concerns regarding implementation of the WISeR prior authorization model for sacral nerve stimulation procedures by outlining operational improvements intended to streamline reviews and reduce administrative burden. LUGPA will continue to monitor implementation and gather member feedback.

Coalition Advocacy 

LUGPA Supports POPCaP Authorization Act

LUGPA joined a coalition of national prostate cancer patient advocacy, clinical, and research organizations in support of H.R. 8553/S. 4993, the Precision Oncology Program for Cancer of the Prostate (POPCaP) Authorization Act. The coalition urged Congress to advance the bipartisan legislation, which would permanently authorize the Department of Veterans Affairs' POPCaP initiative to expand veterans' access to precision oncology, genetic and genomic testing, telemedicine tumor boards, biomarker-driven clinical trials, and other personalized prostate cancer care. LUGPA continues to support policies that improve access to innovative cancer treatments and ensure veterans receive high-quality, evidence-based care.

Delaware Biomarker Testing

LUGPA joined national physician organizations supporting expanded insurance coverage for guideline-supported biomarker testing in Delaware, improving patient access to precision medicine.

Step Therapy Reform

Together with NCODA and other national organizations, LUGPA opposed restrictive insurer step therapy requirements that delay medically appropriate treatment for patients with cancer and other serious illnesses.

Looking Ahead

LUGPA's July advocacy efforts built significant momentum heading into the second half of the year. From expanding bipartisan support for H.R. 4299 and advocating for comprehensive Medicare physician payment reform to engaging on CMS rulemaking and advancing coalition priorities, LUGPA continues to ensure the voice of independent urology is heard in Washington and across the states.

In the months ahead, our advocacy will remain focused on:

• Responding to CMS's CY 2027 proposed payment rules.
• Building bipartisan support for comprehensive Medicare physician payment reform, including the Patients First Act and Provider Reimbursement Stability Act.
• Advancing H.R. 4299, site-neutral payment legislation, and meaningful 340B reforms.
• Supporting policies that protect access to physician-administered therapies and promote competition.
• Monitoring implementation of the WISeR Model.
• Preparing for the September Congressional Fly-In and LUGPA Advocacy Summit.

We encourage all members to stay engaged. If you are interested in participating in future Congressional Fly-Ins or becoming more involved in LUGPA's advocacy efforts, please contact Matthew Glans at [email protected].

Stay informed. Stay involved. Together, we can protect the future of independent urology.

Share Your Story —
Amplify the Voice of Urology 

Have reimbursement issues, administrative burden, patient access, workforce challenges, or sustainability affected your practice? 

LUGPA is renewing its call for member stories to strengthen our advocacy at the federal and state levels. Policymakers respond to real-world impact, and your experiences with the Medicare Physician Fee Schedule, MACRA, prior authorization, step therapy, telehealth, workforce shortages, genetic testing, and other coverage and reimbursement challenges bring urgency and credibility to our message.

Personal stories from physicians and patients help humanize the data, influence legislative conversations, and build support among local lawmakers. Whether you submit a brief written account or record a short video, your perspective can directly shape policy discussions affecting independent urology.

Members may also record stories at upcoming LUGPA meetings as part of our expanded advocacy outreach.

To participate, submit your story to Matthew Glans. Please ensure all shared patient information complies with HIPAA requirements and includes appropriate consent. 

Your voice matters, and together, we can ensure independent urology is heard loud and clear.