Integrated Practices | Comprehensive Care
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In this issue we feature:
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Key Developments
- Reintroduction of the bipartisan Health Workforce Innovation Act (Wyden–Blackburn)
- LUGPA’s formal proposal for Stark Law modernization to enable in-home dispensing of oral anti-cancer therapies
- Finalization of CY 2027 Medicare Advantage and Part D policies
- Introduction of the Provider Reimbursement Stability Act (H.R. 8163)
- Establishment of the FTC Healthcare Task Force
- Proposed CMS prior authorization reforms for drugs
- Release of the FY 2027 HHS budget request
- Announcement of tariffs on certain imported patented pharmaceuticals and APIs
- Connecticut SB 494 regarding 340B program and prescription drug policies
Why It Matters
These developments will shape workforce availability, Medicare reimbursement stability, administrative burdens, drug affordability and access, site-of-service equity, and the long-term viability of independent, physician-led urology practices. Collectively, they influence LUGPA members’ ability to deliver high-quality, cost-effective community-based care amid ongoing consolidation pressures.
LUGPA Action
LUGPA is proactively engaged: supporting workforce expansion, Stark Law and reimbursement reforms, and prior authorization relief; opposing harmful state-level 340B expansions; and providing clinical and operational expertise to federal and state policymakers to safeguard independent urology practices and patient access.
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Provider Reimbursement Stability Act (H.R. 8163)
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What’s Changing
Introduced in March 2026 by a bipartisan group of physician lawmakers led by Greg Murphy, this bill modernizes the Medicare Physician Fee Schedule (MPFS) by:
- Raising the budget neutrality threshold from $20 million to $54.3 million, indexed to the Medicare Economic Index (MEI)
- Requiring claims-based corrections to utilization assumptions for revalued or unbundled codes
- Mandating practice expense input updates at least every five years
- Capping annual conversion factor fluctuations at ±2.5% beginning in 2027 (with exemptions for certain legislative updates)
LUGPA Position
LUGPA strongly supports H.R. 8163 as a critical step toward reducing payment volatility and improving alignment with actual practice costs. We will continue advocating for broader reforms that fully tie physician payment updates to practice cost inflation (MEI).
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Momentum Builds for Site-Neutral Payment Reform
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A high-profile April 28 House Ways and Means Committee hearing on rising healthcare costs revealed a notable shift in the site-neutral payment debate. While discussions focused broadly on consolidation, 340B, and administrative burden, lawmakers highlighted strong payment disparities between hospital outpatient departments and physician-led settings, which continue to drive consolidation and higher costs for patients and Medicare.
Hospital leaders acknowledged opportunities for reform in lower-acuity services, even as they emphasized the need to account for complex and safety-net care. This evolving dialogue builds on the CMS's recent action to expand site-neutral policies beginning in 2026.
LUGPA strongly supports comprehensive site-neutral reform to ensure Medicare pays the same rate for the same service, regardless of setting, when clinical outcomes are equivalent. Aligning payments would reduce incentives for hospital acquisition, lower patient cost-sharing, and strengthen access to high-quality, community-based urologic care.
LUGPA will continue engaging policymakers to advance balanced, data-driven solutions that promote affordability, competition, and patient-centered care.
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CMS Finalizes CY 2027 Medicare Advantage and Part D Policies
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Key Changes
- Streamlined Star Ratings: removal of multiple administrative/process measures and addition of a depression screening and follow-up measure
- Full codification of Inflation Reduction Act Part D reforms, including elimination of the coverage gap, revised benefit phases, reduced out-of-pocket thresholds, and implementation of the Manufacturer Discount Program
- Increased oversight of supplemental benefits paired with targeted regulatory relief
- Net average Medicare Advantage payment increase of 2.48% (approximately $13 billion), with continued use of the 2024 risk adjustment model and refinements to improve accuracy
Implications for Urology
Patients will benefit from lower out-of-pocket drug costs and potentially simpler benefit structures. However, changes to risk adjustment and quality metrics may create payment variability for plans, indirectly affecting provider contracting, utilization management, and network participation.
LUGPA Position
LUGPA supports policies that enhance affordability, reduce administrative complexity, and promote value. We will closely monitor implementation and downstream effects on urology service utilization and reimbursement.
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Bipartisan Senate Bill Targets Health Care Workforce Shortages
Health Workforce Innovation Act (S. 4254 – Wyden–Blackburn)
What’s Changing
Ron Wyden and Marsha Blackburn reintroduced bipartisan legislation in late March 2026 to expand training pathways for allied health professionals through targeted federal grants. The bill emphasizes community-led partnerships involving high schools, community colleges, rural clinics, and community health centers.
Why It Matters
Allied health professionals—including medical assistants, scribes, technologists, advanced practice providers, and support staff—represent over 60% of the healthcare workforce. Persistent shortages in urology practices lead to longer wait times, increased physician burnout, reduced patient throughput, and constrained access to specialized services such as prostate cancer care, BPH management, and ambulatory procedures.
Implications for Urology
Strengthening the local allied health pipeline will improve operational efficiency, support integrated care models, and help independent practices scale without relying solely on hospital employment models.
LUGPA Position
LUGPA strongly supports this legislation as a practical, scalable, and locally driven solution to chronic staffing shortages that threaten practice sustainability and patient access.
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Expanding Access to Cancer Care: Stark Law Modernization Proposal
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What’s Changing
LUGPA submitted a targeted proposal to modernize aspects of the Stark Law to permit physician practices to dispense certain oral anti-cancer therapies directly to patients’ homes under appropriate safeguards, building on flexibilities used during the COVID-19 public health emergency.
Why It Matters
Current restrictions hinder fully integrated, patient-centered cancer care models despite the growing role of oral oncology agents and telehealth-enabled monitoring. Home delivery improves medication adherence, reduces patient travel burden, and supports better outcomes in prostate, bladder, and kidney cancers.
LUGPA Position
LUGPA strongly supports this reform, which promotes coordinated, physician-led cancer care while preserving program integrity and advancing value-based delivery models.
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CMS Proposes Prior Authorization Reforms for Drugs
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What’s Changing
CMS proposed:
- 24-hour turnaround for urgent requests
- 72-hour turnaround for standard requests
- Expanded use of electronic prior authorization
- Public reporting of payer performance metrics
LUGPA Position
LUGPA strongly supports these reforms. Faster, transparent, and standardized processes will reduce treatment delays, lower administrative burden, and improve timely access to medically necessary therapies.
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FTC Launches Healthcare Task Force
What’s Changing
The Federal Trade Commission established a Healthcare Task Force to enhance coordination of antitrust enforcement, consumer protection, and oversight of consolidation, pharmacy benefit managers, vertical integration, and billing practices.
Implications for Urology
Greater scrutiny of hospital and payer consolidation could help level the competitive playing field for independent practices, while also increasing compliance expectations.
LUGPA Perspective
LUGPA supports targeted efforts to curb anti-competitive behavior while ensuring enforcement does not stifle physician-led innovation or integrated care models.
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White House FY 2027 HHS Budget Request
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What’s Changing
The Administration proposed $111.1 billion in discretionary funding for HHS (a 12.5% decrease), alongside agency restructuring and increased emphasis on prevention and chronic disease management. This follows last year’s request for a meaningful reduction in HHS spending, though Congress rejected that proposed cut and will likely do so again.
Implications for Urology
While research funding may face constraints in some areas, the focus on prevention aligns with urology’s emphasis on early detection and value-based care.
LUGPA Outlook
LUGPA will continue advocating for sustainable reimbursement, telehealth flexibilities, and policies that support independent physician practices.
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Tariffs on Imported Patented Pharmaceuticals
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What’s Changing
New tariffs were announced on select imported patented drugs and active pharmaceutical ingredients, with phased implementation and targeted exemptions.
Implications for Urology
Potential upward pressure on costs for certain branded oncology therapies, though most generic urologic medications are expected to see limited immediate impact.
LUGPA Position
LUGPA supports efforts to strengthen domestic supply chains but emphasizes the need to protect patient access and affordability.
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Connecticut SB 494 – 340B Program and Prescription Drug Policies
LUGPA Position
LUGPA opposes provisions in SB 494 that would expand the 340B program or alter drug rebate structures in ways that:
- Create competitive imbalances favoring hospitals
- Reduce transparency
- Fail to demonstrably benefit patients
Action
Connecticut LUGPA members are encouraged to engage with state lawmakers and share practice-specific data on potential impacts to patient access and costs.
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Step Therapy Advocacy – Safe Step Coalition Engagement
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What’s New
LUGPA joined the Safe Step Coalition in urging insurers to reform overly restrictive step therapy protocols.
Why It Matters
These policies frequently delay or deny access to clinically appropriate urologic treatments, contributing to disease progression, worse outcomes, and higher downstream costs.
LUGPA Engagement
LUGPA remains committed to eliminating unnecessary utilization management barriers in favor of physician-directed, evidence-based care.
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CMS “RAPID” Pathway to Accelerate Device Coverage
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What’s Changing
The Centers for Medicare & Medicaid Services and Food and Drug Administration announced the RAPID pathway to align regulatory approval with Medicare coverage decisions.
Why It Matters
This pathway could reduce the current 12+ month delay between FDA approval and Medicare coverage to as little as 60–90 days in some cases.
Implications for Urology
Particularly impactful for advanced diagnostics, minimally invasive treatments, and other breakthrough technologies.
Next Steps
CMS is expected to release a proposed notice with a 60-day comment period. LUGPA plans to engage actively.
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Facilitating Access to Innovation in Cancer Care Act (H.R. 8032)
What’s Changing
Bipartisan legislation would provide separate Medicare reimbursement for certain FDA-approved oncology innovations currently bundled under existing payment policies.
Why It Matters
Packaging policies have restricted access to high-value tools such as blue light cystoscopy and other targeted therapies.
LUGPA Position
LUGPA strongly supports this legislation to preserve beneficiary access to evidence-based cancer care innovations.
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Share Your Story —
Amplify the Voice of Urology
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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.
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