November 2025

     
BREAKING NEWS: LUGPA Policy Alert: President Trump Signs Government Funding Bill into Law, Officially Ending Shutdown and Extending Key Healthcare Provisions


In this issue we feature:

• Executive Summary 
• Policy Update: CMS Releases 2026 Medicare Physician Fee Schedule Final Rule
• LUGPA Political Affairs and Health Policy Update – 2025 Annual Meeting Recap
• Senate Passes Bill to End Shutdown, Restore Key Healthcare Provisions 
• LUGPA Fly-In: Advocacy Amid a Shutdown, Advocating for Reimbursement Reform, ASP+6% Protections, Telehealth Permanency, and Patient Access
• Fourth Community Practice Summit: Advancing the Voice of Independent Medicine 
• Restoring Medicare Part D Home Delivery Flexibility
• LUGPA Joins Coalition Letter Supporting the 340B Access Act 
• Most Favored Nation Drug Pricing Model Resurfaces  
• Tariff Adjustments and Supply Chain Impacts 
• MIPS Value Pathway (Urology MVP): Preparing for 2026

Executive Summary

LUGPA continues to advocate for policies that support independent urology practices and safeguard patient access amid ongoing federal uncertainty. The October 2025 government shutdown has slowed key healthcare operations, yet LUGPA members demonstrated unwavering leadership through our Washington Fly-In and Community Practice Summit.

This month’s advocacy highlights include:

• LUGPA Washington Fly-In: Undeterred by the shutdown, LUGPA members journeyed to Washington, D.C., for targeted advocacy. Productive meetings with Senate offices propelled our 2026 policy agenda forward, emphasizing reimbursement reform and patient access.
• LUGPA Fourth Community Practice Summit: This gathering focused on strategic dialogues among physician leaders and allies, highlighting the critical role of independent practices in driving healthcare innovation and reform.
• Restoring Medicare Part D Home Delivery Flexibility: LUGPA is supporting a bipartisan effort to reinstate Medicare Part D home delivery flexibilities that were critical during the COVID-19 Public Health Emergency. These provisions allowed physician practices to mail Part D drugs directly to patients, ensuring seniors and those with cancer or chronic urologic conditions—particularly in rural or underserved areas—maintained timely access to essential medications.
• LUGPA Supports the 340B Access Act: LUGPA collaborated with a coalition to push for the 340B Access Act, to ensure transparency and accountability in the 340B Drug Pricing Program and shield independent practices from hospital dominance.
• Most Favored Nation (MFN) Drug Pricing Concerns: CMS has reinitiated talks on international reference pricing via an updated MFN model. LUGPA opposes this and promotes market-driven alternatives to lower costs while maintaining access to urologic treatments.
• Tariff Policy and Cost Pressures: Recent tariff hikes on medical devices, active pharmaceutical ingredients, and diagnostic tools may inflate practice expenses by up to 25%.
• MIPS Value Pathway (Urology MVP): CMS is finalizing 2026 updates to the Urology MVP, altering reporting for independent practices.

Policy Update: CMS Releases 2026 Medicare Physician Fee Schedule Final Rule

The Centers for Medicare & Medicaid Services (CMS) has released the CY 2026 Medicare Physician Fee Schedule (MPFS) Final Rule, outlining changes to payment rates, coding policies, and telehealth coverage under Medicare Part B.

For urology, CMS estimates that the policies implemented in the rule will have a net impact of 0% on total Medicare charges. However, the effect will vary depending on the practice setting and participation in alternative payment models. Hospital—employed or hospital-focused urologists will most likely see decreases, while ambulatory and office-based practices may experience increases.

• Non-facility settings (office/ASC): Potential increases aligned with updated conversion factors, supporting independent practices.
• Facility settings (hospital-based): Adjustments may deepen the reimbursement gap across sites of care.

Key Changes Include:

• A 3.26% to 3.77% increase in the Conversion Factor (CF), depending on participation in qualifying alternative payment models (APMs). The non-qualifying APM CF is $33.40 (+3.26%), while the qualifying APM CF is $33.57 (+3.77%). Both include a statutory +2.50% increase.
• A -2.5% “efficiency adjustment” reducing work RVUs for non-time-based services, impacting diagnostic and procedural codes common in urology.
• Revised practice expense (PE) methodology, recognizing greater indirect costs in non-facility settings and using hospital outpatient data for facility-based technical services.
• Telehealth policy updates that streamline the review process for new services, remove frequency limitations for certain visits, and allow virtual supervision for services requiring direct oversight. These changes are effective through December 31, 2026, for specific settings, although ongoing government funding delays have stalled their full implementation.

What It Means for LUGPA Members: The 2026 rule provides modest gains for office-based care and reinforces LUGPA’s advocacy for site-neutral payment reform, ensuring independent practices remain competitive. However, new efficiency and practice expense adjustments may widen reimbursement disparities and pressure smaller practices.

LUGPA will continue to advocate for equitable reimbursement, expanded telehealth access, and sustainable payment models that preserve independent urology care.

LUGPA Political Affairs and Health Policy Update – 2025 Annual Meeting Recap

At the 2025 LUGPA Annual Meeting, Dr. Mara Holton and Dr. Josh Langston led a dynamic session highlighting the year’s major policy and advocacy achievements. Their presentation, “Political Affairs and Health Policy Update – What We Accomplished This Year,” underscored LUGPA’s leadership in defending independent urology amid ongoing payment instability, consolidation pressures, and shifting federal priorities.

Despite the October government shutdown delaying key CMS actions, LUGPA maintained strong momentum throughout 2025. The association’s advocacy helped secure essential wins in the 2026 Medicare Physician Fee Schedule Final Rule, including a 3.26–3.77% increase in the conversion factor—the most significant positive adjustment in years—and potential gains for non-facility (office-based) services. These gains reflect progress toward site-neutral payment reform, a key LUGPA priority that aims to eliminate payment disparities between hospitals and independent practices.

LUGPA’s legislative engagement also advanced on several key fronts. Throughout the year, the association championed bills to stabilize physician payments (H.R. 2474), expand telehealth access, enhance PBM transparency, and safeguard access to cancer therapies. LUGPA members reinforced these efforts through active participation in congressional meetings during the 2025 DC Fly-In and at the Community Practice Summit, helping amplify the independent practice perspective in Washington.

The update also addressed ongoing challenges facing the field. Nearly 70% of physicians are now employed by hospitals or corporate entities, a trend that poses a threat to competition and patient access. LUGPA continues to advocate for policies that promote transparency, fair contracting, and sustainable reimbursement structures, enabling independent groups to thrive.

Looking ahead to 2026, LUGPA’s agenda will focus on reforming Medicare payment systems, modernizing MACRA, addressing urology workforce shortages, advancing precision medicine and AI integration, and maintaining access to in-office cancer therapies.

Key takeaway: Independent practices continue to be essential for delivering high-quality, cost-effective care. Through coordinated advocacy and member engagement, LUGPA continues to ensure independent urology has a strong, unified voice shaping the future of healthcare policy.

Senate Passes Bill to End Shutdown, Restore Key Healthcare Provisions

The Senate has approved a bipartisan funding package (60–40) to end the historic federal shutdown that began on October 1, 2025, with the measure now awaiting passage in the House. The bill would reopen federal agencies and extend several critical Medicare provisions through January 30, 2026, including:

• Medicare Telehealth Flexibilities – Restored and extended, maintaining access to expanded telehealth sites and practitioner types.
• 1.0 Work RVU GPCI Floor – Continued protections against regional payment cuts of up to 20%.
• Delay of PAMA Lab Cuts – Prevents steep reductions to clinical lab reimbursement.

Notably, the legislation is expected to ensure practices are reimbursed for services provided during the shutdown. LUGPA continues to urge swift passage in the House and is expected to authorize retroactive payment for telehealth claims. LUGPA remains committed to securing permanent telehealth parity and stable reimbursement for independent urology practices.

LUGPA Fly-In: Advocacy Amid a Shutdown, Advocating for Reimbursement Reform, ASP+6% Protections, Telehealth Permanency, and Patient Access

Fourth Community Practice Summit: Advancing the Voice of Independent Medicine

Hosted by LUGPA with national partners, the meeting produced actionable strategies to advance site-neutral reform, counter insurer downcoding, promote PBM and 340B transparency, and preserve access to in-office care.

Read the full recap here.

Restoring Medicare Part D Home Delivery Flexibility

LUGPA has joined a growing bipartisan effort urging Congress to reinstate the Medicare Part D home delivery flexibilities that proved vital during the COVID-19 Public Health Emergency (PHE). These flexibilities allowed physician practices to mail Part D drugs directly to patients’ homes, ensuring seniors and patients with cancer or chronic urologic conditions—especially those in rural and underserved areas—could maintain timely access to essential medications.

Following the end of the PHE, CMS reversed this policy, citing Stark Law “location” restrictions. This reversal has reintroduced unnecessary barriers for vulnerable patients, often resulting in delayed or missed treatments. LUGPA and allied organizations emphasize that the change undermines the medically integrated care model, which enables physicians to provide coordinated, patient-centered oversight of therapy management and adherence—services that PBMs and mail-order pharmacies cannot match.

LUGPA is urging Members of Congress to sign a bipartisan letter to HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Mehmet Oz, calling for the restoration of home delivery authority under existing statutory exceptions in the Stark Law. This commonsense reform would enhance access, reduce costs, and improve adherence for Medicare beneficiaries, while supporting community-based specialty care.

LUGPA Joins Coalition Letter Supporting the 340B Access Act

LUGPA joined a coalition of medical organizations in endorsing the 340B Access Act, a bill aimed at increasing transparency and accountability within the 340B Drug Pricing Program. The letter calls for ensuring that drug discounts directly benefit patients and that program participation is conducted fairly and responsibly.

Why It Matters:

Hospital systems have increasingly leveraged 340B discounts to expand market share, often at the expense of independent community practices. The 340B Access Act would strengthen oversight and clarify how 340B savings are used—ensuring that the program fulfills its original intent of supporting patient access to affordable care. LUGPA remains committed to policies that promote transparency, accountability, and fair competition in the delivery of specialty care.

Most Favored Nation Drug Pricing Model Resurfaces 

The White House has reopened consideration of an international reference pricing model through a revised Most Favored Nation (MFN) approach. Under this framework, Medicare reimbursement for certain Part B drugs would align with prices in foreign markets. LUGPA opposes this policy, warning that international pricing formulas ignore the U.S. innovation ecosystem and threaten patient access to cutting-edge cancer therapies.

Instead, LUGPA continues to advocate for:

• Expanded biosimilar adoption to drive price competition.
• PBM reform to reduce hidden costs and improve transparency.
• Value-based purchasing models that reward outcomes over volume.

Tariff Adjustments and Supply Chain Impacts

The Administration’s recent tariff revisions on imported pharmaceuticals, APIs, and medical devices could increase costs for independent practices by 10–25%. These changes affect essential products used in urologic care, including catheters, diagnostic instruments, and certain oncology drugs.

LUGPA is urging federal officials to create medical exemptions for critical healthcare inputs and to coordinate with CMS to ensure reimbursement rates reflect these higher costs. Without adjustments, independent practices could face further pressures that threaten access to care.

MIPS Value Pathway (Urology MVP): Preparing for 2026

CMS’s updates to the Urology MIPS Value Pathway (MVP) are finalized for 2026. The pathway aims to streamline quality reporting but introduces new data submission requirements that could increase administrative burden if not implemented carefully. 

Conclusion
Despite the challenges of a prolonged federal shutdown and shifting regulatory landscape, LUGPA remains steadfast in its mission to advocate for independent urology. Through ongoing engagement with policymakers, coalition partners, and member practices, LUGPA continues to drive reforms that promote fairness, sustainability, and patient-centered care.