September 2025

     In this issue we feature: 

• Executive Summary
• Government Funding and Continuing Resolution Outlook
• Healthcare Extenders at Risk
• Medicare Physician Fee Schedule & Reimbursement Updates 
• Grassroots Advocacy: Send Your Letter Today 
• CMS Proposal Could Limit Patient Access to Urological Supplies
• Drug Pricing Reform & Access to Care 
• Telehealth & Technology Policy
• Site-Neutral Payment Reform
• Workforce Shortages & Practice Sustainability
• State Legislative Activity
• Executive Order on Pharmaceutical Supply Chain Resilience
• Legislative Spotlight: The Patient Access to Higher Quality Health Care Act of 2025 (H.R. 4002) 

Executive Summary

Independent urology practices continue to navigate a healthcare environment defined by shifting payment policies, new regulatory demands, and growing competition from large hospital systems. LUGPA’s Health Policy and Political Affairs Committees remain at the forefront of advocacy, working to:

• Secure sustainable physician reimbursement.
• Preserve patient access to timely, affordable specialty care.
• Strengthen the role of independent practices in an increasingly consolidated system.

This month’s update highlights recent policy wins, ongoing challenges, and opportunities where member engagement can make a decisive difference.

Government Funding and Continuing
Resolution Outlook  

As Congress returns from its August recess, lawmakers face a critical September 30, 2025, deadline to keep the federal government funded. Without action, a shutdown could disrupt healthcare programs, delay payments, and create uncertainty for independent practices.

Tensions are high, and many expect a potential shutdown. The most likely outcome is a continuing resolution (CR), a short-term measure to extend government operations into the early months of fiscal year 2026. While a CR would give Congress more time to negotiate a full-year spending agreement, it would only maintain current funding levels and fail to address long-term healthcare priorities.

For independent urology, key concerns remain unresolved:

• Physician reimbursement updates
• PBM reform
• Drug pricing protections

Healthcare Extenders at Risk  

Several health-related policies are also tied to the September 30 deadline:

• Direct funding programs (e.g., Community Health Center Fund, SHIPs) may face strain if reserves are depleted.
• Medicare payment provisions, such as ambulance add-ons, could be delayed if disruptions extend beyond CMS’s short-term processing window.

Many of these flexibilities will end immediately on October 1 if the government shuts down, forcing providers and patients to cancel already scheduled care.

LUGPA will continue to monitor these developments closely and provide timely updates on any impacts to independent urology practices and patient care.

Medicare Physician Fee Schedule & Reimbursement Updates

CMS has released early details of the 2026 Medicare Physician Fee Schedule (MPFS):

• A 2.5% update to the conversion factor, the first positive adjustment in years, reversing the long trend of declining reimbursement.
• Continued implementation of E/M code changes, which provide modest relief for office-based specialties like urology.

While this improvement is welcome, structural flaws remain:

• Budget neutrality still forces across-the-board cuts whenever new services are added or payment policies are restructured.
• Inflation and rising practice expenses are far outpacing CMS’s limited increases, leaving independent practices under constant financial pressure.
• Ambiguities remain in how CMS plans to handle bundled care models and quality reporting, both of which could shift reimbursement further away from fee-for-service.

LUGPA’s response:

• We are strongly advocating for passage of the Medicare Patient Access and Practice Stabilization Act (H.R. 2474), which would tie physician updates to inflation.
• We continue to educate lawmakers that without reform, independent practices will be unable to recruit and retain physicians, directly harming patient access.
• Our message to Congress is clear: physician payment stability must be addressed with the same urgency as hospital and Medicare Advantage payment policy.

Grassroots Advocacy:
Send Your Letter Today

LUGPA members are the most powerful advocates for independent urology. Every message to Congress reinforces the critical role community-based physicians play in ensuring patients have timely, affordable access to care. Your voice can make a difference.

This month, we urge all members to contact their Representatives and Senators in support of the Protecting Patient Access to Cancer and Complex Therapies Act. This bipartisan bill directly addresses a dangerous unintended consequence of the Inflation Reduction Act that could undermine patient access to life-saving treatments.

Why This Matters

Unless Congress acts, beginning in 2028:

• Medicare reimbursement will shift from the current Average Sales Price (ASP) + 6% to the negotiated Medicare Fair Price (MFP) + 6%.
• The MFP formula does not account for the full costs of storage, handling, and administration of complex therapies in community practices.
• Independent urology and oncology practices will be forced to stop offering some physician-administered therapies because reimbursement won’t cover costs.
• Patients, especially in rural and underserved areas, will lose access to convenient local care and be pushed into higher-cost hospital settings.

The Solution:
Protecting Patient Access to Cancer and Complex Therapies Act

This bipartisan legislation:

• Preserves ASP+6% reimbursement for community-based physicians who administer therapies affected by Medicare drug price negotiation.
• Maintains Medicare’s projected savings under the Inflation Reduction Act, ensuring taxpayer value.
• Protects patient access to cancer and other complex treatments in independent practices where care is often more personal, efficient, and cost-effective.

Take Action Today

Your engagement is critical. By sending a letter to Congress, you help ensure lawmakers understand the real-world consequences of this policy and the need for a bipartisan fix. Together, we can protect patients and preserve the viability of community-based urology.

[Click here to send your letter now.]

CMS Proposal Could Limit Patient Access to Urological Supplies

On August 29, LUGPA submitted comments to CMS regarding its proposed CY 2026 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program rule. CMS is proposing to redefine “item” to include urological supplies, a change that would have significant implications for patients and practices.

LUGPA’s Concerns:

• Patient Safety: Urological supplies are not interchangeable commodities. They must be matched to each patient’s anatomy and condition. Restricting access risks complications, infections, and hospitalizations that raise costs rather than reduce them.
• Practice Impact: Many LUGPA practices supply these products directly to patients to ensure proper fit, training, and continuity of care. Competitive bidding would restrict or eliminate this service.
• Legal Overreach: Congress did not authorize CMS to include prosthetic devices like urological supplies in competitive bidding. Expanding the definition of “item” exceeds CMS’s statutory authority.

LUGPA urged CMS to withdraw the proposal and maintain patient access to safe, individualized urological care. We will continue to monitor this issue closely and keep members informed as CMS reviews stakeholder feedback.

Drug Pricing Reform & Access to Care

Drug pricing remains one of the top policy debates in Washington, with direct consequences for specialty care. Recent developments include:

• CMS’s second round of Medicare Drug Price Negotiation Program selections, which impact certain cancer therapies and supportive drugs used by urologists. Practices are concerned that reimbursement tied to negotiated prices could make in-office administration financially unsustainable.
• Intensifying debate over pharmacy benefit managers (PBMs). Bipartisan proposals in both chambers seek to ban spread pricing, require real-time benefit tools, and mandate disclosure of rebates.

LUGPA priorities:

• Protecting in-office dispensing: Patients prefer the convenience of receiving medications directly from their physician’s office. Eliminating this option would increase patient costs and delay treatment.
• Ensuring pricing reforms don’t destabilize practices: If reimbursement drops below acquisition cost, independent practices could be forced to stop offering certain therapies, leaving hospitals as the only option.
• Promoting PBM reform: We support transparency requirements that pass savings directly to patients and reduce administrative hurdles for physicians.

Why It Matters: The next phase of CMS’s negotiation program will include more oncology-related drugs. Without strong safeguards, reforms meant to lower costs could inadvertently push patients into higher-cost hospital settings—the exact opposite of what Congress intended.

Telehealth & Technology Policy

Telehealth continues to be one of the most effective tools for expanding access, particularly in urology where patients often travel long distances for specialized care.

Federal updates:

• The Telehealth Coverage Act of 2025remains in play. The bill would extend or make permanent flexibilities such as audio-only visits, coverage for patients at home, and cross-state licensure support.
• If Congress fails to act, many of these flexibilities will expire at the end of September 2025, creating uncertainty for practices and patients.

State developments:

• Illinois, New Hampshire, and Ohio recently passed laws requiring commercial insurers to cover telehealth services on par with in-person visits. This trend is spreading, giving states a larger role in protecting patient access.

Emerging issues:

• AI in healthcare: States are stepping into the vacuum left by Congress, proposing regulations around algorithm transparency, bias prevention, and clinical decision support. LUGPA is closely watching these proposals to ensure they don’t inadvertently restrict clinical innovation.

Cybersecurity: Healthcare remains the most targeted industry for ransomware and cyberattacks. Federal policymakers are exploring new mandates, but without funding, compliance could impose another unfunded burden on small and mid-sized practices. LUGPA supports approaches that pair new requirements with resources to help practices implement them.

Site-Neutral Payment Reform

Momentum is building for site-neutral payment reform—reimbursing hospital outpatient departments and independent practices at the same rate for identical services.

Why It Matters:

• Medicare currently pays hospitals substantially more for procedures that independent physicians deliver at lower cost and equal quality.
• These payment disparities incentivize hospitals to acquire physician practices, fueling consolidation and driving costs up for patients.

Latest developments:

• Same Care, Lower Cost Act: 

Introduced in May 2025 by Senator John Kennedy, this bill would require Medicare to pay the same rates for services provided in on- and off-campus hospital outpatient departments, with the aim of reducing deficits by potentially $150 billion over a decade. 

• CMS Rulemaking: 

In July 2025, CMS proposed rules that advance site-neutral policies to lower costs and expand services in lower-cost settings, including payment parity for drug administration and potential reductions in unnecessary inpatient care. 

LUGPA’s advocacy:

• We continue to highlight that site neutrality protects patients by lowering costs and preserving access to care in community-based settings.
• Our message: Medicare should pay for value, not site of service.

Workforce Shortages & Practice Sustainability  

The urology workforce shortage is becoming a crisis:

• The AUA projects a 30% shortfall in practicing urologists by 2035, driven by retirements and limited residency slots.
• Demand for urologic care continues to grow due to an aging population, increased cancer incidence, and expanded screening efforts.

Key legislative focus:

• The Health Workforce Innovation Act would increase graduate medical education slots, target funding for specialties in shortage, and incentivize training in rural and underserved areas.
• LUGPA is pushing for specialty representation in these reforms, ensuring that funding doesn’t flow exclusively to primary care.

Bottom line: Without federal action, patients will face longer delays for specialty care, and independent practices will struggle to maintain capacity.

State Legislative Activity

State legislatures continue to advance policies that affect independent practices in real time:

• Scope of practice expansions: Multiple states are expanding the authority of nurse practitioners and physician assistants. While LUGPA supports collaborative care, we stress that training and quality standards must be maintained to protect patients.
• Prior authorization reform: A growing number of states are moving to standardize forms, set maximum turnaround times, and reduce burdens for providers with high approval rates. These reforms have the potential to significantly cut administrative costs for practices.
• ASC regulations: Some states are reviewing or updating certificate-of-need (CON) requirements, which could either restrict or expand opportunities for physician-owned surgery centers. LUGPA supports reforms that open access and reduce anti-competitive barriers.

Executive Order on Pharmaceutical Supply Chain Resilience 

The Administration has issued an Executive Order directing HHS to strengthen the domestic pharmaceutical supply chain by filling the Strategic Active Pharmaceutical Ingredients Reserve (SAPIR). The initiative aims to reduce reliance on foreign suppliers and secure a six-month supply of critical drug components.

Key Provisions:

• ASPR will identify 26 critical drugs and begin stockpiling APIs, with preference for U.S.-made products.
• The Essential Medicines list will be updated, with plans to expand SAPIR to cover more drugs within a year.
• With only 10% of U.S. APIs produced domestically, the order seeks to address a major vulnerability.

Implications for Urology:

• Supply stability could help prevent shortages of critical medications.
• Domestic incentives may strengthen long-term access to specialty drugs used in urology.
• Cost impact remains unclear, and many drugs outside the initial list will still rely on global supply chains.

We will monitor SAPIR’s implementation to ensure that policies enhance—not disrupt—access to urologic medications, in-office dispensing, and independent practice sustainability.

Legislative Spotlight:
The Patient Access to Higher Quality Health Care Act of 2025 (H.R. 4002)

On June 12, 2025, Representatives Beth Van Duyne (R-TX) and Henry Cuellar (D-TX) introduced the Patient Access to Higher Quality Health Care Act of 2025 (H.R. 4002). The bill would repeal Affordable Care Act restrictions on the development and expansion of physician-owned hospitals (POHs), which have been limited since 2010 under Section 6001 of the ACA.

Current law prevents new POHs from participating in Medicare and restricts existing facilities from expanding beyond their 2010 capacity. Proponents of these restrictions argue they prevent overutilization and protect community hospitals, while critics contend they stifle competition, drive consolidation, and limit patient choice.

Key Provisions of H.R. 4002:

• Remove ACA restrictions on the creation and expansion of POHs.
• Continue to apply Stark Law self-referral safeguards.
• Allow physicians to expand facilities in response to patient and community demand.

Policy Considerations:

• Competition: Supporters argue expanded POHs could increase competition with large hospital systems.
• Access and Cost: Some analysts suggest POHs may improve access and lower costs, while others caution about potential market disruptions.
• Independent Practice: Expanded POHs could create new opportunities for physician-led facilities that integrate outpatient and inpatient services.

H.R. 4002 has been referred to the House Energy and Commerce Committee. Debate is expected to center on competition, cost implications, and the impact on hospital consolidation trends.