Fourth Community Practice Summit:
Advocating for Independent Practice

October 2025

The Fourth Community Practice Summit assembled physician leaders, policy experts, and healthcare advocates from across the nation to address pressing challenges in independent medicine. Hosted by LUGPA and featuring key representatives from OrthoForum, Johnson & Johnson, U.S. Women’s Health Alliance (USWHA), U.S. Urology Partners, and the American Academy of Otolaryngology–Head and Neck Surgery, the event illustrated the expanding unity within the community practice movement.

Held on the 25th day of the ongoing federal government shutdown, which began on October 1 and has significantly disrupted federal operations and services, the Summit facilitated open discussions, collaborative planning, and the formulation of targeted actions. Participants analyzed Washington's volatile policy scene, assessed growing financial burdens on independent practices, and reached agreement on a national strategy to defend physician autonomy, expand patient access, and maintain the foundational values of private medicine.

Setting the Stage: Momentum Amid Policy Uncertainty

Drs. Evan Goldfischer and Mara Holton began the Summit with an in-depth review of Washington's policy context. Uncertainties around Medicare reimbursements and healthcare reforms were framed as opportunities for stronger physician leadership and joint advocacy.

Upcoming MPFS and OPPS regulations are expected to add financial strain and increase reporting demands. These changes have motivated independent physicians to engage more actively, promoting collaboration and raising their profile in policy talks that affect patient access and practice endurance.

The Doc Caucus in Congress was recognized as a committed advocate for physician-led care, pushing for protections for community practice, consistent payment, and fair compensation. Its influence highlights the advantages of physician involvement in federal policy.

The session created a positive, focused atmosphere, emphasizing independent physicians' resilience and dedication to solutions that build a fairer healthcare system valuing quality, innovation, and patient-focused care.

Building a Shared Narrative: The Voice of Independent Medicine

A key focus was on unified messaging, recognizing that scattered advocacy has reduced independent physicians' policy impact. Attendees agreed on the need for private practice groups to develop a shared narrative and coordinated communications campaign emphasizing the benefits of physician-led community care.

Krista Stock of USWHA led a session on updating messaging to better connect with patients, policymakers, and the media. Based on USWHA research, outdated emphases on preservation fail to engage; instead, highlight advancement, innovation, and solutions, presenting independent practices as healthcare pioneers.

Participants viewed independent medicine as a story of growth, improving care quality, cutting costs, speeding access, and strengthening patient bonds. Future narratives should be proactive and confident, emphasizing contributions rather than defenses.

Action Item: Gather communications and marketing teams from partner organizations to build a national message based on four pillars:

Innovation: New care models, technologies, and efficiencies from independent practices.
Payment Stability: Reliable reimbursements supporting ongoing patient access.
Patient Access: Quicker, more affordable care options.
Patient Stories: Real examples showing improved lives and outcomes.

Coalition Building: Expanding the Tent

Expanding the advocacy coalition was a recurring theme, emphasizing inclusion beyond specialties to involve primary care, family medicine, state medical associations, and other clinicians to achieve a unified voice in physician-led care.

Dr. Jeffrey Racca's presentation on insurer downcoding detailed how major payers like Blue Cross, UnitedHealthcare, Cigna, and Aetna use hidden algorithms to cut payments for complex visits from about $175 to $125. This hits independent practices hard, especially those caring for high-acuity patients and with limited resources.

While some, like Cigna, have paused downcoding, the risk lingers. Data shows Medicare's overcoding rate at 0.13%, versus Cigna's 3% claim, illustrating biased data use for cuts. Appeals cost $40–$75 each, increasing the burden.

Dr. Racca called for collective responses through state societies and professional groups to challenge these via legislation and regulation. He urged ties with primary care to show how downcoding and prior authorizations harm all physicians' timely, quality care delivery.

Advocacy should reach beyond medicine, partnering with patient groups, public health organizations, the NAACP, and civic associations to emphasize equity, affordability, and access, shifting the focus from payment issues to patient equity.

Action Item: Collaborate with state medical associations, primary care networks, and community groups to:

Align messaging and draft joint letters for payment and transparency reforms.
Share accurate data to counter insurer distortions and promote patient-centered stories.
Involve patient and community input to advocate for independent, physician-led care.

The Policy Landscape: Challenges and Opportunities

Payment Stability and the Future of the Fee Schedule

Medicare reimbursement instability remains central for independent physicians. Linking updates to the MEI was confirmed as the best long-term fix for predictable, inflation-adjusted payments.

Instability affects more than finances; it hinders innovation, recruitment, and patient access, challenging planning, tech investments, and staffing in smaller or rural practices.

Consensus: Payment stability supports patient stability, allowing independent physicians to balance hospital dominance.

Action Item: Coordinate advocacy for MEI-linked Medicare updates and bipartisan reforms ensuring community care stability.

Hospital Consolidation and the Effect on Patients and Outcomes

Celeste Kirschner and Dr. Evan Goldfischer discussed accelerating consolidation by hospitals, corporations, and private equity, expanding beyond initial takeovers into anesthesiology, radiology, and other specialties, and reducing competition, choices, and independent practice.

Consolidation hides systemic problems: market dominance raises prices while access and quality may not improve. Physicians in consolidated systems experience moral injury from productivity pressures that conflict with patient care.

Policy must address payment disparities that fuel consolidation, including site-neutral payments, 340B oversight, and transparency around ownership.

Action Items:

Advocate site-neutral reforms for equal pay regardless of site, removing incentives for costly hospital shifts.
Support 340B transparency laws requiring savings reporting and patient eligibility standards.
Align coalition messaging to inform on consolidation's impacts on affordability, access, and physician-patient relationships.

PBM and 340B Reform

Dr. Mara Holton analyzed how PBMs and 340B have deviated, driving consolidation, hidden costs, and market issues.

PBMs control drug coverage and pricing, often integrated with insurers, capturing rebates and fees while failing to pass along savings, raising costs, and disadvantaging independents.

340B, meant for safety-net support, now exceeds $60 billion with little oversight, benefits captured by large systems, disadvantaging community practices.

Reforms could restore fairness and provide offsets for MPFS stability.

Action Items:

Back PBM reform for rebate transparency, patient savings pass-through, and anti-competitive limits.
Advocate 340B accountability, tying discounts to patient benefits, with eligibility and reporting rules.
Link reforms to advocacy for stability, affordability, and access.

Telehealth Permanency and Access

Dr. David Albala addressed permanent telehealth needs after the flexibility expiration. Telehealth is essential for access in rural/underserved areas, chronic management, follow-ups, and coordination.

It's an equity issue that requires fraud prevention, infrastructure equity, clarity on malpractice/licensure, reimbursement parity, and audio coverage.

Permanency aligns with reform goals: fewer hospitalizations, better adherence, lower costs. Without action, uncertainty affects investments.

Action Item: Create a unified statement and plan for telehealth extension, including:

Parity across modalities.
Cross-state licensure.
Integration in chronic/value-based models.
Broadband and literacy investments.

Drug Pricing and ASP+6 Reform

Matthew Glans reviewed the Inflation Reduction Act’s (IRA) planned 2028 shift from ASP+6 to MFP+6 reimbursement for Medicare Part B drugs. This change could significantly reduce reimbursements and threaten the viability of community-based practices.

Current System (ASP+6): Provides predictable compensation covering drug acquisition costs and maintaining reasonable margins, particularly for oncology and specialty therapies.
Proposed MFP+6: Introduces pricing uncertainty that may disincentivize practices from acquiring high-cost therapies, potentially limiting patient access, driving consolidation, and increasing overall system costs.
Policy Gap: Policymakers often overlook downstream effects on care delivery and practice sustainability.

Action Items:

Advocate for the Protecting Patient Access to Cancer and Complex Therapies Act to safeguard reimbursement levels.
Collaborate with other specialty groups to counter threats to patient access.
Develop educational materials demonstrating how ASP+6 supports access, innovation, and affordability.
Monitor CMS proposals and comment periods to influence policy in real time.

Precision Medicine, Biomarkers, and Artificial Intelligence

The Johnson & Johnson team highlighted opportunities and challenges in precision medicine, biomarker testing, and AI.

Biomarkers & Precision Medicine: Conflicting policies across 22 states create confusion for coverage, reimbursement, and CMS 14-day rule compliance. Standardization is essential to ensure consistent access and streamline clinical workflows.
Artificial Intelligence: AI can enhance efficiency and care delivery, but payers sometimes misuse it for downcoding or claim denials without transparency, threatening patient care. Federal standards are needed to ensure ethical, transparent, and clinically sound use.

Action Items:

Promote model state legislation to standardize biomarker testing and reimbursement policies.
Clarify CMS guidance, including the 14-day rule, to reduce compliance uncertainty.
Advocate for federal AI oversight focused on transparency, bias mitigation, and preservation of clinical autonomy.
Establish a working group to develop ethical frameworks for AI in healthcare.
Educate stakeholders on the responsible use of precision medicine and AI to improve patient outcomes and efficiency.

Key Takeaways and Action Steps

Unify Messaging: Build a campaign on innovation, stability, access, and stories.
Broaden Coalition: Include primary care, associations, and community groups.
Coordinate Advocacy: Draft letters, share data/practices.
Support Payment Reform: MEI ties, site-neutral policies.
Champion Telehealth: Permanency, parity, access.
Advance Transparency: PBM/340B reforms for protection.
Tell the Story: Use patient/practice narratives for value and trust.