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LUGPA Health Policy Update

Aug. 2025

Independent urology practices continue to operate in a policy environment that is both fast-moving and high-stakes. The LUGPA Health Policy Committee is actively engaged with lawmakers, regulators, and allied physician organizations to protect reimbursement, maintain patient access, and preserve the viability of independent practice.

This update combines highlights from recent health policy discussions and board reports, giving members a snapshot of key developments, emerging challenges, and areas where LUGPA advocacy is making an impact.

Recent Wins

  • Medicare Physician Fee Schedule (MPFS) 2026 – CMS has proposed a 2.5% base increase to the conversion factor, with targeted adjustments for qualifying providers. For many practices, this could mean a net increase of over 3%.
  • Legislative momentum on the Protecting Patient Access to Cancer and Complex Therapies Act, which maintains current ASP+6% reimbursement for Part B drugs and adds provisions to protect against supply shortages.
  • Continued advancement of reforms to the 340B Program, PBM transparency measures, and site-neutral payment initiatives that aim to reduce the pricing advantage of hospital-owned facilities over community practices.
  • Expansion of the Ambulatory Surgical Center (ASC) Covered Procedures List, creating new opportunities for procedures to be performed outside the hospital setting.

Challenges on the Horizon

  • Proposed 2.5% “efficiency adjustment” cuts to certain work RVUs and a 50% reduction in indirect practice expense payments for facility-based services—changes that could disproportionately impact procedure-intensive specialties like urology.
  • Congressional proposals to reduce Medicaid funding and allow enhanced ACA marketplace subsidies to expire; the Congressional Budget Office projects this could lead to 3.8 million more uninsured per year by 2034, with potential downstream effects on specialty care access.
  • CMS proposals expanding site-neutral payment policies for drug administration and tightening price transparency requirements, which could shift revenue streams and increase administrative workload.
  • Ongoing uncertainty in radiation oncology payment models, with potential bundling and reclassification changes under review and a shift to payment based on OPPS APCs.

Looking Ahead

  • Final MPFS and OPPS/ASC payment rules are expected later this year; LUGPA will provide member-specific modeling tools to assess the impact on high-volume urology codes such as biopsies and cystoscopy.
  • Anticipated year-end congressional negotiations may address drug pricing reforms, telehealth extensions, PBM regulation, and ACA subsidy provisions.
  • LUGPA will continue to work closely with congressional champions, leveraging member data and patient stories to illustrate the importance of independent physician-led care.

Bottom line: While this year’s policy landscape includes meaningful wins—particularly in payment updates and legislative progress—significant challenges remain. LUGPA’s advocacy remains focused on ensuring that independent urology practices can continue to provide accessible, high-quality care in their communities.