Health Policy and Advocacy

As the leading voice of independent urology group practices in the US, LUGPA educates policymakers on the benefits of integrated urologic care. Our members drive grassroots efforts by developing thoughtful analysis and engaging public officials through comment letters on major legislative and regulatory proposals.


LUGPA COVID-19 Advocacy Efforts
LUGPA’s Health Policy and Political Affairs Committees have been at the forefront of COVID-19 related issues relevant to LUGPA members.  Click here to see a summary of LUGPA's coronavirus-related advocacy efforts. 

Members of Congress Need to Hear from You!
LUGPA DC Fly-In Dates 
Lawmakers are most responsive when they hear from physicians from their districts and states. That’s why we encourage your group to send a physician and/or senior administrator to Washington, DC to attend our Capitol Hill visits with the LUGPA Political Affairs Committee. If you are interested in attending a LUGPA fly-in, virtual fly-in, or if you would simply like more information, please contact Morgan Cox in the LUGPA office at [email protected].

2021 FEDERAL LEGISLATIVE AND REGULATORY PRIORITIES

Maintain patient access to physician administered cancer therapy through Medicare Part B. The Trump Administration is implementing an interim final rule (IFR) that would reform reimbursement for physician administered drugs under Medicare effective January 1, 2021. Under the IFR, CMS would reimburse physician practices the lowest price of 22 countries.  In addition the policy substitutes the 6% add-on payment with a flat add-on payment of about $148. This policy puts physician practices at risk for acquiring the product at significantly discounted prices that may change quarter-to-quarter and substantially cuts the add-on payment for complex and logistically challenging therapy for advanced prostate cancer.  LUGPA strongly opposes this policy, and will be working in coalition with other stakeholders to defeat, suspend and replace this proposal. [Read more]

Promote neutrality of physician reimbursement regardless of site of service. Hospital systems are often compensated substantially more than physicians by Medicare for identical services. LUGPA is focused on Capitol Hill and in the administration on levelling the playing field between hospital and independent physician reimbursement, in order to ensure that independent physician practices can compete with hospital systems and continue to provide less costly, high quality care in patients’ communities.  [Read more]

Promote Stark reform to allow independent practices to thrive under MACRA while maintaining the IOASE. After years of leading the physician community in advocating reform of the outdated and burdensome Stark self-referral laws, in November 2020 the Trump Administration issued a final rule implementing a substantial regulatory overhaul of that law, adopting many of LUGPA’s recommendations. The Stark Final Rule establishes a series of new exceptions to Stark’s self-referral prohibitions to protect value-based arrangements. Previously these exceptions have been tilted towards large hospital systems, but these new reforms will help level the playing field and give independent practices more flexibility to enter into value based care arrangements in the future. LUGPA will be carefully monitoring the implementation of these regulations during the coming year, while continuing to defend the “In-Office Ancillary Service Exemption” which allows the integrated delivery of care by physician practices under the fee-for service system.  [Read more]

Work to ensure that COVID relief is appropriately focused on the independent physician community.   As soon as the pandemic began, LUGPA worked closely with key legislators and regulators to ensure independent physicians—not just hospitals—had early access to economic relief and adequate resources needed to treat our patients. This relief came in several ways – through the creation of the HHS Provider Relief Fund which provided direct grant monies to our physician practices; financial assistance through the Medicare Accelerated and Advance Payment program; loan forgiveness through the Small Business Paycheck Protection Program and telehealth flexibilities that allowed for continuous coverage, even at the height of the pandemic.  As additional COVID relief packages are considered by Congress and the next Administration, LUGPA will work to ensure that the independent physician community is not left behind in future rounds of funding.

Make permanent telehealth flexibilities provided on a temporary basis during COVID.  In the first COVID relief package passed by Congress in March 2020, CMS was given the authority to remove restrictions for Medicare telehealth services.  This was done through regulatory waivers that lifted geographic restrictions and allowed for a range of telehealth services including new and established patient visits via smartphones or audio-only. CMS, however, is limited by statute and making these changes permanent will require Congressional action. LUGPA will be working with others in the physician community and with patient groups to advance legislation that will make these critical telehealth flexibilities permanent.

Closely monitor CMS’s implementation of legislatively mandated radiation therapy bundles to ensure patient access to cancer treatment. LUGPA helped secure legislation that allayed proposed draconian cuts to radiation therapy in the physician office setting in 2015. That legislation required CMS to create a bundled payment for radiation services.  As a result, CMS has developed the Radiation Oncology Alternative Payment Model.  LUGPA has consistently engaged in the rule-making process as CMS developed the model. The final rule was announced in September 2020, and will take effect on July 1, 2021. LUGPA will engage with CMS in an effort to ensure as smooth an implementation of this policy as possible.     [Read more] 

Continue to monitor and provide comments to CMS regarding policies that affect Medicare fee schedules. CMS is exploring substantial changes to the Medicare physician fee schedule that have disparate impacts on various physician specialties. In the recently released 2021 Physician Fee Schedule (PFS) urology made substantial gains. LUGPA will continue to advocate for reimbursement policies that appropriately protect access to care for the urologic patient.  [Read more]

Advocate for physicians' ability to continue to provide in-office dispensing of pharmaceuticals (where allowed by state statute). Many physician groups offer pharmaceutical dispensing services to their patients. By integrating pharmaceutical dispensing into the physician practice, care coordination is enhanced, and patient compliance is better monitored. Physicians are highly attuned to their patients’ clinical needs and LUGPA is committed to protecting patients’ ability to receive pharmaceuticals from their physicians when they so choose.

Monitor regulatory implementation of MACRA. CMS has taken a go-slow approach on MACRA implementation that has resulted in very little upside reward for high performing practices, including many LUGPA member practices.  LUGPA will encourage CMS to reward high performers in MIPS and approve more APMs so that our practices can participate.  [Read more]