Maintain access to cancer therapy via Medicare Part B and Part D (Stark “Location Test”)
Physician practices that administer Part B drugs should not be put at risk for pricing decisions by manufacturers and Congress. Congress can achieve the same amount of savings for Medicare and patients without upending the reliable buy-and-bill reimbursement system by collecting a rebate directly from pharmaceutical manufacturers. This solution has the support of the entire provider community and does not impair Congress’s desire to reduce drug costs. [Read more]
Make pandemic-related telehealth waivers permanent
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. [Read more]
Promote site neutral physician reimbursement
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]
Continue to promote Stark reform to allow independent practices to engage in Value-Based Care (VBC)
After years of leading the physician community in advocating reform of the outdated and burdensome Stark self-referral laws, in November 2020 the Trump Administration issued a final rule implementing a substantial regulatory overhaul of that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]
Support legislative efforts to reform 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]
Closely monitor and comment on Medicare fee schedules
CMS is exploring substantial changes to the Medicare physician fee schedule that have disparate impacts on different physician specialties. LUGPA will advocate for policies that benefit our practices and urology patients. [Read more]
Provide clinical evidence and regulatory support for molecular urine testing
LUGPA is working to develop clinical evidence and to meet with regulators to advocate for appropriate payment for molecular urine testing. [Read more]
Support legislative efforts directed at healthcare price transparency
LUGPA strongly supports efforts to require hospitals and health systems to make their prices for services publicly available to allow patients to make choices in their healthcare based on competitive price information. [Read more]
Support legislative efforts directed at Pharmacy Benefit Managers (PBM) reform, step therapy, and prior authorization
LUGPA is taking action to address unfair payor policies that negatively impact patient access to care and the ability of urologists to provide appropriate treatment. [Read more]
Oppose proposed FTC rules that would restrict non-competes in the healthcare marketplace
LUGPA will provide comments to the FTC on the negative impact of such rules on the independent practice of urology. [Read more]
Promote access to diagnostic genetic testing for prostate cancer patients
Several Medicare MACs have modified their LCDs such that they now substantially deviate from NCCN and other consensus guidelines. LUGPA supports the bipartisan Reducing Hereditary Cancer Act, legislation which would expand Medicare to cover screening for individuals with a family history of hereditary cancer, and to provide coverage of certain cancer screenings or preventive surgeries that would reduce the risk for individuals with a germline mutation associated with a high risk of developing a preventable cancer. [Read more]
