PAYMENT MODEL WILL IMPROVE OUTCOMES AND REDUCE COSTS
SCHAUMBURG, Ill., July 14, 2017 – On July 5, 2017, LUGPA, submitted the nation’s first urologic-specific Alternative Payment Model (APM) to the Department of Health and Human Services’ Physician-Focused Payment Model Technical Advisory Committee for its review. Recognizing the diverse nature of healthcare delivery for prostate cancer throughout the United States, LUGPA has developed this APM to be accessible to both independently practicing as well as hospital-based urologists, enabling broad national participation for this novel urology specific APM model.
“Our goal was to create an episode-based payment that aligns incentives with best practices in conjunction with recently issued active surveillance guidelines,” said Neal D. Shore, MD, FACS, President of LUGPA. “We believe our proposed APM model achieves the triple aim of improving both patient care and societal health outcomes, while also reducing total expenditures. If approved by CMS, this APM should positively affect U.S. urologic care.”
Key facts and provisions of the submission include:
- In 2015, an estimated 79,000 Medicare Fee for Service beneficiaries were newly diagnosed with prostate cancer, 79 percent of which (approximately 63,000 cases) were localized to the prostate. Seventy-seven percent of men diagnosed with localized prostate cancer received active intervention (AI).
- Data suggests that a subgroup of this population can safely defer active intervention (AI) thus avoiding overutilization of services while reducing morbidity and cost. The proposed APM aligns incentives with clinical best practices and recently issued guidelines for physicians to recommend active surveillance (AS) in clinically appropriate patients with low-risk localized prostate cancer.
- LUGPA’s model introduces a two-part payment model that includes a care management fee structure for the AS of beneficiaries diagnosed with localized prostate cancer as well as a performance-based payment for enhancing performance year utilization of AS relative to a historical period.
- Estimates from Medicare claims data suggest LUGPA’s APM could result in an approximately a 37 percent reduction in expenditures for patients with newly diagnosed prostate cancer.
- Approval of the LUGPA APM creates a vehicle open to all urology practices treating prostate cancer (small or large, independent or hospital-owned, and with or without integration of ancillary services) to participate in APMs; LUGPA anticipates rapid adoption of this APM by urologists nationwide.
“This is the first and only urology specific proposal to be submitted and is one of only a handful of submitted proposals across all of healthcare,” noted Deepak A. Kapoor, MD, chairman of LUGPA’s Health Policy Committee. “When combined with our support for the development and submission of urology’s first two e-clinical quality measures, it is clear LUGPA’s leadership is making a significant commitment to driving policy that will prioritize value based care for all urologists.”
LUGPA believes its proposal will optimize outcomes, increase patient satisfaction and reduce utilization of unnecessary services, while simultaneously decreasing healthcare costs. The decision to develop a urologic APM exemplifies LUGPA’s leadership in the urology community and its commitment to optimizing the value and quality of care for early stage prostate cancer patients. The development and submission of the LUGPA’s APM is consistent with the organization’s long-standing positions on healthcare improvement.
LUGPA is a trade Association that represents independent urology group practices in the U.S., with more than 2,300 physicians who make up more than 25 percent of the nation’s practicing urologists, and provide more than 30 percent of the total urologic care in the U.S. The Association is committed to providing the best resources and information for its member practices through advocacy, research, data collection and benchmarking efforts. LUGPA advocates for independent urology practices by promoting quality clinical outcomes, fostering new opportunities and improving advocacy in the legislative and regulatory arenas. For more information, visit lugpa.org.