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February 2025
In this issue we feature:
LUGPA’s Third Community Practice Summit
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The Community Practice Coalition Meets with Representative Greg Murphy, MD.
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On January 25, LUGPA participated in the Third Community Practice Summit, bringing stakeholders together to address pressing healthcare challenges and advocacy priorities.
The event began with a Pre-Summit Dinner featuring Rep. Greg Murphy, MD, a practicing urologist and senior legislator. As a member of the Ways and Means Committee and Co-Chair of the GOP Doctors Caucus, Rep. Murphy highlighted challenges facing community practices, including Medicare reimbursement, access to innovative therapies, and regulatory reforms. He emphasized advocacy for key legislation such as HR 6683 (stabilizing Medicare physician payments) and HR 5391/S. 2764 (protecting access to cancer therapies), and HR 5526/S. 3458 (restoring in-office dispensing).
Key Summit Sessions:
- Medicare Reimbursement Reform: Focused on reversing proposed 2025 fee schedule cuts, incorporating inflation adjustments, expanding telehealth access, and advancing site-neutral payment reforms.
- Malpractice Reform: Examined the impact of rising costs from frivolous lawsuits and proposed solutions, including caps on non-economic damages, alternative dispute resolution, and stronger expert witness standards.
- 340B Program Reform: Highlighted the need for increased oversight and transparency to ensure program benefits are directed toward underserved populations.
- COA Prescription for Health Reform: Introduced a comprehensive strategy to address consolidation, reimbursement challenges, and access to oncology therapies. Key initiatives included combating hospital consolidation, reforming PBM practices, and aligning MPFS with better-funded outpatient payment systems.
- In-Office Dispensing (IOD): Explored the benefits of IOD for patient care and advocated for legislation to restore and expand it alongside telemedicine advancements.
- Hospital Competition: Analyzed the negative effects of consolidation and emphasized the importance of site-neutral payments, stricter anti-kickback enforcement, and greater pricing transparency.
The summit concluded with a collaborative discussion to identify top advocacy priorities, including PBM reform, MPFS updates, and addressing the Inflation Reduction Act’s impact on patient care. Members were encouraged to engage in collective outreach and advocacy efforts, share resources, and amplify their voices in shaping healthcare policy.
For more details, you can read the full recap here.
Bipartisan Bill Reintroduced to Address
Medicare Physician Fee Schedule Cuts
The Medicare Physician Fee Schedule (PFS) faces another round of cuts in 2025, with CMS implementing a 2.83% reduction to the conversion factor. These cuts further strain independent practices, exacerbating physician burnout and limiting patient access—challenges worsened by congressional inaction.
Since 2001, inflation-adjusted Medicare payments have dropped 33%, while practice costs have surged 59% (AMA). Despite a modest 7% increase in payments, the financial gap continues to grow.
On January 31, Rep. Greg Murphy, MD (R-NC), reintroduced the Medicare Patient Access and Practice Stabilization Act, a bipartisan bill designed to offset the 2025 PFS cut by increasing Medicare payments by 6.62% starting April 1, 2025. This adjustment aims to stabilize physician reimbursement, account for inflation, and prevent financial strain on independent practices.
Key Provisions
- Reversing Cuts: A 6.62% increase to neutralize the 2.83% reduction.
- Inflationary Updates: Adjustments to reflect rising operational costs.
- Preserving Care Access: Supports practice stability, particularly in underserved areas.
Stable Medicare reimbursement is essential to maintaining high-quality urological care. LUGPA strongly supports this legislation and urges members to advocate for its passage to ensure financial sustainability for independent practices and continued access to care for Medicare patients.
LUGPA Partners with OBFA Coalition on
2025 Health Care Reform
LUGPA recently participated in a critical meeting with the Office-Based Facilities Alliance (OBFA) Coalition, where leaders discussed legislative and regulatory priorities for the upcoming year. These discussions included plans to reintroduce key bills such as H.R. 10136, which proposes a new site-of-service designation for minimally invasive endovascular care, and H.R. 8404/S. 4330, the ROCR Value-Based Program Act seeks to stabilize radiation oncology reimbursement.
The coalition also emphasized advancing site-neutral payment policies, specifically addressing H.R. 5378, the Lower Costs, More Transparency Act, which was recently passed in the House. Concerns remain over MedPAC’s proposed office rate adjustments, which could worsen cost disparities and threaten practice sustainability.
Efforts to reform the Physician Fee Schedule (PFS) also took center stage, with advocacy focusing on separating high-cost supplies and procedures from the PFS to create fairer reimbursement models.
LUGPA Advances Ambulatory Surgery Center (ASC) Reform Efforts
LUGPA continues to work closely with the Ambulatory Surgery Center Association (ASCA) and other stakeholders to address pressing ASC issues. ASCA is preparing comments on the ASC-covered procedures list, focusing on specialty codes, including cardiovascular procedures. Advocacy efforts prioritize site-neutral payment policies, price transparency, and advancing the 2024 Outpatient Surgery and Quality Access Act, which promotes equal cost-sharing in ASCs and carefully tests new quality measures.
Recent legislative developments have introduced potential challenges, including proposals that could tie hospital, ASC, and MPFS rates, potentially impacting physician compensation.
At the same time, LUGPA is monitoring excessive reporting requirements under new transparency measures. By addressing these challenges, LUGPA remains steadfast in its efforts to ensure fair policies for ASCs, focusing on affordability and access to care.
Tax Reform Threatens Nonprofits’ Tax-Exempt Status
As the 2025 tax reform deadline approaches, nonprofits, including LUGPA, face growing risks from proposed changes that could tax non-donation revenue streams such as membership dues, sponsorships, and educational income. These measures threaten associations' ability to serve their communities and foster innovation.
In response, LUGPA has joined the ASAE’s Community Impact Coalition, a group of over 50 organizations advocating for the preservation of nonprofit tax exemptions. Planned activities include the creation of educational materials, an advocacy toolkit, and active participation in ASAE’s March 2025 fly-in.
The coalition’s outreach to lawmakers will emphasize the critical role of nonprofits in bridging service gaps left by government and business. LUGPA will continue to work tirelessly to protect the tax-exempt status essential for supporting independent urology practices.
Medicare Drug Price Negotiation and Xtandi
On January 17, 2025, the U.S. Department of Health and Human Services (HHS) announced the inclusion of 15 additional drugs, including Xtandi (enzalutamide), in the Medicare price negotiation program authorized under the Inflation Reduction Act. Xtandi, a critical treatment for metastatic castration-resistant prostate cancer (mCRPC), plays an important role in advanced prostate cancer care. The program aims to reduce patient out-of-pocket costs while expanding access to vital therapies.
While lower prices could ease financial barriers for patients and practices, there may be potential challenges related to supply chain adjustments or coverage policies. Urology practices are encouraged to stay informed about updates to Medicare policies and adapt their prescribing practices as needed. LUGPA will continue to provide resources to help practices navigate these changes effectively.
Finalized Ban on Medical Debt in Credit Scoring
In January, the Consumer Financial Protection Bureau (CFPB) finalized a rule removing medical debt from credit reports, a move that will benefit approximately 15 million Americans. This landmark regulation prohibits lenders from considering medical debt in credit decisions and enhances patient privacy protections. The CFPB estimates that these changes will increase credit scores for consumers with medical debt by an average of 20 points and facilitate the approval of thousands of affordable mortgages annually.
LUGPA applauds this reform and remains dedicated to reducing financial toxicity in healthcare. LUGPA is committed to addressing the root causes of high healthcare costs and ensuring equitable access to care for all patients through continued advocacy for site-neutral payment reforms, hospital price transparency, and value-based care initiatives.
Regulatory Freeze Impacts HHS Rulemaking
In January, the White House initiated a governmentwide regulatory freeze, pausing progress on healthcare regulations for 60 days. This action halts the rulemaking process, including the issuance of new rules, as the administration transitions leadership at the Department of Health and Human Services (HHS) and assesses its regulatory priorities.
The freeze affects regulations proposed but not finalized by the Biden administration, such as updates to the HIPAA Security Rule and new rules for prescribing controlled substances via telehealth. It also delays the implementation of finalized Biden-era regulations that are not yet effective. These steps allow the White House time to review, modify, or rescind regulations in alignment with its policy goals.
Similar regulatory freezes occurred at the start of the first Trump administration in 2017 and the Biden administration in 2021, serving as a tool for new leadership to understand the regulatory landscape and establish its direction.
The 60-day pause allows the administration to determine its focus areas while awaiting the confirmation of key agency officials. This review process could have significant implications for healthcare policies and regulations that impact independent urology practices, including telehealth, HIPAA compliance, and other critical areas.
LUGPA will continue closely monitoring these developments and advocate for policies supporting independent urology practices. Members are encouraged to stay informed about changes and engage with LUGPA’s advocacy efforts to ensure their voices are heard.
To stay current on new and emerging policy issues affecting independent medicine, please visit LUGPA’s Health Policy and Advocacy page.
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