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November 2024
In this issue we feature:
Election Insights: Impact on Independent Urology Practices
As the 2024 election approaches, healthcare providers, including independent urology practices, are navigating a potential landscape of significant policy shifts and regulatory changes. To help LUGPA members stay informed, LUPGA hosted a 30-minute webinar on October 22, 2024, focusing on how different election outcomes could impact the healthcare sector, particularly urology. The webinar will cover key issues such as changes to reimbursement models, regulatory requirements, and broader healthcare policy shifts that could affect practice management.
Moderated by Dr. Evan Goldfischer, LUGPA President, the panel featured expert insights from Dr. Mara Holton, Chair of LUGPA's Health Policy Committee, Dr. David Albala of Associated Medical Professionals, and Dr. Joshua Langston, Chief Medical Officer of Urology of Virginia. Attendees engaged in a Q&A session to explore how potential election outcomes might influence their practices and patient care.
The full recorded version of the program can be found here.
LUGPA Advocacy Spotlight: Congress and LUGPA Unite for Medicare Physician Fee Schedule Reform
LUGPA is actively working to halt harmful cuts under the Medicare Physician Fee Schedule (MPFS) that threaten the financial viability of independent practices, particularly in rural and underserved areas. The Centers for Medicare & Medicaid Services (CMS) has proposed a 2.8% payment reduction for 2025, marking the fifth consecutive year of cuts. These reductions add to the pressures independent urology practices face due to rising operating costs and unsustainable reimbursement rates.
On October 11, a bipartisan coalition of 233 members of Congress sent a letter to House Speaker Mike Johnson and Minority Leader Hakeem Jeffries, urging essential reforms to the MPFS. The letter emphasizes systemic issues like unsustainable payment reductions that fail to reflect rising expenses and the detrimental effects on patient access to specialized care. Additionally, Congress members highlighted concerns with the Merit-based Incentive Payment System (MIPS), citing inefficiencies and undue financial burdens on providers.
LUGPA has joined a bipartisan coalition supporting the Medicare Patient Access and Practice Stabilization Act of 2024, introduced by Representatives Dr. Murphy (R-NC), Panetta (D-CA), Miller-Meeks (R-IA), Dr. Bera (D-CA), Dr. Bucshon (R-IN), Dr. Ruiz (D-CA), Dr. Joyce (R-PA), and Dr. Schrier (D-WA). This legislation would prevent the proposed 2.8% cut and secure a 0.5% Medicare Economic Index (MEI) update for 2025, a step aligning with LUGPA’s advocacy to stop the cuts and pursue long-term physician reimbursement stability.
LUGPA’s Key Advocacy Priorities
LUGPA’s policy goals are focused on preserving independent practices and protecting patient access to specialized urologic care. The organization is working with lawmakers to address:
- Stopping the 2.8% Cut: Urging immediate action to halt the scheduled 2025 payment reduction.
- Reforming the MPFS: Advocating for inflation-adjusted, permanent payment updates to sustain the financial health of independent practices.
- Protecting Access to Care: Pushing for reforms that prioritize patient access, especially in underserved areas.
LUGPA remains committed to working with Congress to secure fair, inflation-adjusted updates that will protect the financial stability of independent urology practices and ensure Medicare beneficiaries retain access to high-quality healthcare services.
Delaware House Bill 302: Expanding Prostate Cancer Screening Coverage
On October 28th, Delaware Governor John Carney signed Delaware House Bill 302 into law, which will require health insurance policies to cover prostate cancer screenings for men at risk. The bill expands coverage to include various types of screenings and clarifies the age requirements for coverage, ensuring that men at average and higher risk have access to necessary screenings.
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Nathan Diller (second from right) attends
the signing ceremony for HB 302 on October 28. |
Key Provisions of HB 302:
Coverage: All health insurance policies in Delaware must cover prostate cancer screenings.
Screening Types: The bill broadens the definition of prostate screenings to include digital rectal exams, PSA tests, and related laboratory work.
Screening Ages:
- Age 50: Men at average risk
- Age 45: Men at high risk
- Age 40: Men at even higher risk
HB 302 ensures that prostate cancer screenings are covered regardless of policy exclusions or whether they are part of routine or annual exams. LUGPA has actively worked with both state and national groups to promote this important legislation, advocating for expanded access to screenings that can save lives.
LUGPA Board Member Nathan Diller will attend the bill signing, marking a significant victory in our efforts to improve prostate cancer screening access and support men’s health. Read more.
CMS Releases Guidance for the Second Round of Medicare Drug Price Negotiation Program
On October 2, 2024, the Centers for Medicare & Medicaid Services (CMS) released final guidance detailing the second phase of the Medicare Drug Price Negotiation Program. This initiative, created under the Inflation Reduction Act, is aimed at lowering drug costs for Medicare beneficiaries by negotiating directly with pharmaceutical companies. The first round of negotiations, completed in August 2024, focused on ten high-cost drugs, with prices set to take effect in January 2026. The second round will include up to 15 additional drugs, with CMS expected to announce the selected medications by February 2025. The new prices from this second phase will be effective starting in January 2027.
A key component of this program is the use of a Medicare Transaction Facilitator, which will streamline the process by managing data exchanges and providing optional payment facilitation between drug manufacturers and pharmacies. The goal is to ensure that Medicare beneficiaries can access reduced prices efficiently and without unnecessary barriers. Notably, this final guidance reflects public feedback and introduces patient-centered improvements, such as the inclusion of up to 15 patient-focused roundtable events in Spring 2025. These roundtables will allow CMS to gather input from patients and stakeholders, ensuring that the selected drugs meet financial and clinical needs.
For LUGPA members, this program could result in significant changes to drug cost structures, particularly for expensive therapies often prescribed in urology. Including more drugs in the negotiation process could alter reimbursement rates and medication access, necessitating adjustments in practice management. LUGPA will continue to monitor these developments and provide updates to help members navigate these changes effectively.
Telehealth Modernization Act of 2024
Telehealth has become an essential part of healthcare delivery, particularly in the wake of the COVID-19 pandemic. The Telehealth Modernization Act of 2024 (H.R. 7623) aims to preserve and expand the telehealth flexibilities introduced during the pandemic, extending key provisions through 2026. This legislation allows rural health clinics and federally qualified health centers to serve as distant sites for telehealth services, ensuring continued access to care for patients in underserved areas. Additionally, the bill extends the Hospital at Home Telehealth Program through 2029, providing a longer runway for healthcare providers to implement innovative care models that reduce the need for in-person hospital visits.
A major highlight of the legislation is the continuation of audio-only telehealth services, a critical option for patients in areas with limited broadband access. H.R. 7623 also expands the types of practitioners eligible to provide telehealth services, allowing more comprehensive care delivery. For LUGPA members, these provisions offer enhanced opportunities to integrate telehealth into urology practice, improving access to care for patients who may face barriers to in-person visits. LUGPA will continue to advocate for telehealth policies that benefit independent urology practices, ensuring that members can provide high-quality care regardless of geographic limitations.
Improving Seniors' Timely Access to Care Act
(H.R. 8702)
In October, a bipartisan majority of U.S. Representatives voiced their support for the Improving Seniors' Timely Access to Care Act (H.R. 8702), which aims to reform the prior authorization process used by Medicare Advantage (MA) plans. With over 33 million Americans enrolled in MA plans, streamlining this process is critical to reducing delays in care. This legislation would modernize prior authorization by establishing an electronic process for MA plans, standardizing requirements, and improving transparency around how prior authorization decisions are made. Unfortunately, despite widespread support, the bill has not reached a full floor vote.
For healthcare providers, prior authorization remains one of the top administrative burdens, often causing unnecessary delays in patient care. A recent audit found that MA plans eventually approved 75% of requests initially denied, highlighting the inefficiencies in the current system. This bill addresses these challenges by creating expedited timeframes for commonly approved services and increasing oversight to ensure beneficiaries receive timely care. LUGPA supports this legislation, as it aligns with our mission to reduce administrative barriers and improve the quality of care for seniors. If passed, this bill would significantly reduce the time urologists spend on prior authorization tasks, allowing for more focus on patient care.
Cybersecurity in Healthcare: A Call to Action
Healthcare has become an increasingly targeted sector for cybercriminals, with data breaches rising dramatically in recent years. In 2023, over 133 million individuals were affected by healthcare data breaches—double the previous years. The MOVEit file transfer service breach, which compromised the personal data of over 900,000 Medicare beneficiaries, is one of the most significant examples of the growing threat. This breach exposed sensitive information, including Social Security numbers and Medicare claims data, underscoring the vulnerabilities in the healthcare sector's digital infrastructure.
The financial and reputational damage from such breaches can be devastating for independent practices. The cost of the MOVEit breach alone is estimated to exceed $15 billion, factoring in identity theft risks and fraud exposure. Ransomware attacks are also rising, with 46 healthcare systems targeted in 2023. These attacks disrupt patient care and pose long-term financial risks for healthcare providers.
LUGPA urges its members to prioritize cybersecurity by investing in robust security measures, educating staff on best practices, and staying informed on the latest threats. Protecting patient data is essential to maintaining trust and avoiding the financial consequences of cyberattacks. We will continue to provide resources and guidance to help members safeguard their practices against this growing threat.
On September 26, Senators Ron Wyden (D-OR) and Mark Warner (D-VA) introduced the Health Infrastructure Security and Accountability Act to strengthen cybersecurity across the U.S. healthcare system. The bill mandates that the Department of Health and Human Services (HHS) enforce stricter cybersecurity standards for healthcare providers and related entities, with stronger rules for critical organizations. It removes the cap on HIPAA fines to deter large corporations from neglecting cybersecurity and allocates $800 million for safety-net hospitals and $500 million to help other hospitals improve their defenses.
By staying proactive in addressing these critical issues, LUGPA members can ensure they are prepared for future challenges, from election-related policy changes to new telehealth opportunities and cybersecurity risks.
LUGPA Meets with Allies to Discuss Radiation Oncology Treatment Reform
In October, LUGPA met with the Association of Freestanding Radiation Oncology Centers (AFROC) to discuss critical issues affecting both organizations, particularly upcoming changes to radiation oncology treatment delivery CPT codes. AFROC's Washington counsel highlighted an initiative spearheaded by ASTRO that proposes eliminating separate CPT codes for intensity-modulated radiation therapy (IMRT). This change poses a significant threat, as it could result in substantial Medicare payment reductions for IMRT procedures in freestanding facilities, many of which are operated by LUGPA members.
Both organizations expressed deep concerns about how this coding modification could impact reimbursement rates and access to patient care. The meeting reinforced the need for ongoing advocacy to address these challenges and safeguard the financial viability of independent urology and radiation oncology practices.
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