LUGPA Policy Update 
Promoting Fairness for Medicare Providers Act of 2024

Dec. 19, 2024 

Representatives Gus Bilirakis (R-FL), Danny Davis (D-IL), and Greg Murphy (R-NC) recently introduced the Promoting Fairness for Medicare Providers Act of 2024 (H.R. 10136). This bill seeks to reform Medicare payment rules to address the disparity in reimbursements for surgical procedures requiring high-cost supplies performed in office-based facilities compared to ambulatory surgical centers (ASCs). If enacted, this legislation could significantly benefit independent urologists and their patients.

Key Provisions of the Bill

1. Equal Payment for Comparable Services
   The bill ensures that office-based facilities are reimbursed at 90% of ASC rates for specified surgical procedures involving high-cost supplies.
2. Patient Cost Protections
   It caps patient coinsurance for these procedures at the inpatient hospital deductible amount, reducing financial burdens on patients.
3. Eligibility for High-Cost Procedures
   Defines eligible procedures as those with supply costs exceeding a set threshold (e.g., $500) and provides for annual updates to this list.
4. Regulatory Standards
   Mandates health and safety standards for office-based facilities participating in Medicare, ensuring quality care.

The bill offers both immediate and long-term relief for independent urologists. Aligning Medicare payments with the actual costs of procedures promotes financial sustainability for practices and preserves access to high-quality urologic care in office-based settings. This measure is particularly vital in rural and underserved areas, where alternatives to hospital-based care are limited.

Potential Effects of H.R. 10136

• Reimbursement Stability: Establishes a new "office-based facility" site-of-service category to ensure fair compensation for services involving high-cost supplies.
• Strengthening Independent Practices: Stops further closures of office-based centers by improving financial viability for interventional services.
• Protecting the PFS: Shields other providers from further payment erosion caused by the migration of high-cost supplies to office-based settings.
• Addressing Site-of-Service Disparities: Reduces inequities in payment and mitigates healthcare consolidation trends.
• Expanding Rural Access: Improves access to care in rural and underserved areas where ASCs are scarce and specialty services are limited.
• Pandemic Preparedness: Maintains a low-cost site-of-service option for interventional care when hospitals prioritize pandemic responses.

LUGPA supports the sponsor’s efforts to address critical disparities in Medicare reimbursement. We will continue to advocate for legislative solutions that protect independent practices, improve patient access, and ensure the sustainability of office-based care.