Sustainable Physician Reimbursement

Medicare reimbursement rates are crucial for independent urologists, significantly impacting the financial viability of their practices. Fair and adequate reimbursement rates ensure that urologists can provide high-quality care to Medicare beneficiaries without incurring financial losses. Insufficient reimbursement rates can lead to reduced access to care, limited resources for investing in advanced technology, and challenges retaining skilled healthcare professionals.

LUGPA advocates for fair and sustainable Medicare reimbursement rates for urologists to address this issue. LUGPA engages in dialogue with policymakers and legislators to raise awareness of the importance of appropriate reimbursement rates for independent urologists and their patients. By advocating for reasonable and updated reimbursement rates, LUGPA aims to support independent urologists in providing the best possible care while maintaining the financial stability of their practices.

MACRA Reform

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reform, Medicare reimbursement rates, and Medicare fee schedules influence the payment models and incentives for healthcare services, encouraging efficient and high-quality care delivery.

Reforming MACRA is crucial for the program's long-term viability. MACRA's flawed pay-for-performance programs pit providers against each other and fail to drive physicians toward value-based care. The disconnect between the current Medicare physician payment policy and the expenses incurred by independent practices leaves urologists struggling financially, leading to burnout, early retirement, and the physician shortage.

As a group greatly affected by these issues, LUGPA emphasizes protecting physicians by providing stable payment updates that reflect economic realities and healthcare practice costs. LUGPA has submitted comments to Congress on improving MACRA and Physician Payment Reform, recommending:

  • Developing physician-focused payment models
  • Repealing the ineffective MIPS program
  • Providing meaningful payment rewards for high-performing practices
  • Ensuring site neutrality payments to maintain patient access and control healthcare costs

Through these efforts, LUGPA aims to support sustainable physician reimbursement, ensuring independent urologists can continue delivering high-quality patient care.


 

Links to LUGPA Materials:

LUGPA Policy Brief - MedPAC Recommends Linking Medicare Physician Reimbursement to Inflation - December 2024

LUGPA Policy Alert: CMS Finalizes 2025 Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System - Nov 6, 2024 

LUGPA Policy Brief: Medicare Patient Access and Practice Stabilization Act - November 4, 2024 

LUGPA Policy Update - CMS Announces Stability in Medicare Advantage and Part D for 2025 - September 27, 2024

LUGPA Policy Brief: Provider Reimbursement Stability Act (H.R. 6371) - Oct. 2024 

Policy Brief: The Urgent Need for MIPS Reform - Sept. 2024 

LUGPA Submits Comprehensive Feedback on CY 2025 MPFS and OPPS Proposed Rules, Advocating for Independent Urology Practices Sept. 2024 


LUGPA Champions Medicare Payment Reform Following Latest CMS Proposal


LUGPA Policy Overview: New CMS Proposed Rules on the Physician Fee Schedule (PFS) 
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July 2024

Addressing Prescription Drug Costs Through Prescription Drug Affordability Boards - April 2024 

Promoting Payment Parity and Competition in Urology Care - March 2024 

LUGPA Policy Update: The Preserving Seniors’ Access to Physicians Act of 2023 - Dec. 21, 2023

Announcing New Resources on 2024 Medicare Physician Fee Schedule Changes - Nov. 2023 

Medicare Fee Schedules

LUGPA Policy Brief: Seniors' Access to Critical Medications Act - Oct. 2023 

CMS Releases New Interoperability and Prior Authorization Final Rule - January 2024 

Pharmacy Benefit Managers (PBM) Reform 

The Lower Costs, More Transparency Act - December 2023 

Update: No Surprises Act - Aug. 2023 

Monitor Regulatory Implementation of MACRA