As my LUGPA presidency comes to an end, I am gratified that I can look back at our Association’s unparalleled growth and success over the past 2 years. We have witnessed LUGPA make significant strides in member growth and services, acquisition and expansion of in-house staff capability, healthcare policy and advocacy, and practice benchmarking and management.
Our Association has grown to represent more than 25% of practicing urologists across the country who are dedicated to advancing value-based medicine by preserving and protecting the independent, integrated model of urologic care. LUGPA physicians provide more than 30% of the total urologic care in America; our Association now boasts 139 member groups, 2100 physicians, and 130 administrators.
During the past 2 years, our internal operations have strengthened. LUGPA has become one of the only national urology organizations with its own full-time staff. The addition of our first Chief Executive Officer, Celeste Kirschner, and Marketing Communications Specialist, Maureen Lyons, has boosted our capabilities. Celeste has led our Association through rigorous strategic planning sessions to ensure that LUGPA is looking toward well-aligned development and growth. She has helped our Association overcome obstacles and is working hard to turn LUGPA into the full-service association that our members require. LUGPA staff work together with our member-driven committees, contracted management company, and LUGPA’s legal, advocacy, and communications consultants in Washington, DC.
These past 2 years have been pivotal for LUGPA and the independent urology practices we represent. We celebrated monumental legislative and regulatory achievement in advancing value-based payments, neutralizing hospitals’ longstanding economic incentive to grow at the expense of independent medicine, and stabilizing reimbursement for a variety of urologic services.
LUGPA has witnessed the passage of more affirmative legislation for independent urology practices over the past 2 years than we have previously seen in more than 20 years. Our legislative victories validate LUGPA’s extensive efforts in the political and policy fronts. Congress is actually taking notice of LUGPA’s extensive engagement with critical issues related to independent urology and medicine.
LUGPA coordinated its grassroots and political resources with the larger medical community, resulting in Congress passing the Medicare Access and CHIP Reauthorization Act (MACRA) in April 2015, which repealed the hopelessly flawed Sustainable Growth Rate (SGR) formula. LUGPA’s role in helping pass MACRA was specifically cited by Congressional leadership. As important as it was to move away from the outmoded SGR model, the equally significant long-term impact of MACRA for independent urology is future participation in Alternative Payment Models (APMs), which represent wholly new payment systems in which each physician practice takes on financial risk for managing the care of a patient population. We at LUGPA believe that our practices are uniquely positioned to succeed in the upcoming era of value-based reimbursement.
The MACRA victory helped to continue to put LUGPA on the radar in Washington, DC, and made policymakers aware of LUGPA’s enthusiasm for the emerging paradigm of value-based care. Helping pass landmark legislation such as MACRA might normally have been more than enough to celebrate. However, since MACRA’s passage approximately 1.5 years ago, we have benefitted from a series of additional regulatory and legislative victories.
In mid-2015, LUGPA and its allies persuaded the Centers for Medicare and Medicaid Services (CMS) to back away from many proposed reimbursement cuts that could have devastated independent urology practices, including cuts to radiation therapy, extracorporeal shock wave lithotripsy, and laser procedures for benign prostatic hyperplasia.
Then, in late 2015, the Bipartisan Budget Act was passed, which contained “site of service” language that we believe will help level the playing field between hospitals and independent practices. As a result of this legislation, hospital-acquired physician practices will no longer be eligible for increased reimbursement (for providing exactly the same services as they did before they were acquired!) if they are not physically located on a hospital campus.
LUGPA also played a central role securing passage of the Patient Access and Medicare Protection Act in December 2015. The Act effectively froze radiation reimbursement at current levels for approximately 2 years. The freeze provides predictable reimbursement while LUGPA develops APM bundles for radiation services in collaboration with CMS.
Reacting to changes in the healthcare policy has become the new normal as we work through a dynamically changing policy landscape. We have been engaging in a host of additional policy issues that have the potential to impact patient care and independent urology:
Beyond health policy, LUGPA has advanced in many other ways over the past 2 years. I wish to highlight some of these.
LUGPA has significantly increased networking opportunities for our members as we established LUGPA regional meetings in 2015 and 2016—LUGPA Integrated Urology Practice Forums. Regional meetings provide LUGPA practices a geographically convenient, intimate forum in which to engage in dialogue with peers regarding the challenges of practice today. LUGPA regional meetings will continue in 2017.
LUGPA’s 2016 Annual Meeting, held in November 2016, garnered record attendance, increased media attention, and received very positive reviews from membership and invited attendees. The general sessions of the LUGPA Annual Meeting were outstanding, as we heard from leading health policy experts nationally regarding MACRA implementation and the future of healthcare in general. This year’s LUGPA continuing medical education course, Optimizing Bladder Disease Management, provided attendees a comprehensive look at the newest development for both bladder cancer and voiding dysfunction.
In addition to our regional and annual meetings, the inaugural Prostate Cancer Academy, a jointly sponsored conference by LUGPA and MedReviews, LLC (New York, NY), was held in September 2016, in Denver, Colorado. The educational seminar was offered to senior urology residents, urology oncology fellows, and early-career urologists. This is part of LUGPA’s emerging effort to reach out to residents as well as younger physicians in the independent urology community.
LUGPA has implemented a new Political Affairs Committee to better streamline our advocacy efforts. The Political Affairs Committee will work hand-in-hand with the Health Policy Committee and will focus on fundraising and Congressional Champion Development fly-ins to allow our members to interact directly with members of Congress and other policy makers, and participate in grassroots political activities. We encourage all of our members to become involved in LUGPA’s advocacy efforts.
LUGPA’S clinical and financial benchmarking project allows groups to report data so that they can measure their performance against that of others across a host of metrics. This type of feedback is crucial for groups that wish to elevate their performance. The data include procedural information, physician demographics, practice data, and financial metrics. The LUGPA Benchmarking Project is among the most extensive urology benchmarking databases anywhere. As the data have become more robust, we have seen more participating groups than ever over the past 1 to 2 years.
LUGPA is joining forces with Integra Connect to pioneer the development of multiple urology-specific APMs. It is imperative, as we shift from a fee-for-service reimbursement model to one of value-based care, that we drive the development and validation of urology-specific APMs. Currently, there are virtually no eligible APM options for urology, but CMS recognizes the need for specialty-specific APMs and is creating a process by which stakeholders can develop and submit specific APM models for review and approval. To benefit from an APM, providers need integrated clinical and financial systems to monitor treatment pathway adherence and quality metrics, patient outcomes, and practice costs. LUGPA is currently developing two APMs for which we need independent urology practice involvement: Prostate Cancer Biopsy Taking Risk on Sepsis, and Positive Biopsy/Localized Prostate Cancer. LUGPA hopes to develop six APMs over the next several years.
LUGPA’s member satisfaction rates are outstanding, which is a source of great pride for our organization. In a 2016 member survey, 87% of LUGPA members indicated they are satisfied with their LUGPA membership, 96% of our members plan to continue their practice’s LUGPA membership, and at least 75% participate in LUGPA meetings or events or keep updated through LUGPA communications.
Much like large consumer companies and other trade associations, LUGPA monitors its net promoter score (NPS). The NPS is a key indicator of member satisfaction, as it measures whether members would recommend membership to their colleagues.
LUGPA’s NPS in 2016 is the highest measured NPS ever recorded by our survey consultant for a trade association!
The LUGPA Board of Directors is in the process of implementing a new affiliation category for membership (Emeritus) that will allow retired LUGPA physicians or administrators to remain affiliated with the Association. Emeritus members will receive LUGPA communications, gain access to the LUGPA website, and will be able to attend LUGPA meetings and events. In addition, Emeritus members may be appointed by the LUGPA president to serve on LUGPA committees.
The 2017-2019 LUGPA Strategic Plan was developed by the LUGPA Board in August 2016 with an emphasis on advocacy, benchmarking projects, and assisting urology practices to succeed under value-based care. New initiatives will include efforts to promote leadership development among LUGPA’s physicians and administrators, and an increasing focus on reaching out to residents and young urologists in LUGPA groups.
In order to survive, urology groups will need to continue to consolidate to achieve the scale and market presence required to succeed in today’s healthcare landscape. However, simply consolidating into large groups is no longer enough to ensure success and survival as an independent group. LUGPA groups increasingly need to shift beyond consolidation to an emphasis on increased integration—both business and clinical—if they are to survive in the value-based world that is emerging.
LUGPA has become the premier urology organization committed to preserving and advancing the independent practice of urology. LUGPA is increasing its presence and scope continuously, and is fully committed to assisting LUGPA groups in their journeys from consolidation to integration over the next several years.
It is with gratitude that I thank the LUGPA membership for their support during my 2-year term as LUGPA President. I am certain that our successes together will continue and be amplified under the capable vision and leadership of Neal Shore, MD, as he assumes the role of LUGPA President this fall.
