LUGPA continues to champion the independent practice of urology by introducing innovative products, seminars, and services to support its member practices. LUGPA strives to advance both clinical and administrative excellence for the association’s approximately 2300 physicians who are responsible for roughly 30% of urologic care in the United States.
In the first 6 months of 2017, the LUGPA Board of Directors have continued their commitment to innovation, additional resources, educational programs, and services designed to assist member practices and our physician constituency in order to strengthen practice management, advocacy, research, data collection, benchmarking, and patient outcomes. LUGPA’s 2017 initiatives reflect the association’s mission to preserve and protect the independent, integrated model of urologic care. New LUGPA undertakings include those discussed here.
MedReviews, LLC, and LUGPA launched the inaugural Bladder Cancer Academy program on June 9-10, in Chicago, IL. This conference offered LUGPA members a unique opportunity to explore the burgeoning intricacies of bladder and kidney cancer research, and the rapidly evolving approved treatments. During the Bladder Cancer Academy, we presented, discussed, and debated all available preventive, diagnostic, therapeutic, and management options for bladder and kidney cancer; it comprised a diverse and distinguished faculty.
Also new this year, LUGPA introduces its Virtual Cross Fire Education Series. The monthly program’s live, video conference platform offers interactive capabilities with online audience polling and a real-time “Questions & Answers” segment, creating a novel experience among presenters and our online member-attendee audience.
LUGPA’s first live, Virtual Cross Fire discussion and debate, “Developing an Effective Advanced Prostate Cancer Clinic,” is scheduled for June 27, 2017. The new online program is produced by LUGPA in collaboration with PlatformQ Health (Needham, MA). LUGPA’s Virtual Cross Fire series will subsequently be available for on-demand viewing. Select programs will be eligible for continuing medical education credits.
LUGPA appreciates that urology practice clinical and business integration is often heterogeneous; therefore, we are continuing our annual series of regional meetings. The 2017 LUGPA Regional Meetings began in Detroit, MI, continued in Phoenix, AZ, and concluded in Philadelphia, PA. The LUGPA regional meetings provided LUGPA practices a geographically convenient, live, and smaller-scale forum in which to engage peers on a multitude of clinical and business integration topics. We appreciate member support and attendance.
Building on its success in 2016, MedReviews and LUGPA are preparing for the second annual Prostate Cancer Academy. Planned for October 13-14, 2017, in Los Angeles, CA, this educational seminar will combine senior urology residents, urology-oncology fellows, and urologists in a novel educational setting to promote prostate cancer clinical excellence. This 2-day educational session will present the latest developments in diagnosis, evaluation, and management of all stages of prostate cancer. The exclusive educational opportunity is a unique blend of academic and independent urology practice experiences for the 100 individuals who are nominated to attend the event.
LUGPA is pleased to announce the release of Urology Practice Management: LUGPA’s Guidebook. This comprehensive publication is now available for purchase. An electronic version is available free to all LUGPA members. The guidebook is a collaboration of expert advice authored by LUGPA urology specialists and invited experts, and provides invaluable guidance to assist urology practices to efficiently navigate daily and evolving healthcare challenges. The guidebook reviews urology best practices and procedures, and provides insight and instruction on clinical and operational topics that are essential for all member practices.
This year, LUGPA has established a new committee for our membership to explore not only unique and important topics for early career urologists, but also to further explore membership diversity. The committee will focus on physicians in our member groups who have been practicing for fewer than 15 years, and introduce a variety of topics and new initiatives for their leadership development and other areas of innovation.
LUGPA continues its efforts to develop a “Health Data Exchange” in order to benchmark LUGPA member practices. LUGPA has been engaging members, over a 5-year timeframe, in detailed surveys and conference calls, to produce the best benchmarking data reports available about independent urology groups. LUGPA is currently working to collect data for its next benchmarking report and reminds members that LUGPA practices that participate in benchmarking surveys will continue to receive the LUGPA benchmarking data at no cost.
Political advocacy is essential for independent urology groups navigating the ever-changing healthcare landscape. LUGPA has been evaluating and preparing comments on current and potential future healthcare policy that will affect patient and physician access to care. LUGPA Health Policy and Advocacy team efforts have actively engaged on several issues, discussed below.
LUGPA is currently reviewing the recently released US Preventive Services Task Force (USPSTF) recommendation on prostate cancer screening that is a revision of its 2012 recommendations. In summary, the updated recommendation changes the grade for prostate-specific antigen (PSA)-based screening from “D” to “C” for men aged 55 to 69 years. As a result, the USPSTF now recommends that clinicians consider discussing the potential benefits and harms of PSA screening with men aged 55 to 69 years. For men aged 70 years and older, the USPSTF maintained its “D” recommendation that they not be screened for prostate cancer; however, it did not adequately address men younger than age 50 years, which could include higher-risk populations, inclusive of African American men and men with increased hereditary familial risk.
LUGPA strongly opposed the grade “D” rating issued by the USPSTF in 2012, and believes that the recent increase in newly diagnosed advanced prostate cancer with more aggressive biology is due, in part, to those misguided recommendations. Regrettably, patients diagnosed with these higher-grade and higher-stage cancers have less likelihood for cure. Although the change in recommendation from grade “D” to “C” softens the recommendation regarding PSA screening with respect to men aged 55 to 69 years, LUGPA is still concerned about the USPSTF’s continued use of arbitrary age cutoffs in issuing its recommendations, both for younger and older men.
LUGPA has always recommended that patient-physician shared decision making include thoughtful and clear communication with men of all ages who might be at risk for prostate cancer. For patients newly diagnosed with prostate cancer, LUGPA believes a full discussion of all treatment options (including active surveillance and approved interventions) is required.
LUGPA continues its review of the USPSTF draft recommendations and will work collectively with all experts in the field to issue comments reflecting LUGPA’s commitment to the rights of individual men to access appropriate screening services. LUGPA will share with its members our subsequent official comments on the USPSTF draft guidelines and will continue to appraise member practices of any new developments.
Recently, the Physician-Focused Payment Model Technical Advisory Committee accepted LUGPA’s Letter of Intent (LOI) outlining its inaugural advanced payment model (APM) proposal for newly diagnosed, localized prostate cancer. There have been only 17 LOIs submitted nationally to date, and none is genitourinary specific; LUGPA’s proposal is the first in this category. In conjunction with the dedication contributed by LUGPA’s APM and health policy leadership, as well as our strategic partners, we have ongoing dialogue with the Center for Medicare and Medicaid Innovation. LUGPA will be formally submitting this inaugural APM soon. Approximately 60 member practices are participating in ongoing reviews of more than 500 patient charts with combined pathway development exercises. LUGPA’s final APM submission and implementation will not only have robust methodologic evidence, but will also have real-world practicability for urologic care.
The LUGPA APM model proposes episode-based payments for newly diagnosed, localized prostate cancer patients. Evidence-based literature confirms that a subgroup of this population can safely defer or avoid active intervention therapies, thus avoiding or reducing potential attendant morbidities and healthcare costs. LUGPA has proposed an episode-based payment model that aligns incentives for physicians to recommend active surveillance in clinically appropriate patients, allowing these patients to avoid unnecessary interventions. The LUGPA-developed APM will incentivize patient-physician shared decision making, compensating physicians for the management time required to responsibly continue these patients on active surveillance. Benchmarks will be defined based on a hybrid of an individual practice’s historic clinical decision making and regional decision-making patterns, considering prior use of active surveillance and interventional therapies. If total episode spending is less than the designated benchmark, and the practices continue to provide measurable, quality care, then groups will be eligible for a performance-based payment.
Although LUGPA designed the APM with our members in mind, the proposal is designed to allow participation from all urologists, regardless of practice size, affiliation, or ownership of ancillary services. This proposal aligns the financial incentives of urologists with patient-physician shared decision making to appropriately care for very low- and low-risk prostate cancer patients. The LOI can be accessed here (https://aspe.hhs.gov/system/files/pdf/255906/LOILUGPA.pdf). We look forward to the submission of the LUGPA APM, and we will keep our Reviews in Urology audience informed of LUGPA’s progress.
With the evolving transition to value-based care, there is a need to develop novel payment paradigms that align physician compensation with these new practice models. Existing Stark Law is recognized as outdated and counterintuitive to current federally mandated healthcare legislation. LUGPA’s Health Policy and Advocacy team is actively working in a bipartisan fashion to revise the law and allow for a fair and balanced access to care that will assist all healthcare providers and patient clinical outcomes. LUGPA is a key member of a collaborative involving nearly two dozen medical societies that are aligned in these efforts.
LUGPA’s comments on the final Medicare Access and CHIP Reauthorization Act (MACRA) regulations (released October 2016) set forth several suggestions that Medicare and Medicaid Services could consider to ensure that specialty providers and integrated urology practices can participate meaningfully in the Merit-based Incentive Payment System, APM incentive, and other programs under the rule. LUGPA is continuing to monitor the implementation of MACRA and will communicate information to its members on how best to meet the challenges of the new payment system.
I would like to acknowledge the efforts of the LUGPA Board of Directors and all LUGPA Committee members who have contributed their time, expertise, and excellence to successfully complete and continue these programs and projects. Thank you to all LUGPA members for your continued support. As always, I encourage your input and feedback.
