LUGPA president details decade of successes with eye on future

Chicago-A decade since its founding, LUGPA is looking to the future with ambitious goals aimed at sustaining and strengthening the practice of independent urology.

That was the message of LUGPA President Neal D. Shore, MD, at the association’s 10^thanniversary meeting in Chicago. Dr. Shore detailed 10 years of successes that span LUGPA’s initiatives in advocacy, health policy, practice management, clinical practice, and education.

Originally named the Large Urology Group Practice Association, the group was initially formed to address the specific needs of practices with 10 or more physicians. In 2009, the membership quota was changed to allow associate membership to groups with between five and 10 physicians. LUGPA membership is now open to all independent urology practices in the United States.

“We had a symposium, which was a big deal for us, in 2010, at the AUA [annual meeting],” Dr. Shore recalled. “The AUA recognized the importance of what we were trying to accomplish-that we were striving to ultimately preserve and advance the independent practice of urology, which is our mission statement. Back then, that was… why we were decidedly unique from other urologic associations.”

That mission holds true today, and is reflected in the initiatives that LUGPA has carried out and those planned for the future, Dr. Shore, a urologist in Myrtle Beach, SC, said.

Health policy/advocacy

In 2010, the LUGPA board began recognizing the need to have their voice heard by representatives in Washington. “And there were members of that board who understood the importance of health policy/advocacy and political affairs awareness and the importance of raising revenue so we could have a seat at the table,” Dr. Shore said.

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That same year, LUGPA raised close to $280,000 in political contributions. In the 2017-2018 political cycle, LUGPA groups’ political contributions grew to more than $1 million.

Among the group’s health policy accomplishments was an effort to ensure the accountability of the U.S. Preventive Services Task Force (USPSTF), which had essentially recommended against prostate cancer screening in 2012. LUGPA worked with members of Congress to introduce the USPSTF Transparency and Accountability Act of 2012 (H.R. 5998).

“We were vociferous in getting our message across on the Hill as well as to the entire house of urology and house of medicine,” Dr. Shore said.

A Government Accountability Office report on self-referral for radiation therapy services also drew a strong retort from LUGPA.

“We were able to push back on sometimes spurious articles that would come out from other organizations… that wanted to denigrate the high-quality work that we were doing,” Dr. Shore said. “We have to stave off that internecine warfare.”

LUGPA submitted comments on the Medicare Outpatient Prospective Payment System for the first time in 2015, resulting in a 9% increase in payment, Dr. Shore said.

After comments by LUGPA and a large physician coalition, CMS officially withdrew its controversial proposed rule relating to the Medicare Part B drug payment model, which he said proved to be another example of LUGPA’s resources working for the benefit of the membership’s economic model.

Dr. Shore also credited LUGPA for the first urology-specific electronic Clinical Quality Measure approved by the Centers for Medicare & Medicaid Services, which went into effect in 2018.

“We’re very committed to value-based care,” he said, and this includes the development of alternative payment models (APMs).

LUGPA has long advocated to maintain the In-Office Ancillary Service Exemption (IOASE), which Dr. Shore said allows independent physicians to provide care that is integrative, multidisciplinary, proximal to physician clinics and patients, and affordable. “It goes without saying that we want to do this in a way that optimizes care, with excellent outcomes, or value. That has been a core mission to our health policy.”

Dr. Shore said the IOASE will allow independent practices to participate in reforms under the Medicare Access and CHIP Reauthorization Act, including APMs.

Site neutrality for physician reimbursement is a topic that urologists will be hearing more about very soon. The idea is to make reimbursement a level playing field, regardless of site of service. “If we’re doing the same work as someone else but they happen to be in a large domiciled hospital system, then we’re not getting 50% for the same effort to perform it,” said Dr. Shore.

In another recent legislative development, LUGPA is advocating for the introduction of The Medicare Care Coordination Improvement Act of 2017. This legislation, he explained, would facilitate physician group practice development and participation in APMs by exempting “value and volume” from the fair market value standard; allow practices to use “designated health service” (eg, radiation, pathology) revenue to incentivize physicians on treatment protocols; and empower the Department of Health & Human Services to provide the same waiver authority for all types of APMs that have been provided to the Medicare Shared Savings Program’s accountable care organizations.

Next:Practice management, leadership/young urologistsPractice management

The LUGPA board recognized early on that other associations saw certain initiatives as not necessarily germane to the independent practice of urology. “One of them in particular was the notion that community-based urologists who had the right dedication and the right infrastructure could provide GU oncology systemic therapy,” Dr. Shore said. “LUGPA, assuredly, led that path. It was LUGPA that said, urologists can give systemic therapy and urologists can have advanced prostate cancer clinics, and it’s been LUGPA that has continued in that path as it relates to bladder cancer and kidney cancer.”

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The association has embarked on benchmarking to help practices determine how they are performing internally and against other LUGPA practices. “That has been resoundingly successful for many of us, but we weren’t satisfied as a board. What we’re doing in 2019 is an initiative to make that even better for you because we recognize the importance of benchmarking data,” Dr. Shore told attendees, indicating that more information would be forthcoming.

Leadership/young urologists

A stated goal of LUGPA is to become the go-to organization for information about the advantages of joining an independent group practice after residency or fellowship and provide valued resources for young urologists in independent practice. To that end, LUGPA has created the recently renamed Urology Forward program (formerly Young LUGPA) to identify and engage LUGPA members in practice less than 15 years. More than 400 individuals have been identified since the program launched in 2017.

“Transitioning leadership is key to LUGPA’s future as more-experienced urologists retire,” Dr. Shore said. “LUGPA Forward will ensure the LUGPA mission to preserve and advance the independent practice of urology.”

Leadership at the corporate level of group practices is also critical, he noted.

“The groups that are thriving, the groups that are not feeling threatened, the groups that are secure in what they’re doing are the groups that not only have physician leadership but assuredly have non-physician strong, articulate administrative leadership,” Dr. Shore said.

Education

Another goal, he said, is for LUGPA to be the leader in education, specifically for community urologists. On the clinical side, this includes a partnership with Reviews in Urology, which became the association’s official journal in 2012; launch of regional meetings; annual CME courses; co-sponsorship of the International Prostate Cancer Update meeting; and Prostate Cancer Academy, in which 50 urology residents and fellows meet with 50 LUGPA members to discuss what’s cutting edge in prostate cancer. (Bladder Cancer Academy was launched last year.)

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UroCare Live TV features live broadcasts with audience attendee interaction, and LUGPA OnSite brings LUGPA experts to members’ offices for clinical and business education guidance and solutions, especially related to urologic oncology care.

On the practice management side, LUGPA published its first book, “Practice Management for Urology Groups: LUGPA’s Guidebook,” in 2017.

Clinical practice

A key initiative relevant to current prostate cancer practice relates to active surveillance in the independent practice setting. In 2014, LUGPA received a grant from Genomic Health, Inc. to investigate active surveillance in prostate cancer among LUGPA groups, and data from that study are now available. (See related article.)

The study showed that, in men diagnosed with prostate cancer in the setting of a community urology practice, adherence with active surveillance is good after 3 years of follow-up.

“A majority of urologic care is delivered in community practices, but there is a lack of information about active surveillance management and adherence in contemporary community practice,” said study author Jeremy Shelton, MD. “Our study gives insights into these issues from a large contemporary patient cohort.”