LUGPA President Dr. Goldfischer discusses the challenges facing independent urology

Independent urology continues to face issues including reimbursement cuts and staffing. In this interview, LUGPA President Evan R. Goldfischer, MD, MBA, FACS, discusses goals for his term and also summarizes a session on prostate-specific membrane antigen-positron emission tomography (PSMA-PET) that he led at the 2022 LUGPA Annual Meeting in Chicago, Illinois. Goldfischer is the director of the Research Department at Premier Medical Group in Poughkeepsie, New York.

Evan R. Goldfischer, MD, MBA, FACS

What health policy wins and losses occurred in 2022?

The legislative calendar is not over yet; we're obviously striving to get rid of that 4.4% reimbursement cut. We've also made great progress with extending telehealth to make it permanent. I think we were successful in getting rid of the [ambulatory surgical center] cuts as a result of the Supreme Court ruling this year. We continue to make progress with [Merit-based Incentive Payments system], [Medicare Access and CHIP Reauthorization Act of 2015], and [alternative payment model] reforms and to really build our relationships with the congressmen and congresswomen and with the senators, so that we're going to be even more successful in 2023 and 2024.

Could you talk a little bit about LUGPA's legislative and advocacy goals for 2023?

As you know, Congress somehow every year seems to decrease our reimbursement. If you look back over the past 20 years, hospitals have done reasonably well with reimbursement. I think the Medicare conversion factor about 20 years ago was about $31, which would be about $56 in today's dollars. We're at $33, so we've gone backwards. We have to do better there. We definitely want to make telehealth permanent. We think that's an important part of the practice of medicine now. There's also site payment neutrality. The fact that the same procedure can be done in 2 different places - an ambulatory surgery center/office and a hospital - and have completely different reimbursement rates, makes no sense.

What are the biggest challenges facing independent urology practices?

There's just a lot of financial pressure on us to survive financially, given the reimbursement cuts. In addition, labor shortages face all of us, but particularly in independent urology, we're trying to always maintain a really high-quality staff. There are just not enough people out there. I think just about every urology practice is looking. We want to encourage residents to go into independent urology, but now they're obviously being courted for employed opportunities by academic practices. We want to make sure that independent urology continues to thrive by recruiting new people to independent urology. That's what we're going to try and do.

Could you discuss your goals as LUGPA president?

Obviously, number one is health policy. We've got to be on the Hill, and we've got to do more with state legislatures. That's going to be priority number 1. Number 2 is programming for our independent groups. We have our annual meeting. We have 3 regional meetings. We have Prostate Cancer Academy, we have Bladder Cancer Academy, and we have a Urology Resident Summit coming up in March, just to name a few of the programs that are coming up. Programming is going to be big.

[Another goal is] getting our younger members involved. We have more younger members here at the annual meeting than we've ever had before. We want to make that a priority. We have a group specifically dedicated to younger members called LUGPA Forward. We have a leadership program, which is a formal training program that takes about a year for members to participate in that's completely paid for by LUGPA. So, another goal is membership expansion and engagement of our younger colleagues.

You chaired a discussion on PSMA-PET at this meeting. Could you summarize the key takeaways from this discussion and talk about the value of PSMA-PET to physicians and patients?

Every once in a while, something comes out that's a game-changer. PSMA scanning is definitely a game-changer with regard to imaging and advanced prostate cancer in urology. People are still getting their hands around this new technology because we've only had it since March. Because of the nature of the isotope and how it's made, it's still not available to everybody. Now we're trying to understand what it means when you find these micrometastases in terms of the treatment algorithm. Are you still a candidate for radical prostatectomy? Are you still a candidate for radiation therapy? Or at that point, when you have micrometastases, does it mean hormonal therapy and advanced oncolytics? We're still getting our hands around that, but 1 thing is if you talk to people in the room, the consensus was PSMA scanning is definitely a game-changer for us.