Budget Proposal Focuses Discussion of Physician Self-Referral Reform

New Budget Encourages Participation in APMs

Chicago, IL, February 16, 2018 – Earlier this week, President Trump released a proposed budget for 2019, which included several proposals that impact independent physician practices. Two of the outlined proposals will directly impact LUGPA practices: the first proposal eliminates the regulatory burden of physician self-referral regulations for practices participating in alternative payment models (APMS), a topic on which LUGPA has persistently advocated, while the second proposal requires prior authorization for certain ancillary services. The following statement can be attributed to Neal D. Shore, MD, FACS, president of LUGPA, the leading voice for urologists in independent practice:

LUGPA applauds the White House for its 2019 budget proposal that calls for legislation to eliminate burdens placed on physicians and streamline the regulations surrounding self-referral for physicians participating in advanced payment models (APMs). This proposal would protect practices eagerly awaiting the opportunity to operate under alternative payment models by enacting a new exception to physician self-referral laws for independent practices participating in an APM.

The Medicare Care Coordination Improvement Act introduced with bipartisan support in the House and Senate last year would do just that. The bill, supported by LUGPA, enhances the ability of independent practices to operate under alternative payment models and waive prohibitions in the Anti-Kickback Statute. This will enable physician practices to align incentives for value-based care and allow patients to access high-quality services at the location of their choosing. LUGPA strongly supports H.R. 4206 and S. 2051 – we urge Congress to take swift steps to enact The Medicare Care Coordination and Improvement Act and to reject the incorrect assumptions regarding self-referral in the President’s budget. Doing so will remove the red tape that bars physicians from delivering comprehensive, patient-centered care in a value-based reimbursement framework.

LUGPA believes the President’s proposal to require prior authorization is unnecessary and will raise costs. According to a 2015 study from Milliman and the American Medical Association[1] expenditures for ancillary services are marginal in independent practices as compared to hospital settings, with data consistently showing that ancillary services provided in independent practices cost less and are growing more slowly. This study reinforces findings from an earlier study published in the Journal of the American Medical Association (JAMA) that found spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups[2].

LUGPA is optimistic about the encouraging steps Congress and the Administration are taking to equip physicians with the permissions necessary to provide high-quality services to patients.

LUGPA is a trade Association that represents independent urology group practices in the U.S., with more than 2,300 physicians who make up more than 25 percent of the nation’s practicing urologists, and provide more than 30 percent of the total urologic care in the U.S. The Association is committed to providing the best resources and information for its member practices through advocacy, research, data collection and benchmarking efforts. LUGPA advocates for independent urology practices by promoting quality clinical outcomes, fostering new opportunities and improving advocacy in the legislative and regulatory arenas. For more information, visit lugpa.org.

[1] American Medical Association, Milliman Study, March 2015 https://www.ama-assn.org/practice-management/medicare-office-ancillary-services-exception

[2] Delivery system integration and health care spending and quality for Medicare beneficiaries.

McWilliams JM, Chernew ME, Zaslavsky AM, Hamed P, Landon BE.

JAMA Intern Med. 2013 Aug 12;173(15):1447-56. doi: 10.1001/jamainternmed.2013.6886.