LUGPA, the national nonprofit trade association representing independent urology groups in the US, has issued a warning about the Centers for Medicare and Medicaid Services' (CMS) recent proposal to reduce physician reimbursements as part of the 2025 Medicare Physician Fee Schedule (PFS). This proposal is another significant cut that threatens the financial viability of independent urology practices and patient access to care, according to LUGPA.
The proposed 2025 conversion factor of $32.36 represents a 2.8% decrease from 2024. This component of the PFS is constrained by the legal requirement for Medicare programs to maintain budget neutrality. As a result, any increase in reimbursement for one service necessitates a decrease for another.
LUGPA, alongside other leading physician groups nationwide, has long advocated for an overhaul of this policy because it fails to account for inflation and the rising costs of providing medical care. "Keeping up with rising costs with fixed to lower reimbursement every year is a significant barrier," said incoming LUGPA president Scott Sellinger, MD, of the Advanced Urology Institute in Tallahassee, Florida. "No business can sustain on this financial model, and independent practicing urologists are no exception."
The association said 92% of medical groups are reporting increased operating costs, so these proposed cuts are alarmingly shortsighted. From the 2020 schedule to the proposed 2025 schedule, the MPFS conversion factor has decreased by about 10.33%. However, the average inflation rates have increased costs by approximately 20%, according to LUGPA. The group said the ongoing and cumulative pay cuts are eroding the foundation of independent urology practice. It contends that urologists who are small business owners are increasingly driven towards early retirement or employment by large hospital systems. Under the guise of budget neutrality, CMS has perpetuated this detrimental trend, resulting in increased consolidation and higher healthcare costs, according to LUGPA.
The group has consistently urged Congress to implement stable payment updates that accurately reflect the costs of healthcare practices. LUGPA's Health Policy and Political Advocacy teams are working with other stakeholders to create a unified front and engage lawmakers to push for legislative adjustments to ensure fair compensation. LUGPA members will also meet directly with lawmakers in Washington, DC, to advocate for reforming how Medicare reimburses physicians.
LUGPA says it will continue to promote member awareness and involvement through online and in-person events and ongoing public messaging, highlighting the impending impact on patient care. Urology practices may have to evolve as payment schedules change, Dr Sellinger said. "Large urology group practice is one of the best ways to save money. Virtually every line item, from insurance to supplies, can be less expensive in independent practices with more providers," he said.
The 2025 proposed rule would strengthen primary care, expand access to behavioral health, oral health, and caregiver training services. It allows for maintaining telehealth flexibilities and expanding access for colorectal cancer screenings and hepatitis B vaccinations. However, LUGPA contends that creative solutions are urgently needed. It would like to see CMS and Congress to undertake systemic reform.
"The continued assault on physician reimbursements is unacceptable for all physicians, but it's important to recognize that urology is particularly vulnerable here," said Ruchika Talwar, MD, associate medical director in population health and assistant professor of urology at Vanderbilt University in Nashville, Tennessee. "We have a dire shortage of urologists, particularly in rural America. Those practices, often independently owned, cannot afford to keep their doors open when inflation and overhead costs continue to crush their viability."
Dr Talwar, who also is on the Board of the American Urological Association's Political Action Committee, said unless some of the current policies are changed, there could be considerable patient harm. "The result is a major decrease in access to care," he said. "If Medicare and the federal government do not create a sustainable solution, the urology shortage will only worsen, and our patients will suffer."
Because of factors specified in the law, average payment rates under the PFS are proposed to be reduced by 2.93% in 2025 compared with the average amount for these services in 2024. This amounts to a proposed estimated 2025 PFS conversion factor of $32.36, a decrease of $0.93 (2.80%) from the current 2024 conversion factor of $33.29.
CMS is proposing to strengthen the Medicare Shared Savings Program further, which is Medicare's permanent Accountable Care Organization (ACO) program. For the first time, CMS is proposing to allow eligible ACOs with a history of success in the program access to an advance on their earned shared savings, known as prepaid shared savings. This program encourages investment in staffing, healthcare infrastructure, and additional services for patients on Medicare. It includes nutrition support, transportation, dental, vision, hearing, and Part B cost-sharing reductions.
CMS wants to further incentivize participation in the Shared Savings Program by ACOs that serve people with Medicare who are members of rural and underserved communities by adopting a health equity benchmark adjustment similar to that in the Innovation Center's ACO REACH Model. The REACH Model has been associated with increased safety net provider participation. CMS is proposing to move the Shared Savings Program towards the Universal Foundation of quality measures, creating better quality measure alignment for providers and driving care transformation.
During the COVID-19 pandemic, CMS took action to expand access to telehealth services to ensure patients could continue to access health care. Congress' temporary extension of flexibilities related to payment for many telehealth services is scheduled to expire at the end of 2024. CMS is examining telehealth and its impact on access and quality. Proposals in this year's rule would allow for CMS to maintain flexibilities with telehealth services. The current proposal calls for a permit for certain practitioners to provide virtual direct supervision to auxiliary personnel when required.
CMS is proposing temporary extensions of virtual supervision for a broader range of services when teaching physicians virtually supervise telehealth services provided by residents in teaching settings. Without Congressional action, however, beginning January 1, 2025, the statutory restrictions on geography, site of service, and practitioner type that existed prior to the COVID-19 pandemic will go back into effect. After that date, patients with Medicare will need to be in a rural area and a medical facility to receive non-behavioral health services via Medicare telehealth.