As the 2021 annual meeting of the Large Urology Group Practice Association (LUGPA) gets underway, Renal & Urology News interviewed the association’s president, Jonathan Henderson, MD, Chief Executive Officer for Regional Urology in Shreveport, Louisiana, for an update on major trends impacting urology practices and LUGPA’s advocacy efforts amid the political changes in Washington DC.

What are your priorities for the coming year?

Dr Henderson: Over the next year, I plan to reengage groups after the past 2 years of isolation and financial strain; actively engage the remaining independent groups who are not yet members of LUGPA; continue to interact with legislators and regulators to level the field in site-of-service; and persist in efforts to keep urologists fee schedule equitable.

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In the year since the last annual meeting, has the landscape for independent urology practices changed?

Dr Henderson: I have no surprise answer here. The landscape has changed in a similar fashion for any business operating in COVID. Keeping staff has been a challenge at times. As to patients, we are now absolutely overwhelmed. No one knows if this is a limited time COVID catch up or we are just coincidentally starting to see the front edge of the silver tsunami. The only real urology-specific change has been the increased number of employed urologists. The financial strain of COVID was the initiator here. The other response was increased practices being acquired by private equity. In my opinion this is the far healthier response in cases of financial distress.

Although urology practices appear to have rebounded in terms of caseloads from the height of the pandemic in March-June 2020, do you think COVID-19 has led to permanent changes in how independent urology practices operate?

Dr Henderson: The only real substantial change has been the widespread adoption of telehealth. This is not specific to urology, but I must point out this has been wildly popular with patients.

Will the shift to Democratic control of both houses of Congress and the White House change LUGPA’s advocacy efforts?

Dr Henderson: Not much. We have always been very even handed with regard to political party. Our health policy team has wisely developed relationships with the people who are now in positions of leadership, so we have a voice in DC. The really interesting thing has been that even accounting for the transition of power, DC has been really silent on health policy until the past few weeks. Now, though, in the past couple weeks, we have a dump truck emptied at our front door by the administration with the MPFS [Medicare Physician Fee Schedule], OPPS [Outpatient Prospective Payment System], Part D drug price changes, Part B drug pricing changes, etc. The good news, again, is that our health policy team has positioned themselves well to evaluate and respond.

What legislative actions at the federal level, if any, in the past year have been favorable to independent medical practices?

Dr Henderson: We have been very happy with the support in DC to level the site of service differences. The SCOTUS [Supreme Court of the United States] granted our writ of certiorari in the AHA [American Hospital Association] challenge to site neutrality. That was a huge win. The result of that is evidenced in the ongoing change of attitude throughout the government to eventually pay one price for one code regardless of the site of service. This will support our model of health care delivery: we do it faster, better, cheaper. Everyone wins under the LUGPA model. Another big win is the adherence to hospital price transparency, for the same reason.

Are there any recent trends that you foresee having a negative or positive effect on independent urology practices?

Dr Henderson: The obvious trend has been the increase in practices partnering with private equity. As I stated earlier, this is the healthy response to financial strain, rather than selling to a hospital. The other notable trend has been a dramatic increase in utilization of APPs [advanced practice providers] in our practices, which I believe has been a wonderful addition for both our practices and patients. Lastly, out of necessity, our groups are adhering more tightly to business principles, utilization review and pathway adherence. And for the most part these are good things.