At the annual meeting of the Large Urology Group Practice Association (LUGPA) in Chicago, Illinois, Deepak Kapoor, MD, Gary Kirsh, MD, John McManus, and Tracy Spicer explored a range of issues impacting health policy during a panel discussion moderated by Richard Harris, MD.

Dr Kapoor began by detailing a list of wins and setbacks that LUGPA has had in advocating for pricing and reimbursement policies with the Centers for Medicare and Medicaid Services (CMS). Many of these were around evaluation and management coding changes. “CMS put up a series of proposals that will enable us to simplify the degree of record-keeping and rely more on the integrity of physicians and the amount of time spent on the cognitive aspects of what we do, as opposed to just clicking boxes to meet coding levels,” Dr Kapoor said in an interview after the forum. “While we may have lost a couple of codes, in terms of making the lives of physicians easier and aligning the notion of volume and value…this was a tremendously successful year for us.”

When the panel turned to its next topic, Dr Kirsh said “it’s hard to open a newspaper today and not see something about drug pricing.” Early in his term, President Trump expressed interest in linking drug pricing to an international pricing index, but that proposal ultimately went nowhere, Dr Kirsh said. Reform could involve taking a hard look at how providers are paid by Medicare Part B, which covers medically necessary procedures, including drugs to treat cancer. Dr Kirsh said that he thinks tweaking Part B’s average sale price (ASP) program — in which providers can charge the drug’s ASP, plus 4.3 percent — would be a start. “Policymakers don’t like the notion of a fixed markup,” Dr Kirsh said, but capping the markup at a certain price point could have drawbacks in terms of access to care. Spicer added that working with patient advocacy groups on these issues has been promising. “We’re starting to turn the tide” with their help, she said.

The panel then turned to the topic of reforming the so-called Stark Law, which was originally passed in 1990 and has been updated with phased rulings by CMS several times. In lobbying for reform, Kapoor said, LUGPA has taken a unique approach with a combined “interplay of health advocacy and policy.” The approach has paid off in the form of exceptions for group practices to Stark; in particular, Dr Kapoor highlighted the new designation of value-based enterprises, which are granted an exception in part thanks to LUGPA’s work. “This is absolutely game-changing, it’s truly remarkable,” Dr Kapoor said. The reform was “fueled by continued interactions by doctors” with lawmakers. Dr Kirsh explained that Eric Hargan, the deputy secretary of the Department of Health and Human Services, has been “absolutely clear” in his commitment to reforming the Stark Law. “The people at [Health and Human Services] are some of the most friendly to independent urologists,” he quipped.

The panel agreed that a major concern moving forward involves site neutrality. The fact that hospitals are often paid more for performing the same service than an independent urologist is allows the hospital to leverage its pricing, creating unfair competition, Dr Kirsh said. He added that CMS “has taken upon itself through rulemaking to really push the envelope” of expanding site neutrality to include more providers and reduce billing disparities. The American Hospital Association fought back in court, however, and site neutrality is far from settled. Noting that federal judge recently denied CMS’s request to stay an earlier ruling that declared site neutrality unlawful. Dr Kirsh said there’s still work to be done; “as an organization, one of the topmost priorities is to continue to chip away at that disparity.”

References

Kapoor D, McManus J, Spicer T, Harris R. LUGPA Health Policy Forum. Presented at: LUGPA 2019 Annual Meeting; November 8, 2019; Chicago, IL.

United States District Court for the District of Columbia. American Hospital Associate, et al (Plaintiffs) v Alex M Azar II, Secretary of the Department of Health and Human Services (Defendant). Civil Action No. 18-2841 (RMC).