Ask the Experts – Mara R. Holton, MD

Expert Perspective
Meeting Highlights From LUGPA 2019
Mara R. Holton, MD

Mara R. Holton, MD

Practice Community: Annapolis, Maryland

Hospital and Institutional Affiliations: CEO/President, Anne Arundel Urology, Annapolis, Maryland, University of Maryland Baltimore Washington Medical Center, Baltimore, and a member of the board of directors of the Large Urology Group Practice Association (LUGPA), where she serves as vice chair of health policy.

Practice Niche: Urology

The Large Urology Group Practice Association (LUGPA) held its annual meeting in Chicago from November 7-9. Former Florida governor Jeb Bush delivered the keynote address, experts debated the pros and cons of independent practices partnering with private equity firms, and LUGPA board president Richard Harris shared results of a 2019 survey the organization conducted of its members. Renal & Urology News discussed the meeting with Mara R. Holton, MD, who sits on LUGPA’s board of directors and is the organization’s vice chair of health policy. An edited transcript follows.

Question 1. What was your impression of the meeting overall?
My honest assessment is that this was the most vital meeting that I’ve been to in the last 3 or 4 years. I think some of that reflects that there are really exciting initiatives going on in Washington to promote independent practice, and we (LUGPA Health Policy and Political Affairs committee) have been both able to be a part of shaping that agenda as well as moving it forward. The national meeting was an exciting opportunity to share those efforts and I left the meeting really invigorated. In addition, there were some really great sessions and speeches pertaining to a number of other topics, from national discourse to micro issues about specific details of practice management. Overall, the sense was that this is a really active organization that is impacting policy and providing guidance for members going forward.
Question 2. Was there a session or speaker who really stood out to you?
Everyone was really, really impressed with Governor Bush’s presentation. I think all of us went home thinking about the state of the Union and what changes could be more positive for the country as a whole. He articulated a national agenda and priorities which were reasoned and thoughtful and his comments about civility, political discourse, and incentive-building resonated with everyone in the room.
[With regard to healthcare reform on the national political stage], I thought that his comments straddled the middle quite nicely, essentially emphasizing that the most radical proposals on both sides are essentially unworkable, which I think everyone knows in their heart of hearts. And I appreciated his comments about identifying key players who have to be included in conversations about how to meaningfully impact change in the healthcare landscape as a whole.
Question 3. What were some of the important takeaways from the Health Policy Forum?
Well, the 2019 meeting opened with health policy and political affairs, which has really been the touchstone of LUGPA’s strategic initiatives for almost the last decade. This year, we have seen some very interesting initiatives coming out of the administration and its agencies to allow independent practices to function in a value-based landscape in a way that is more meaningful, particularly with proposals pertaining to Stark reform. That’s extraordinarily exciting for independent groups, and potentially extraordinarily impactful. And, [it] frankly reflects a lot of foundational work that has been done by LUGPA, both on the health policy side and on the political affairs side, over the last ten years.
Question 4. And your thoughts about the debate on partnering with private equity?
Kudos to the group that produced that compelling video for [Dr E. Scot Davis]. Overall, I think it was a fair, nicely balanced conversation which highlighted some of the meaningful advantages of independent practices allying with capital partners, as well as highlighting some of the potential perils. They really demonstrated that there is no one solution in the current healthcare landscape.
I think there is quite a bit of consternation among independent groups about the implications of private equity. Many are questioning whether they should consider engaging with a capital partner. So, educating ourselves is absolutely critical as we watch the marketplace change and watch investment [by] PE groups increase—and it is increasing. But I also believe that hearing a point/counterpoint like that allows those of us who haven’t fully committed to information gather and to appreciate that there are advantages and disadvantages, and there is no perfect solution. [It’s important to take] a critical evaluation of all strategies.
Question 5. Which breakout sessions about the challenges of running a practice stood out to you?
I think people really found the open mic sessions interesting, because it’s an opportunity for LUGPA members to really take advantage of each other’s knowledge and information and experience. And as much as the policy, lobbying, and strategic initiatives are critical, the foundation of LUGPA is really information-sharing between groups that, despite having different patient groups and geography, often face very similar problems and challenges. Thus, the breakout sessions are always a chance for groups to benefit from communal knowledge and experience. I think those sessions are really appreciated—particularly by the people who are involved in administration and practice logistics, which is something we all struggle with across the board.
Question 6. What did you find most impactful in Dr Harris’s presidential address?
LUGPA is stronger and better every year and our presidents have been extraordinary, in their knowledge base, practice experiences and their tremendous time and energy commitment to growing and building this organization’s utility to the member groups. A clear demonstration of this has been the benchmarking effort, in response to LUGPA groups’ survey response indicating this as a “want.” LUGPA membership has grown, and there was an opportunity to consolidate data from the critical mass of members, and take some of that information and push it out to groups going forward in a way that helps them make strategic decisions and evaluate whether they’re aligned with other groups of similar size and similar focus. This is part of the value-add of membership and reflects the responsiveness of the organization to the needs and wants of its member groups.
Furthermore, Dr Harris made manifest the massive work and commitment to the traditional pillars of LUGPA—lobbying, health policy, and clinical advocacy and the degree to which we all see the benefits of those sustained efforts. Thus, the take away was the indubitable value of an umbrella organization to lobby collectively on our behalf while providing resources and contacts as we grow our practices and better care for our patients in an ever changing landscape.