During the annual meeting of the Large Urology Group Practice Association (LUGPA) in Chicago in November 2013, the organization’s president, Deepak A. Kapoor, MD, completed his 2-year term and handed the gavel to incoming president Juan A. Reyna, MD.
Urologists in Cancer Care sat down with both leaders to learn about the successes and challenges LUGPA experienced during Kapoor’s term in office and the issues expected to take center stage under Reyna’s direction.
Kapoor is chairman and CEO of Integrated Medical Professionals, PLLC, in Melville, New York, and Reyna is with Urology San Antonio.
Deepak A. Kapoor, MD
Dr. Kapoor: Proud to Have Increased Organization’s Membership
UCC: What were the biggest issues you tackled during your term as LUGPA’s president?Kapoor
: One of the things I’m most proud about is that, over my 2-year term, membership has grown by close to 30%. At this point, more than a quarter of all urologists in the United States are LUGPA members, and nearly one-third of independent practicing urologists are in groups that are members of LUGPA. The greatest challenge we’ve been facing is the profound uncertainties that exist around the future of health care. We’re trying to cope with the changes that the Affordable Care Act is going to bring, but so many of the changes are so vague. We also have the continual uncertainty associated with the Sustainable Growth Rate, or SGR issue.
As the private sector is trying to cope with the healthcare exchanges and the expansion of the Medicaid program, urologists have the additional burden of dealing with the myriad changes that are going to be coming down in the Medicare system; in the average urology practice, 45 to 55 percent of patients are covered by Medicare, with the exception of certain subgroups such as pediatric urology. As a consequence, some of the regulatory changes in the Medicare system are of real concern. But we’ve been extremely active in Washington to tell the story of what our member groups can bring, especially in terms of providing tremendous access on a community level in an affordable and high-quality venue. Getting that message out has been extremely important for us.
The other great challenge we’ve seen is the mischaracterization of integrated, comprehensive health care. Unfortunately, this has occurred because medicine is a zero-sum game: If urology practices are providing services [such as radiation therapy, imaging, and laboratory services], that means other people are no longer providing those services. For a urology practice, these business lines enable us to control the quality of services needed to provide care for our patients, but they are extensions of our core skills. For other specialties, that’s all they do, and in an attempt to protect their revenue streams, they’ve resorted to gross distortions to attempt to recapture lost market share via legislative fiat. In the course of that debate, we’ve needed to combat misinformation about our use of in-office ancillary services. Fortunately, physicians in both chambers of Congress have recognized the importance of preserving patient access to these services.Your organization is composed mainly of large urology groups, and there seems to be a trend toward smaller groups across the country merging and growing. What will this trend mean to the independent practice of urology?
Regardless of practice milieu, every urologist fundamentally has more in common with any other urologist than with physicians practicing in other specialties; therefore, our needs are extremely similar to each other. These synergies enable us to develop group practices in which we can practice at a very high standard while simultaneously reducing overheads through shared economies of scale. When you look across the United States, anywhere in the country where there’s enough population density to support group practice integration, you have seen LUGPA groups develop, often becoming dominant players in their market. It’s very important that people understand that having a large share of the market is not a violation of any type of antitrust rules. In fact, if you’re behaving in a pro-competitive fashion, market share is something that can be very positive and productive. It enables you to deal with third-party payers to ensure that compensation is fair and reasonable, prevent predatory hospital systems from limiting access to genitourinary services, and, most importantly, standardize services across a region to ensure that our specialty is practiced in accordance with the highest medical and ethical standards.