Independent urology practices are at a crossroads as they face substantial Medicare payment change, shifts in physician employment and autonomy, and cutting edge developments in clinical care.
Neal D. Shore, MD
Independent urology practices are at a crossroads as they face substantial Medicare payment change, shifts in physician employment and autonomy, and cutting edge developments in clinical care, according to the Large Urology Group Practice Association (LUGPA). The association’s annual meeting, held November 5 to 7, 2015, in Chicago, Illinois, will strike a balance between business and clinical challenges faced by urology practices.
The transition from fee-for-service to value-based care is a key theme of the business challenge section at the meeting. Most payers and providers expect value-based reimbursement to overtake fee-for-service by the year 2020. Value-based reimbursement, which rewards providers for the quality and efficiency of care, not volume, is slowly and steadily gaining a foothold through new care models, such as Accountable Care Organizations and patient-centered medical homes.
Declining payer reimbursement, higher business expenses, increasing involvement in patient care by government and private payers, more aggressive competition, novel treatments and surgical techniques, and patient preferences for comprehensive yet cost-effective medical care are just a few market trends that are currently shaping urologists’ and practice managers’ strategic decisions. In order to thrive, progressive urology practices have been forced to take action.
“At the end of the day, it is important for urologic groups to work collaboratively and to encourage the growing importance of physician subspecialization,” said Neal D. Shore, MD, president-elect of LUGPA, in an interview before the start of the meeting. “The annual meeting will emphasize the importance to maintain the vitality of the independent practice of urology.”
The sea change that is occurring involves not just a shift from a volume-based to a value-based reimbursement system, but includes advances in oncolytic and non-oncolytic therapeutics, device development, and greater use of clinical pathways. “We can best serve our patients through a combination of both clinical and business integration,” continued Shore, who is serving as the chairman of the meeting and is director of the Carolina Urologic Research Center, a division of Atlantic Urology Clinics.
Attendees at the meeting can look forward to joining business-oriented breakout sessions that focus on professional service agreements, in-office dispensing, practice management benchmarking, and tips and advice about applying innovative approaches to business challenges. The keynote address, “US Healthcare Policy Under ACA and Beyond,” will be delivered by Robert Laszewski, president, Health Policy and Associates Inc., of Washington DC. Laszewski was named the Washington Post's Wonkblog "Pundit of the Year" for 2013 for “one of the most accurate and public accounts” detailing the first few months of the Obamacare rollout.
The continuing medical education (CME) portion of the meeting, which comprises a dedicated half-day at the conference, will address testosterone replacement therapy and testosterone suppression strategies—an important clinical issue confronting urology practices, said Shore. The CME course addresses how to optimize testosterone management for both of the hypogonadal and prostate cancer patient populations.
“This year’s CME courses revolve around the warnings, justified or not, about testosterone supplementation and suppression,” said Shore.
Sessions during the CME sessions will focus on testosterone supplementation, including a recent FDA warning letter regarding possible increased risk of heart attack and stroke. This discussion will involve talks from both sides of the argument: John P. Mulhall, MD, Memorial Sloan Kettering Cancer Center, will argue that warning labels are justified while Abraham Morgentaler, MD, Harvard University Medical School, is taking the position that warning labels are not justified.
In the prostate cancer arena, attendees can look forward to presentations on androgen deprivation therapy for men with androgen sensitive prostate cancer. This session will focus on the differences between different types of hormonal therapies, specifically agonists and antagonists. Along these lines, another session will focus on whether urologists should administer novel oral hormonal therapies, such as abiraterone acetate (Zytiga) and enzalutamide (Xtandi). Building on this further, another session will focus on what to do following progression on these agents.
“On the one hand, we are discussing specific recommendations in testosterone supplementation for our hypogonadal patients. But for the prostate cancer patient, we are suppressing testosterone levels in order to thwart their prostate cancer,” said Shore. “This requires a risk benefit analysis for early and late stage prostate cancer patients. There is a plethora of top-level evidence, as well as controversial and conflicting evidence, for both of these patient populations. As the chairman of the program I am looking forward to all these talks.”