Laura Hegwer

As health care reform and payment policies evolve, LUGPA is ensuring that independent urologists have a strong voice in Washington and the resources they need to sustain successful practices, said Richard G. Harris, MD, LUGPA president, at the association’s 2019 

Originally named the Large Urology Group Practice Association when it was formed more than a decade ago, LUGPA is the nation’s only trade association for independent urologists and their practices.

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During his presidential address, Dr. Harris unveiled how the association aims to strengthen independent urology through its 3-year plan, which includes five strategic pillars. Specifically, LUGPA aims to:

“Every one of our pillars helps practice groups and physicians achieve excellence,” said Dr. Harris, a urologist at UroPartners in Chicago.

Dr. Harris credited LUGPA’s health policy and advocacy team for giving independent urologists a voice in Washington in recent months. He pointed to the proposed Stark Law reforms from the Centers for Medicare & Medicaid Services (CMS) as LUGPA’s biggest success this year.

“We were heavily involved in trying to help change that,” he said.

Although specifics have yet to be released, Stark reforms would help independent urology practices participate in value-based payment models, he said.

In 2019, LUGPA representatives also had a productive meeting with administrators at the Center for Medicare & Medicaid Innovation on the proposed Medicare Radiation Oncology model, which would qualify as an alternative payment model under the CMS Quality Payment Program.

The association also continued to press CMS for site-neutral payments under the Outpatient Prospective Payment System.

“If the government and insurers truly want to save money, the future is with us,” Dr. Harris said, citing the potential cost savings associated with outpatient versus hospital care.

To foster the next generation of leaders and help young urologists learn the business of medicine, LUGPA held its first full-day rising chief residents summit this past June. The event covered a variety of topics to help them transition to full-time practice, such as negotiating for a job, evaluating employment contracts, and managing finances, Dr. Harris said.

Dr. Harris also provided an update on LUGPA Forward, the association’s leadership development initiative for urologists in practice for less than 15 years. Established in 2017, the initiative now includes more than 400 young professionals. “They bring a tremendous amount of energy, vision, creativity, and new ideas,” Dr. Harris said.

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He also unveiled a new leadership development program for physicians and administrators that will include in-person and online education.

During his presidential address, Dr. Harris described several projects that LUGPA plans to pursue during the next 3 years, including a benchmarking program and salary survey, to ease members’ operational challenges and ensure organizational excellence.

And even though member engagement was strong in 2019, LUGPA aims to add even more strategies to get practices involved in 2020 and beyond, Dr. Harris said.

“We don’t want this to be just a select group of individuals who are running this,” he said. “We want it to be as open as possible… and get as [much] broad-based involvement as we can from physicians and administrators.”

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As health care reform and payment policies evolve, LUGPA is ensuring that independent urologists have a strong voice in Washington and the resources they need to sustain successful practices, said Richard G. Harris, MD, LUGPA president, at the association’s 2019 annual meeting in Chicago.

LUGPA president: Association will stay vocal in 2020 and beyond

Independent urologists provide the same quality of care for men on active surveillance (AS) for prostate cancer as urologists in largely academic settings, compared with prior studies, according to research presented at LUGPA’s 2019 

“Even in the real world, people on active surveillance are getting equivalent, guideline-appropriate management,” said Jeremy B. Shelton, MD, MSHS, a urologist in Los Angeles who updated attendees on the study.

The LUGPA active surveillance project, which is supported by an unrestricted grant from Genomic Health, Inc., was designed to assess the quality of care that AS patients receive from independent urologists.

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From 2013 to 2014, a research team led by Dr. Shelton and Neal D. Shore, MD, recruited nine LUGPA practices from across the country to participate in the study. In less than 2 years, the team accrued a large cohort of 557 AS patients treated by independent urologists that could be compared with large academic cohorts.

“In very short order, we made a very large, robust, contemporary cohort, which I think speaks to the opportunity of partnerships between researchers and community providers,” Dr. Shelton said.

Earlier research on the LUGPA cohort found that adherence to AS was equivalent to that found in research cohorts from academic institutions after 3 years of follow-up in community practices. For this latest research presented at LUGPA, researchers followed 392 men who were on AS for at least 2 years to understand how closely their care followed National Comprehensive Cancer Network (NCCN) guidelines for AS.

According to Dr. Shelton, researchers found about one-third (32.1%) of LUGPA patients were managed according to NCCN guidelines. This represents a slightly higher compliance rate than the Michigan Urological Surgery Improvement Collaborative (MUSIC), also a community-based cohort, which reported 26.5% compliance with NCCN guidelines.

“The take-home message is that this large LUGPA cohort of independent practices that were not coordinating or comparing AS management plans in any formal way did similarly to the MUSIC cohort in compliance with guidelines during a similar time period,” said Dr. Shelton, who is preparing his third paper with findings from the LUGPA cohort.

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In addition, researchers found that almost all men (93%) treated at the LUGPA practices had at least one PSA follow-up test within the first year of diagnosis. Most AS patients had their first PSA about 3 months after diagnosis, their second PSA about 6 months after diagnosis, and their third PSA about a year after diagnosis, Dr. Shelton said.

The LUGPA research also found that more than 40% of AS patients had a repeat biopsy within 2 years, typically about 1 year following diagnosis. Although this percentage reflects “a fair use of repeat biopsy for that time period,” it still represents a potential area for further study to understand what is driving avoidance of repeat biopsy, Dr. Shelton said. “Understanding practice patterns is what can enable quality improvement, and this was the driving motivation behind the research to begin with.”

Findings from the LUGPA cohort appear to offer a counterbalance to some published research suggesting that community-based urologists might have a financial incentive to manage prostate cancer patients with surgery or radiation rather than AS, Dr. Shelton said. In fact, this latest report suggests that independent and academic practices provide similar care.

“The care given by LUGPA practices is at least as good as what other published studies show,” Dr. Shelton said.

Independent urologists provide the same quality of care for men on active surveillance for prostate cancer as urologists in largely academic settings, compared with prior studies, according to research presented at LUGPA’s 2019 annual meeting in Chicago.

Author | Laura Hegwer

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LUGPA president: Association will stay vocal in 2020 and beyond

Men on AS receive guideline-driven care from community practices