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    LUGPA announces urology-specific APM

    While support for medical research is a major concern for Dr. Shore, he noted that physicians must deal with the reality of how they are paid for their services to Medicare beneficiaries. Thus, in April, LUGPA announced a new urology-specific Alternative Payment Model (APM) for newly diagnosed, localized prostate cancer.

    Developed by LUGPA under the Medicare Access and CHIP Reauthorization Act of 2015, which ended the sustainable growth rate formula for Medicare reimbursement, the new APM would make it possible for urologists to be reimbursed based on the value, rather than the quantity, of services provided.

    “There is a recognition that historically we have over-treated many patients who may benefit from active surveillance as opposed to active intervention therapy, such as surgery,” Dr. Shore said. “Assuredly, there are many patients who should have active intervention therapy, but we need to do a better job of encouraging the physician in a value-based model so we can get a management fee to provide the right treatment to the right patient at the right time.

    Read: Hospital ratings correlate with Ca surgery outcomes

    “Under our model, there would be better health care provided to patients throughout the country as well as cost savings to the entire health care system. There are provisions to assure high quality is accomplished. There is a monthly fee to help encourage the most appropriate resource utilization of treatment. All advanced alternative payment models are predicated on high-quality patient-physician shared decision-making.”

    The new LUGPA APM is to be submitted to the Physician-Focused Payment Model Technical Advisory Committee, which advises the Secretary of Health and Human Services on such proposals. The approval process is complex and could take some time before it is completed, Dr. Shore said.

    “But LUGPA believes that this model will optimize outcomes, increase patient satisfaction and reduce utilization of unnecessary services, while simultaneously decreasing health care costs,” he said.

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    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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