When the founding partners of Chesapeake Urology Associates (CUA) in Maryland decided to merge their practices, Sanford J. Siegel, MD, CUA’s president and CEO, drew inspiration from another consolidation process.

“I read a lot about American history and I looked at the birth of this country,” Siegel explained. “If you look at this country under the Articles of Confederation, each state was very autonomous, which led to a weak central government. It wasn’t until the states came together under the Constitution and had a single purpose that the United States started to blossom.”

With that vision in mind, Siegel, then running a smaller version of CUA, joined forces with Thomas B. Smyth, MD, of Maryland Urology Associates, and Brad D. Lerner, MD, of Urologic Surgical Associates to form the current version of CUA in 2006.M

The practice now has 14 urology centers and 16 surgical centers in the state, and is staffed by 43 urologists, one urologic pathologist, four radiation oncologists, a dozen physician assistants, two nurse practitioners, and 400 additional employees. Smyth is CUA’s vice president, while Lerner is the clinical director of the CUA-affiliated Summit Ambulatory Surgical Centers.

Looking back, Smyth called the full-scale merger “the most important decision we made as a group... to fully integrate our practices, financially, operationally, and even culturally. We could have said, ‘You need to adopt all of Chesapeake Urology’s methods while you need to take on Maryland Urology’s way of doing things.’ But we made a decision to take a risk...we didn’t merge incrementally.”

The idea of integration has continued to be one of the keys to the practice’s success. Urologists in Cancer Care talked with Siegel and Smyth about the challenges they faced making CUA into a unified practice, some obstacles they’ve overcome, and what the next stage is for the group in the post–Affordable Care Act [ACA] era. Our editors also spoke with one of newest members of the practice about the future of urologic cancer care.

Caregivers in a Corporation

It’s become trendy for business entities to refer to their employees as “family,” but Siegel doesn’t see it that way. “I don’t call them employees or family members; they are caregivers. Our strength is in the fact that everyone believes in our vision, which is to provide a superior patient experience.”

While the CUA physicians no doubt agreed with that vision in theory, obtaining buy-in to some of the practicalities of becoming a large group practice was another matter. One of the main challenges was getting the physicians—a group Siegel described as “healthy skeptics” who prefer to be their own bosses—to accept a new professional framework.

For instance, Smyth recalled that within a year of the merger, the physicianleaders realized that they needed to invest in administration to manage operations, finance, marketing, and human resources.

“That was tough for our physicians to swallow initially,” he said. “They said, ‘You [physician-leaders] are doing great. We are about to turn a corner, why do we need to invest in all these new people?’ It was huge leap of faith for all of us.” That leap paid off as it freed up the physicians to focus on their goal of superlative patient care. CUA is “first and foremost, a business, and we run it like one with a strong infrastructure that can support the growth, which is a part of our ongoing strategy,” Siegel said.

The group experienced the unpleasant side of doing business when a series of newspaper articles suggested that CUA had significantly boosted the number of Medicare prostate cancer patients it referred for intensity-modulated radiation therapy (IMRT) after investing in its own IMRT machine (Washington Post, February 28, 2011; Baltimore Sun, January 17, 2012).