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What Lies Ahead in Urology

Raoul S. Concepcion, MD, FACS
Published: Friday, Nov 30, 2018
Raoul S. Concepcion, MD, FACS

Raoul S. Concepcion, MD, FACS

Medicine is becoming increasingly complex. The data and information that need to be processed by a provider in order to care for patients continue to increase daily. When this pressure is combined with the growing demands placed on our time to satisfy all the regulations that have been thrust upon us by the government and payers, it is no wonder physician burnout is becoming more common and driving many into premature retirement. This early exodus compounds the preexisting shortage that many specialties anticipate will worsen over the next decade. As the general population continues to live longer due to advances in care and nutrition, an increasing number of patients require medical care, so much so that providers who remain will be inundated with more and more patients. With diminishing payment and concomitant mounting overhead, this vicious cycle of early retreat will continue as providers are no longer able to effectively manage all of these patients and still provide the quality of care that we all strive to deliver, our patients deserve, and payers mandate. It is the patient who ultimately loses in this scenario.

From my vantage point, there are a few things that urologists need to consider in order to be successful in this new model, especially those in larger groups that can facilitate this paradigm shift:
  1. Encourage subspecialization within your practice. Driving patients toward providers that have clinical interest and a passion for a particular disease state should enhance care, promote better outcomes, and improve patient satisfaction.
  2. Develop standardization/pathways of care, based on current guidelines, and, more importantly, monitor compliance with the guidelines. For those who are noncompliant, be willing to enforce penalties to maintain the group culture.
  3. Begin to develop true outcome metrics to support your pathway design. As we know, many of the metrics that are currently deployed are process measures. For a starting point, we should define limited metrics that can be measured easily.
  4. Encourage data aggregation. We all falsely believe that our individual group’s data are worth the barrel price of oil charged by the Organization of Petroleum Exporting Countries during the oil embargo crisis of the early 1970s. Respectfully, groups need to rethink this. The value of data is dependent on who is buying, what questions are being asked, and whether there is sufficient volume and geographic representation.
With large urology practices currently managing thousands of patients across many disease states, the more we can agree to pathway adherence, outcomes tracking, and compliance and develop a comprehensive plan for data sharing, the more successful we can be as a specialty moving forward.
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