Oregon Urology Institute
The cornerstone of the Oregon Urology Institute (OUI) business model was kidney stones: In 1997, two separate practices, Oregon Urology Specialists and Urology Healthcare, joined forces to start a lithotripsy service.
“That joint venture helped build a lot of trust between our two practices,” explained Bryan Mehlhaff, MD, medical director of what is now known as OUI. “Then we started talking about building a clinic that we would own together. For a short period of time, we functioned as two parallel groups but practicing in the same space. Little by little, we started merging our billing, scheduling, and clinical functions… then formally merged into OUI.”
Headquartered in Springfield, Oregon, the practice boasts 15 physicians and five physician assistants. Its services include an imaging center, a surgery center, pathology lab, a physical therapy program, and a radiation center that is dedicated solely to prostate cancer treatment.
Although OUI is the dominant provider of urology care in the area, this large urology practice isn’t immune to the economic challenges in light of the recent changes in healthcare, such as the implementation of the Affordable Care Act (ACA), wrangling over the high cost of care, and meeting the demands of a growing patient population.Urologists in Cancer Care
spoke with Mehlhaff and retired physician Robert Litin, MD, about how OUI is adapting its well-established practice to an ever-shifting healthcare landscape.
Robert Litin, MD
The Prostate Cancer Challenge
The screening and treatment of prostate cancer has been the subject of intense debate and controversy in recent months. Many feel the field faltered when the US Preventive Services Task Force (USPSTF) came out with its recommendation in 2011 that healthy men should no longer have PSA measurements as a screening test for prostate cancer. However, tremendous strides have been made in the treatment of advanced prostate cancer, including the immunotherapy sipuleucel- T (Provenge) and the therapeutic agent abiraterone acetate (Zytiga). Despite the controversy in this area, Mehlhaff has strived to make a difference in the treatment of prostate cancer at OUI.
“I’ve been the champion of treating advanced prostate cancer in our group. It took a while to educate my partners on the new treatments and convince them that those patients don’t have to go straight to the oncologist. So I’ve made it a mission to help my group look at the treatment opportunities that we have here,” he said.
But these treatments come with significant price tags that may seem to put urology at odds with the current ethos of cost-cutting in healthcare. However, Mehlhaff pointed out that, unlike other cancers, therapeutic options in prostate cancer have come about at a slower pace.
Bryan A. Mehlhaff, MD
“There hasn’t been as much development in prostate cancer as there has been in colon cancer or breast cancer, for example,” he said. “Both those disease states currently have a lot of very expensive, but effective, therapies associated with them. In some ways, we are just catching up in urology in terms of what we can offer prostate cancer patients. So at this point, these treatments seem very expensive, but if you compare it to the cost and efficacy of common treatments for other cancers, the costs are not out of the ballpark.”
Not that OUI advocates a “treat all comers” approach. “Our job here is to do what is best for our patients, and that doesn’t mean that every patient should get the most expensive and aggressive therapy,” Mehlhaff said. “I recently had a very elderly patient who expressed interest in Provenge. With his array of other medical problems, I didn’t feel he was an appropriate candidate for that treatment. Instead, we looked at oral therapies for him. I think using our clinical knowledge is the best way to implement cost control.”