Michael Barkoukis, MD
Michael Barkoukis, MD, and Tim Sidor, MD, started SouthWest Urology of Cleveland, OH, in 1982 from scratch with $100,000 in borrowed capital, a box of pens, and a copy machine. Both men grew up on the west side of Cleveland, and both ended up at Case Western Reserve University in the same medical school class. Both aspiring urologists were accepted into a residency program at the University Hospitals in Cleveland, and as their training progressed, they decided to begin a urology practice together. “I had looked at several other jobs in the Cleveland area, but I felt that there was a niche on the southwest side of Cleveland,” Barkoukis said.
From those humble beginnings 35 years ago, the successful practice has grown to include a main office in Middleburg Heights, 5 additional locations, a team of 9 urologists, and a support staff of 60 full- and part-time employees, including 20 surgery center staffers.
The greater Cleveland area in Cuyahoga County is dominated by hospital groups that offer oncology treatment, among them the Cleveland Clinic and University Hospitals, but SouthWest has become the largest independent urology practice. “We’ve tried to differentiate ourselves from the larger academic centers, and we would like to continue to do that,” said Lawrence A. Gervasi, MD, CPI, medical director of clinical research and director of SouthWest’s advanced prostate cancer clinic.
Integrated Model of Care
SouthWest is proud of its level of integrated service. The practice has urologists who specialize in roboticassisted surgery, erectile dysfunction, the diagnosis and treatment of advanced prostate cancer, and women’s urologic health. Their diagnostics department has imaging capabilities that include computed tomography scans and state-ofthe-art magnetic resonance imaging (MRI) fusion biopsies. SouthWest also has an in-office drug dispensary. The physicians follow a model that encourages physicians to work as team players, rather than trying to do everything themselves, according to Claudio Zanin, MBA, CEO of SouthWest Urology.
“I’ve seen a lot of different compensation models that focus more on productivity—and the more you work, the more you make. Our model lends itself to quality, where a doctor sees a patient, explains the situation, and refers the patient to someone who is really good at doing the procedure,” Zanin said. Because the practice offers all aspects of urological care, a collaborative culture fostered by the integrated model is crucial to taking care of patients, he added.
The comprehensive, integrated care at SouthWest helps the practice to compete with the diversity of offerings at hospital systems as Cleveland Clinic, said Barkoukis, who is president of SouthWest and clinical professor of Urology at Case Western Reserve University. “A lot of our patients like the idea that they can pull into a local neighborhood parking lot, come into the building and see their doctor, have their x-ray performed in the same building, and have their surgery.”
However, when it comes to systemic chemotherapy, the practice does not have a medical oncologist to manage patients on this treatment, so patients must be referred elsewhere. To resolve this, the practice is considering hiring a medical oncologist to bring that area of care to their practice. The only oncology service they do not have avaialble is pediatric oncology.
For the last 10 years, SouthWest’s main office has been in Middleburg Heights, which has its outpatient ambulatory surgery center and imaging centers on the first floor, offices on the second floor, and the research center on the third floor. They also have 5 satellite offices, 1 in Medina, OH, 1 in Brook Park, OH, 1 at St. Vincent Charity Medical Center in Cleveland, and another at Marymount Hospital in Garfield Heights, OH.
Partnerships Providing Quality Care
The company is able to obtain experimental treatments for patients through a collaboration with a company that manages clinical trials. “We have a unique situation where we work with a company that’s called Clinical Research Solutions. They supply the clinical research coordinators, and I do the physician’s part, recruiting patients for trials,” said Gervasi. A few years ago, when SouthWest first decided to do clinical trials, they realized that outside expertise would be critical to managing the program effectively.
The challenges for an independent practice running studies can pile up quickly, practice members said. Revenue for studies is not booked consistently, and funding may have to come from the practice itself to cover interim costs of staffing and resources. If a practice should make a mistake in their administration of a trial, they may never get paid or be able to cover all the costs involved in running a study.