Charlie Jung, MD
Virginia Urology, a practice with specialists in surgery, radiation, and oncology, has grown steadily over 75 years by remaining patient focused. Centered in Richmond with multiple locations along the Interstate 95 corridor, Virginia Urology has always prioritized quality care—not just in the office but outside too—for example, when providing follow-up care. To the physicians, this makes financial as well as ethical sense.
The group encompasses 7 clinics, a dedicated urology hospital, and 2 ambulatory care centers. “We want to grow in a sense that covers all aspects of medical care and make the fragmented healthcare system more cohesive,” Charlie Jung, MD, a urologist at Virginia Urology, said. He added that the group didn’t make it a goal to become a large practice; it just happened that the demand for its services was strong. “We never started acquiring groups for the sake of getting bigger. It was about taking care of patients in the Richmond area.”
In September, Virginia Urology opened the doors of its newest Richmond facility—a 90,000-square-foot treatment center that includes an ambulatory surgery center with 9 operating rooms, an imaging center with computed tomography and MRI, an infusion center, and an expanded pathology department with a molecular diagnostics laboratory. The new center was created from a preexisting structure that Virginia Urology renovated and modernized.
The new facility enables the group to better cover the continuum of cancer care, from initially seeing a patient in the office to following up with diagnosis, surgery, or other treatments to managing care when the patient goes home. Jung says this is how they can best ensure quality care and overcome any challenges presented by poor coordination in the broader healthcare system.
Sometimes ahead of payers’ readiness to cover new treatments, Virginia Urology has found ways to provide the cutting-edge therapy that patients want. Over the past 4 years, the practice has been performing fusion-guided prostate biopsies. A challenge the group ran into when adopting the new technology was figuring out how to efficiently perform the procedure despite the “economic pressures” of the current health system, Jung said. When Virginia Urology first started performing fusion biopsies, payers were not covering the extra time and complicated features involved. Because of this, the practice charged patients a fee for the additional labor, time, and overhead associated with fusion biopsy. This caused problems within the group because the physicians felt that fusion biopsies were important clinically, but on the financial side, the payments didn’t cover all related costs.
“The difference between doing a fusion biopsy and a regular biopsy is that the payments are the same, but one takes a lot longer than the other,” Jung explained. “We made an effort to get payments for fusion biopsies, and we created a payment model for patients to have access to fusion biopsies [in cases of] payers that were not covering them.” Over time, as the procedure picked up popularity among clinicians, some of the larger providers began authorizing payment.
The use of fusion biopsy was so successful at Virginia Urology that the group has gone a step further and obtained certification to perform prostate magnetic resonance imaging (MRI) scans and are purchasing a 3TMRI machine. The practice has also recently hired Afshan A. Ornan, MD, a urologic radiologist who specializes in prostate MRI, to work jointly with Matthew J. Bassignani, MD, Virginia Urology’s head of radiology. Together they will be responsible for reading all the prostate MRI scans. “It’s important to have a radiologist involved because they are crucial in the planning of biopsies. They’re very helpful in marking the lesions and looking for any lesions that could have been missed,” Jung said.
The practice has found ways to coordinate the efforts of physicians so that precious time is saved and attention can be focused on the needs of patients. When reviewing a patient’s disease and treatment options, the physicians at Virginia Urology hold a teleconference if necessary to bring specialists together and then relay their guidance to the patient. This reduces the time a patient may spend waiting to see a variety of specialists, waiting for them to discuss the case, and then waiting for the results. The resulting information is shared with the primary care physician, who then has a thorough discussion with the patient about the cancer diagnosis and treatment options.
One aspect of inpatient care that has challenged Virginia Urology is the lack of control over outcomes when a patient leaves the group’s offices. “There are a lot of things that can go wrong because the people at the hospital are not necessarily under your control,” Jung said. Partnerships with inpatient facilities have enabled Virginia Urology to become involved in the preoperative work-up. When a patient progresses to surgery, everything is finely tuned, he said.
Virginia Urology has a protocol that standardizes postsurgical care: Patients receive consistent guidance on diet and home-based recovery. The practice also has a hospital program for addressing complications of care. All scheduled prostatectomy patients and their caregivers attend a class led by a Virginia Urology nurse to better understand the procedures they will undergo. This helps to manage expectations and ensure better outcomes.
Eyeing the potential to improve receipts, the group is collecting data on hospital admissions, discharges, and surgeries related to complications and protocol adherence. “We think by collecting that data, we can make a presentation to insurance companies for better payment models and for better referrals to our system,” Jung said.
Physicians at Virginia Urology share profits equally, which is rare for groups as large as they are—over 40 physicians across the Greater Richmond area. “Some may see this as a weakness because doctors aren’t compensated for [exceptional] individual work, but I find that it’s actually best for our group, especially as we move forward, because we are able to do large projects and get into new projects without conflicts of interest. You can get the whole team on board, and the team has the same goals as the practice,” Jung explained.