"If you build it, they will come," became a catchphrase thanks to the 1989 movie "Field of Dreams." For the founders of The Urology Center of Colorado (TUCC), it was more than just a saying.
The Urology Center of Colorado
In 2003, urologist Richard Augspurger, MD, and healthcare administrator Bob Asinof developed a plan to create a singlesite, full-service urology practice. So they began pitching their vision to individual practices in the Denver area.
“Bob and I saw where medicine was headed, and we knew that large-group practices were the future,” said Augspurger, TUCC’s medical director. “We wanted to be big enough that we could capitalize projects, because it’s very difficult to do that in a small group. We also wanted to offer the highest-quality care to our patients, and one of the best ways to do that was in a single location. Finally, we wanted to offer integrated ancillary services to our patients and capture the revenue [technical fees] that we were previously sending out.”
“We wanted to create a center of excellence where all outpatient urologic care could be provided in one facility,” explained Asinof, Chief Executive Officer of TUCC. “We knew we had to find land to build the center. We did that at the start. If the groups and individuals put money in the real estate early on, there would be no turning back.”
Two Colorado-area practices, Colorado Urology Associates and Western Urologic Associates, merged to form TUCC, and in 2006, the center opened the doors of its 60,000-square foot facility, offering Colorado urology patients what Asinof called a “one-stop healthcare experience.”
Urologists in Cancer Care spoke with Asinof and Augspurger about the practice’s history and how such a large group manages to stay at the top of its game. In addition, Eric Gross, MD, TUCC’s radiation oncologist, offered his perspective on the advances his field has made in treating urologic cancer.TUCC includes radiology, laboratory, and pathology services; a urologic cancer treatment program including robotic surgery and radiation therapy; a clinical research department led by Lawrence Karsh, MD; and an ambulatory surgical center. The practice has 16 physicians and four allied health professionals, plus over 100 employees and support staff.
The practice has also established the TUCC Foundation to support its community outreach programs such as “The Blue Shoe Run for Prostate Cancer,” an annual 5K run/walk fundraiser for prostate cancer research and community screenings.
How does a major organization like this run smoothly? Constant communication facilitated by having everyone in the same place.
“We have a lot of interaction between our physicians, which make us very culturally strong as a practice,” Augspurger said. “It’s not just a collective of physicians, working out of multiple locations, practicing medicine without any input for their colleagues. We really work collaboratively.”
Those united efforts include an executive board that meets monthly to develop the practice’s game plan. There are also several subcommittees that manage TUCC’s clinical programs, operations, and marketing.
Patient undergoing image-guided radiation therapy with a linear accelerator.
It’s in urologic cancer that TUCC has refined its group-effort strategy. First, they have an in-house tumor board that includes urologists, pathologists, and radiologists, as well as medical and radiation oncologists. “A medical oncologist from one of the largest cancer treatment centers in the state holds office hours at our facility twice a month,” Augspurger said.
TUCC also formed a committee focused on castration-resistant prostate cancer and consisting of the research director, urologists, the medical oncologist, and a reimbursement specialist. “Our physicians are able to present their prostate cancer cases to this panel, which helps figure out the next step: Is this patient a candidate for a trial? Is he a candidate for a treatment like Provenge? Then, we make recommendations based not only on what’s best for patients clinically, but also what’s most cost effective,” Augspurger said.
“Starting in April, we’ll invite patients’ primary care physicians (PCPs) to attend the committee meetings to get their input,” he added.
This approach allows TUCC to find balance between meeting the expectations of their patients—who may want access to any and all treatments, regardless of the cost—and a healthcare system that demands more and more accountability.
Richard Augspurger, MD
“On the whole, patients are responsive to our recommendations, especially after we tell them that we presented their case to our review committee for their input and expertise,” Augspurger said. “And it helps us ensure that we are offering the highest quality care that still meets the goal of containing costs.”Gross came to TUCC in 2008 after completing elective rotations at the MD Anderson Cancer Center in Houston and Memorial Sloan-Kettering Cancer Center in New York City. As a radiation oncologist, he’s seen the tremendous advances the field has made in cancer care.
“With radiation therapy, we’ve been able to transition away from having to perform major, potentially disfiguring surgery,” he said. “We saw that shift most dramatically in breast cancer, and we’re now seeing it happen in urologic cancers.”
He cited image-guided radiation therapy (IGRT) and brachytherapy as two modalities that have altered the treatment of prostate cancer, and he anticipates that radiotherapy will soon become more common in the treatment of bladder cancer.
“With bladder cancer, [radiation therapy] has a role in bladder sparing, although it’s more commonly used overseas,” he said. “The standard of care in the United States is radical cystectomy, but the data show that you can use chemotherapy and radiotherapy just as effectively.”
But when asked what he considered to be one of the most striking advances in urologic cancer care, Gross did not cite a specific treatment. “What I think has been very groundbreaking has been our shift away from intervention toward more surveillance,” he said. “The role of surveillance has become more prominent in early-stage prostate and testicular cancer.”
Given the scrutiny that medicine now faces from government agencies and payers, the “less is more” approach is one way that practices can avoid accusations of overutilization. Another is to keep a keen eye on outcomes, Gross said.
Eric Gross, MD
“Our approach is to manage and present our outcomes data. I think that’s key for any practice that is going to survive in this volatile healthcare market,” he said. “If a practice is able to produce data and show that it has consistently practiced responsible medicine using evidence-based guidelines, it has a much better chance of surviving.”With the passage of the Patient Protection and Affordable Care Act (ACA), TUCC is potentially looking at a much larger patient population. Rather than waiting to see how the ACA plays out, the practice has gone on the offensive.
Asinof explained that the group has reached out to the two largest PCP practices in Denver to discuss how TUCC can better meet the needs of their patients.
“It’s no longer just about treating an individual patient; we now have to look at treating populations of patients,” he said. “In the Denver area, we have over 2 million people. The PCPs control most of our patient flow, especially for urologic cancer care. At the same time, cancer care has become very expensive and we have to find ways to cut costs. We’re talking about strategies we can use to work together more efficiently and effectively.”
Cancer survivorship is another issue that TUCC has embraced, especially for its younger patients with testicular cancer who are looking at a long life after a highly curable disease. “There are a lot of considerations with this population,” Gross said. “Are they candidates for surveillance? What’s their socioeconomic status? Are they likely to change jobs? How will that impact their healthcare benefits? Do they want to have a family? Given the life expectancy of these patients, we want to help them focus on their overall health: cardiovascular disease, obesity, smoking cessation, and nutrition.”
Stephen Ruyle, MD, meets with a patient in one of TUCC’s exam rooms.
TUCC is also looking to bring more physicians to the practice, including specialists in female urology. While they’re aware that recruitment will not be easy given the current shortage of urologists and the trend for physicians to bypass private practice for “safer” jobs such as hospital or healthcare system employees, the TUCC team is primed to go the distance.
“We have to make ourselves attractive to someone who is finishing residency and may be saddled with medical school debt, so he or she doesn’t feel overburdened by what it would take to join the group,” Augspurger said. “We are in the process of pursuing avenues to meet that challenge.”