Despite reimbursement trends, urologists can regain financialcontrol

As all practicing urologists know, shrinking reimbursement for urologic services has become the norm. But current market forces actually favor the specialty, and urologists can take control of their financial future - as long as they are willing to take a handful of forward-thinking steps.

That was the message yesterday from Michael J. Naslund, MD, who addressed senior residents during the Career Pathways in Urology meeting, a practice management primer for senior residents. Physicians, including urologists, are partly to blame for declining reimbursement rates, but that doesn't mean nothing can be done, he said.

"We have continued to take care of patients and offer our services at lower and lower prices," said Dr. Naslund, of the University of Maryland School of Medicine, Baltimore. "Effectively, what doctors have done is, by accepting these lower rates, we have set the market price lower. They key is to structure ourselves into large, dominant groups to where we think we have the market power to say no.

"Once we do, prices will go back to fair market value."

In addition to forming large physician groups, urologists need to take three additional steps, Dr. Naslund said: capture revenue from ancillary patient services, such as ambulatory surgical centers, lithotripsy, pathology/lab services, and imaging; drop low-paying health plans; and become politically active through lobbying and contributions to UROPAC, the urology political action committee.

The supply-demand relationship currently favors urology, he told the residents. An aging U.S. population and new technology used to diagnose and treat urologic conditions are helping to drive demand. And contrary to what some might think, the current supply of urologists is also in their favor, according to Dr. Naslund.

"In most cities at least, urology supply-demand is balanced. There is not a shortage. Some are saying there is. I absolutely strongly disagree with that."

Dr. Naslund's message was not lost on meeting attendee Mark Memo, DO, chief urology resident at Akron (OH) General Medical Center.

"What it demonstrates is that you've got to have a progressive thought process in the way you approach your practice," Dr. Memo said. "For us to have the ability to maintain a nice, comfortable living, we have to focus on some of these ancillary revenue-generating services."

Career Pathways is an annual event run by the American Association of Clinical Urologists.