Urology practice change coming in the form of new alliances, accountable care organizations

Any one of these milestone events could potentially determine the country's approach to health care delivery. Together, they create unprecedented uncertainty among the entire medical community.

Urology Times asked urologists around the country how-and if-they're preparing for potential changes to the health care system that may come this year. Are they making any major changes, such as expanding or downsizing their practices? Or are they marking time until the dust settles? Most of the urologists we spoke with are embarking on practice-changing moves, including forming new alliances with area hospitals or other practices and gearing up for participation in accountable care organizations (ACOs).

"Within the last year, I went from being a solo practitioner to merging with another urology group, a radiation oncology group, and a medical oncology group to make a multispecialty group," Dr. Rudnick explained. "We did this, in part, to position ourselves to take part in the accountable care organizations we presume are coming and to align ourselves with the major health care provider who runs our local hospital.

"It also opens up ancillary revenues that weren't available to us before; we can now offer radiation and CT scans, and we've been able to improve our contracts based on the size of our group.

"We felt that combining into a bigger group would help secure our income and help us pool resources to deal with compliance issues such as electronic medical records. We're able to spread the salaries of our technology staff over a larger number of doctors."

New hospital partnerships

"We are forming cooperative undertakings with the hospital," Dr. Gorelick said. "Some things we used to do for the hospital and the community as a service, we are now asking the hospital to consider compensating us for, such as covering the emergency room 24 hours a day, 7 days a week, 365 days a year.

"In some cases, the hospital will hire us for our services, or they may compensate us in a different fashion, such as providing services as a group. For instance, we're going to hold catheter education training for the entire nursing and house staff of the hospital. This should improve the quality of care for the patients and decrease the need for us to be called in at 2:00 AM, but it will take time.

"We also man the indigent urology clinic for the city of Danbury that the hospital runs," Dr. Gorelick added. "In the past, we've done that gratis. The hospital gets some compensation from the state; not much, granted, but we've never gotten anything. Now, because of the economic pressures, we're going to get a small stipend for running the clinic."

A practitioner for 23 years, Dr. Gorelick says it's not as much money as the physicians make in the office, but at least it's something. They are also adding some projects to the mix.

"We've never done clinical research, but the hospital wants to get into that," he said. "So they're going to set up the infrastructure, research nurses, and all of that, then one of our physicians will act as principal investigator and our physicians will partner with them.

"It will be a win-win for both groups. The hospital has a certain vision of where health care is going. With President Obama's ACOs, the hospital knows that in order to take on risk contracts, they want quality, responsible physician groups that practice high-quality, cost-effective medicine to partner with. It should help us because right now they don't subsidize us at all, yet we do all of our surgeries in the hospital."