What is your practice doing to enhance its income?

Dr. Spitz“We’ve been exploring options for enhancing our practice income for quite some time. We added a pathology laboratory; we have a partnership in a lithotripsy unit. We also perform microwave thermotherapy procedures in our office. We’ve expanded our practice into a new geographic area with a couple of new urologists, and we are looking at expanding our contracts with payers for patients in the new area.

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We sell a minor amount of nutritional supplements, and are considering reselling generic sildenafil, because it’s a better product than is generally sold as generic, and for the same price. We are considering developing a men’s center and a women’s center, and we are exploring developing a telemedicine component to our practice.

We decided not to do radiation therapy, CT scans, or MRI imaging because we don’t have the patient volume sufficient to support those treatments as the reimbursement for them decreases steadily.

These are all interesting endeavors that give us an added dimension to our practice, but it’s unfortunate that we have to do these things in order to assure the continued survival of our practice, rather than choosing to do these things as additional areas of professional interest. It is sad we cannot sustain our livelihood on traditional patient care alone. We have to divert our attention to these other means of revenue; it’s too bad that straightforward patient care cannot be a sufficient model for successful private practice.”

Aaron Spitz, MD
Laguna Hills, CA

NEXT: “Anyone in private practice is trying to find ways to enhance the bottom line."

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“Anyone in private practice is trying to find ways to enhance the bottom line. Urology, unlike some specialties, can’t usually incorporate things like laser surgery or Botox injections; that’s outside of what we do. But we’re always looking at whether we could modify hours, evaluating what revenue comes from office hours versus hospital time, whether it’s consults or surgery. We’re looking at referring groups that we can enhance relationships with or start new relationships with.

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It’s an ongoing process, not just establishing new sources of revenue but enhancing current revenues and managing overhead. Medicine has been changing constantly over the last 20 years I’ve practiced-downward pressures on reimbursement from insurance companies, increasing state and federal regulations.

Now, the biggest challenge I see is maintaining or forging a private practice of urology in the face of the corporatization of American medicine-the formation of larger medical groups, particularly ACOs, and the type of relationship you develop with those groups because you don’t want to be caught outside of referral patterns, whether they’re multispecialty groups, ACOs owned by larger entities, such as hospitals, insurance companies or, even, as in my area, private venture capitalists that have started practice groups. They can influence their flow of referrals.

Being a primary referral specialty, we have to be cognizant of what’s going on, not just in urology but with our primary referrers. If you do it correctly, you have the numbers to negotiate better reimbursements. The challenge in a large city like where I live is to have multiple referring alliances.”

Nathaniel Barnes, MD
Houston

NEXT: "We’ve never gotten into products; we feel queasy about it."

“We’re looking, but don’t like a lot of the ideas. So much is gimmicky. We’ve discussed things like urodynamics. That’s a waste of time, at least for us. We’re a small practice; we don’t accept insurance, so we’re not typical. We don’t have the volume that people who accept insurance do. Many things good for a larger practice don’t fit our smaller practice. We’ve never gotten into products; we feel queasy about it. We don’t participate with Medicare, although we accept Medicare patients.

We cut a couple of staff positions-I think we had too many for a while-that’s a money saver.

There are many things we could do, but they don’t fit our practice because we don’t have the volume to justify them. We’ve gotten away from things like female urology and a lot of incontinence surgery. We’ve decided to focus on general urology. We do a lot of radical prostate surgeries, bladder cancer, etc.

If you’re going to opt for newer technology, you have to practice on a larger scale than we do. We didn’t see any advantage in the robot, so we avoided it, and that put a crimp in our practice because everybody demands that now. Manufacturer reps agree. They said, ‘You don’t have enough volume to make it worthwhile for us to even teach you how to do the robot.’

We’re just practicing and taking what comes in. We’re not overworked, but were happy. We’ll probably practice this way until it’s time for each of us to retire. Then we’ll just hang it up.”

Nicholas Constantinople, MD
Washington

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