Member Census Shows LUGPA Practices Exhibit High Level of Innovation, Sophistication, and Growth

LUGPA News Member Census Shows LUGPA Practices Exhibit High Level of Innovation, Sophistication, and Growth Scott B. Sellinger, MD,1 Neal D. Shore, MD, FACS2 Board of Directors, Chair, Membership Committee; Advanced Urology Institute, Tallahassee, FL; 2President, LUGPA; Atlantic Urology Clinics, Myrtle Beach, SC 1LUGPA [Rev Urol. 2018;20(2):94–97 doi: 10.3909/riu0805] © 2018 MedReviews®, LLC T he future is bright for LUGPA urology groups, regardless of practice size, and this is reflected by the results of a recent member survey. The survey demonstrates that LUGPA member practices exhibit a remarkably high level of clinical and administrative innovation and integration within a healthcare system that is fraught with complexity. LUGPA conducted a focused survey of its member groups in late 2017 to better understand the groups’ existing services to patients. The survey also served to identify opportunities for LUGPA to provide members with innovative education, consultative services, and beneficial products to advance and preserve the independent practice of urology. A remarkable 88% of member practices responded. In total, we collected valuable, detailed data from 129 LUGPA practices, covering topics from the use of advanced practice providers to expanded service offerings. LUGPA’s dedication to its mission to preserve and advance the independent practice of urology is a full-time commitment. LUGPA Group Practice Size Although some observers of health care may associate LUGPA with very large urology groups, our survey showed that nearly half of the groups responding to the survey employ 10 physicians or fewer (Figure 1). LUGPA welcomes all independent urology groups as members regardless of the number of physician members. Opportunities for Growth: Urogynecology, Advanced Practice Providers, Scribes, Telemedicine, and More Our survey revealed that only 8 of the 129 groups responding (6%) employ urogynecologists in their practices. The demand for urogynecology services continues due to an expanding aging population that enjoys an enhanced life expectancy. It is estimated that more than 30% of women are affected by urogynecologic disorders during their life.1 Unmet needs for female patients may represent a unique opportunity for further expansion of services in urology groups. 94 • Vol. 20 No. 2 • 2018 • Reviews in Urology 4170018_07_RIU0805_V2_ptg01.indd 94 9/11/18 5:22 PM LUGPA News (71%) currently receive pay for oncall availability. Careful analysis by groups to determine their market position relative to receiving on-call pay should be undertaken. Groups should consider the multiple factors influencing the likelihood of compensation and pay rates in the local market. As the healthcare system continues its evolution, new options should be explored to manage emergency department call coverage. 70 60 Number of Groups 60 50 40 32 30 18 20 10 10 0 10/2 11 to 20 21 to 30 5 4 31 to 40 41 to 50 51/1 Number of Urologists Mean 22 urologists per practice Median 11 urologists per practice Mode 6 urologists per practice Figure 1. LUGPA group practice size. Although the use of advanced practice providers (APPs), such as physician assistants and nurse practitioners has increased over the past several years, opportunities for LUGPA groups to expand their workforce capabilities are numerous. Fifty-seven groups (44%) had no physician assistants employed within their groups. Those practices that did include physician assistants as part of their workforce (56%) employed an average of three APPs per group. The majority of LUGPA groups surveyed (62%) did not employ any nurse practitioners. Of those groups that did employ APPs, an average of 2.5 nurse practitioners were employed per group (Figure 2). Although the use of scribes to assist physicians in medical record documentation and electronic health record (EHR) charting has been more widely used in other specialties, information about the use of scribes in urology has been lagging. In our survey, 41% (53) of the groups reported that they used scribes. This represents an opportunity for urology groups to examine whether the use of scribes could be an option to provide improved administrative efficiency and thus clinical optimization while also serving as a respite for EHR fatigue for their providers. Despite interest in telemedicine nationwide, the utilization of tele-urology services appears to be in its infancy. Only 9% (11) of LUGPA groups reported the provision of any telemedicine services. Telemedicine has been one of the key topics discussed at the 2018 LUGPA Regional Meetings, with attendees expressing a great deal of interest in the use of telemedicine to expand their practice’s services capabilities. Although hospital call agreements can be a headache for some, of the 129 respondents, 91 practices Integrated Care Models Prove Successful One of the hallmarks of many LUGPA groups is the successful integration of services and resources for efficient delivery of patient care. To that end, it is not surprising to find that approximately 70% of the practices surveyed currently have in-house laboratory and pathology services. The provision of these services greatly reduces turnaround time and improves continuity of patient care, providing an advantage over non-integrated systems.2 While only 17% of the responding practices have an advanced bladder cancer clinic, an impressive 50% have developed an advanced prostate cancer clinic; and this number should continue to increase as more groups embrace the importance of advanced genitourinary cancer clinic models. Given the number of practices having prostate cancer clinics, it is laudable that 44% of the responding practices have a multidisciplinary model that includes both radiation services and radiation oncologists. Fifty-six percent of the practices surveyed provide in-office dispensing of drugs, which also correlates with the number of practices offering advanced cancer clinics. Vol. 20 No. 2 • 2018 • Reviews in Urology • 95 4170018_07_RIU0805_V2_ptg01.indd 95 9/11/18 5:22 PM LUGPA News continued (A) 60 57 27% (35 groups) Number of Groups 50 73% (94 groups) 40 Yes No 30 22 19 20 Figure 3. LUGPA group expansion plans. 10 0 8 0 1 2 3 3 3 4 5 5 6 4 7 2 1 1 1 8 9 14 27 Number of Physician Assistants Number of Nurse Practitioners (B) Mean 3 physician assistants Median 1 physician assistant Mode 0 physician assistants 14 13 12 Imaging 10 8 8 6 7 6 5 4 4 3 2 2 0 Given the continued demand for urologists, it is noteworthy that nearly one-third of the LUGPA practices that responded to the survey currently participate in teaching or training residents and fellows, thereby assisting the development of our future urology workforce. Of the 129 respondents, 35 groups (27%) indicated plans to expand; most of those groups planning to add one, two, or three additional clinics (Figure 3). 1 0 2 3 4 6 8 8 10 19 20 49 Number of Groups Mean 2.5 nurse practitioners Median 1 nurse practitioner Mode 0 nurse practitioners Figure 2. (A) Number of physician assistants employed by LUGPA groups. (B) Number of nurse practitioners employed by LUGPA groups. With an aging and expanding US male population, the number of patients diagnosed with benign prostatic hyperplasia, prostate cancer, incontinence, and impotence will continue to increase. Improvements in next-generation imaging and therapeutic devices have augmented the development of minimally invasive techniques in urologic care. Imaging advances have had a major effect in the areas of diagnosis, surgical planning, and therapeutic assessment of urologic diseases. Eight percent of the responding practices provide MRI services, 70% provide transrectal ultrasounds, 62% provide abdominal/renal ultrasounds, 57% provide scrotal ultrasounds, 55% offer CT imaging, 42% offer x-ray imaging, and only 21% provide DEXA scan services (Figure 4). Electronic Health Records With innumerable choices in EHR vendors, there are a wide variety of 96 • Vol. 20 No. 2 • 2018 • Reviews in Urology 4170018_07_RIU0805_V2_ptg01.indd 96 9/11/18 5:22 PM LUGPA News 80% 70% 70% 62% 57% Percentage of Groups 60% 55% 50% 42% 40% 30% 21% 20% 8% 10% 0% MRI Transrectal Abd/Renal Scrotal US US US CT X-ray DEXA Type of Imaging Figure 4. LUGPA groups that offer imaging services. 16.28% 29.46% systems in use by LUGPA groups. Nearly one-third of LUGPA groups (29%) reported using UroChart HER (IntrinsiQ Specialty Solutions, Springfield, MO). An unexpected finding was that 15% of the groups reported using more than one EHR vendor in their practices (Figure 5). Independent urology groups of all sizes can benefit from LUGPA membership. Although all these integrated services may not be within the reach of all groups, the learning and networking opportunities that LUGPA groups have available with their membership are extremely valuable and provide ample opportunities for groups seeking to maintain their independence and thrive in the complex healthcare market today. For information on LUGPA membership, visit www.lugpa.org. References 6.98% 1. 1.55% 13.18% 2.33% 7.75% 2. 6.98% 10.08% 16.28% 10.85% 0.78% 3.10% Kirby AC, Luber KM, Menefee SA. An update on the current and future demand for care of pelvic floor disorders in the United States. Am J Obstet Gynecol. 2013;209:584.e1-584.e 5. Porter MM, Lee TH. The strategy that will fix health care. Harvard Business Review website. https://hbr. org/2013/10/the-strategy-that-will-fix-health-care. Accessed July 2, 2018. 1.55% ALL SCRIPTS 16.28% APRINA 6.98% CENTRICITY 13.18% CERNER 6.98% ECLINICAL WORKS 10.08% EMD 1.55% EPIC 3.10% GREEN WAY 10.85% ISALUS 0.78% MERIDIAN 16.28% NEXTGEN 7.75% OTHER/NOT SPECIFIED 2.33% PULSE 1.55% UROCHART 29.46% Figure 5. Electronic health record systems in use by LUGPA groups. Vol. 20 No. 2 • 2018 • Reviews in Urology • 97 4170018_07_RIU0805_V2_ptg01.indd 97 9/11/18 5:22 PM