On this episode of BackTable Urology, Dr. Jose Silva and Dr. Jay Simhan, director of reconstructive urology at Fox Chase Cancer Center, discuss how urologists can demonstrate their value to hospital systems.

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SHOW NOTES

First, Dr. Simhan explains the changing nature of urology practice. He opts for the term “health systems urologist” over “private practice urologist” because many urologists are managed by smaller medical groups that are owned by larger hospital groups. He notes that this multi-tiered system of management can cause tension around decision making and increase senior leadership turnover when hospital finances change.

Then, Dr. Simhan explains the four ways that doctors can generate value, which is clinical productivity, departmental service, academics or research, and teaching. Clinical productivity is often measured by the RVU system, which assigns a certain number of value units to a procedure. Hospital systems may encourage urologists to choose surgical procedures over office-based procedures to increase RVUs. Although RVUs are arbitrarily set by the Centers for Medicare & Medicaid Services (CMS), each hospital or medical group can increase the number of RVUs per procedure to their own discretion. Dr. Simhan believes that urologists should band together to negotiate fair RVU systems.

Finally, they end the episode by discussing concrete ways to demonstrate value as a urologist. Generally, minimizing complications and maximizing RVUs is helpful. Dr. Simhan advises urologists who are joining a new system to build their name and referral network to earn a long term contract. Usually, there is no RVU requirement in the first employment contract. In the later years, he recommends putting in the effort to understand productivity metrics and downstream costs and revenues in order to maximize earnings and potential.