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Major Trends Affecting Urology Practices in

the U.S.By Brighter Health Network

www.BrighterHealthNetwork.com

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Urology Practices – Background Info

• No. of practicing urologists in 2015 - 11,990 • No. of U.S. practicing urologists has been steadily declining and is now at a

30-year low.• An aging urology workforce - The median age of practicing urologists in the

United States is 55 years. Over 7% of urologists are older than 70 years and 44% are older than 55 years

• Urologist-to-patient ratio : 3.7 per 100,000 people (ratios vary, depending on location)

• Overall, 92% of clinicians are men; however, 18% of those younger than 45 years are women. In addition, 83% of practicing urologists are white, about 13% are Asian, and just over 2% are black.

• Nearly 63% of practicing urologists in the US are in private practice (including solo, single urology or multispecialty groups)

• In the United States, 62% of counties do not have a single urologist• Oncology Most Popular related fellowship

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Consolidation

• Urologists experiencing many changes within their specialty.

• A Urology Times survey reported –

– Solo practice declined from 37% in 2006 to 29% in 2012.

– Those who joined single and multi-specialty practices increased from 57% to 71%.

• Urologists see work-life balance and higher compensation as the main advantages of being employed by healthcare facilities and joining bigger practices. It also decreases their financial risk, administrative responsibilities, and practice management burdens.

• For a list of the largest urology practices in the U.S., see http://www.bhnco.com/Resources/largest_urology_practices_in_unitedstates.html

Urologists in Solo Practice2006 = 37% 2012 = 29%

Urologists in Group Practice

2006 = 57%2012 = 71%

Source: Urology Times Survey

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Changing Personal Preferences

Choosing employment over private practice is a growing trend

• Cost, administrative pressures send more into hospital employment, large groups

• Multispecialty has a built-in referral base which lowers total workload on urologists

• Employment does take some of the burdens of running a practice off physicians’ backs

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The Solo Urologist Conundrum

• Solo and private practices have undeniable appeal, with biggest attraction being autonomy.• But it also has major challenges, such as:– EMR challenges and problems adopting latest and greatest EMR Systems– Reimbursement models don’t take the true administrative and practice costs into

consideration. – Difficulty finding referral sources and as existing referral sources join group practices this

becomes increasingly difficult– General feeling is that urologists are working harder and making less. By analyzing work

relative value units (RVUs) in a number of smaller urology groups, it has been verified that they have had an approximate 10% decrease in income while generating the same number of work RVUs. Large groups have been able to generate more RVUs under similar market pressures and therefore remain an attractive model over smaller urology groups.

– Can’t support radiation therapy and other capital intensive services without being part of larger group practices

– Can’t achieve efficiencies and cost reduction through economies of scale an scope. For example, there is limited ability to reduce duplication of backroom administrative functions.

– Solo Urologists have limited access to clinical integration with like-minded folks which hinders their ability to learn from others and improve value and patient experience.

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Regulatory Uncertainty

• Urologists’ concerns relate almost universally to rapidly evolving U.S. health policy and the challenges it entails.

All related to Regulatory environment

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Aging and Demographics

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Benefits in Large Urology Group

Benefits in employment and large group practice :

• Can share information among doctors in the group practice• Able to integrate the delivery system.• Being in a larger practice allows urologists to share financial

risks and practice burdens, and offers economies of scale.• Better reimbursement (actually ranked third among reasons

urologists for considering hospital employment)• Job security and access to technology and practice

innovation• Access to the latest-and-greatest EMR Systems • Access to analytics that allow the group’s urologists to

better monitor and report on quality• Stabilized income at a reasonable level for a period of time

The word for success in today’s health care climate: Collaboration

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Outsourcing

• Commensurate with consolation is outsourcing– As practice grows, it has enough size to outsource

certain functions to further make itself more efficient.– Examples:• Medical Billing – Any size practice can outsource

medical billing but larger practices get much better terms and rates.

• Specialty Diagnostics – Many urology practices outsource things like urodynamics to specialty diagnostic firms. This prevents them having to own the equipment and reduces demands on their staff, making them more efficient.

• Outsourcing also allows larger practices to focus more. They can outsource non-core tasks and maintain focus on urology. This also keeps the head-count down and helps mobilize the practice’s entire workforce in the right strategic direction.

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5 Trends for Urology Practices

• A relatively recent trend among U.S. urology practices is the opening of men’s health centers that offer urologic and non-urologic care.

• Urologists continue to rely on advanced practice practitioners to meet patient demand while the work force declines. 36% of urology practices use a physician assistant (PA), and 28% use a nurse practitioner. This trend is expected to continue and may accelerate.

• Shift from electronic systems for patient records and prescribing. This trend is at or near its peak. A recent survey showed 83% of urologists use an EHR and 85% using e-prescribing. A full 100% of academic urologists and 100% of those in large practices now use an EHR, compared with 63% in solo practice and 85% in those belonging to groups of two to nine. Similar results were observed for e-prescribing usage: 98% of urologists in large practices, 86% of those in groups of two to nine, and 74% of solo practitioners.

• Urologists derive most of their income from patient care (88%), while 12% comes from ownership in an ancillary service or product. We see great potential here. Larger urology practices will use their balance sheets to significantly expand their ancillary services.

• Outsourcing will continue to grow. Much of the consolidation has already happed, but will surely continue. However, now that practices are consolidated they will begin to expand their outsourcing to realize the efficiencies they want to gain. Areas this will likely occur in include: specialty diagnostics (like urodynamics), billing, marketing, lead generation and referrals, and core staffing. As larger practices set the strategic direction for outsourcing, smaller practices will follow suit.

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Additional Points to Ponder

• There has been a decrease in the supply of urologists relative to population growth, which is expected to be exacerbated by an aging and relatively older urology physician workforce, particularly in rural areas

• A slight increase in female urologists

• Gravitation of younger urologists toward group practice in urban areas.

• Number of rural urologists and the number of international medical graduates have continued to decline since 1981.

• Over the past 10 years, an increasing number of urologists are now in group practices (over 60%), and these tended to be younger and in urban settings.

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About Brighter Health Network (BHN)

• About Brighter Health Network (BHN)– Leading provider of mobile medical diagnostics including

Urodynamics, Anorectal Manometry, Urocuff Testing, and more– Serves over 300 clinics and hospitals nationwide.– Serves Urology Practices of all sizes and interacts with them daily,

which served as the basis for this presentation.– Visit www.BrighterHealthNetwork.com for more info.– For one (1) minute corporate overview, see this video: https://

vimeo.com/184366711 – If you are interested in urodynamics outsourcing visit this link and

sign up: • http://

www.bhnco.com/Urodynamics/Urodynamics-Testing-Services.html

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Thank you !

A special thanks to the Urology Times for many of the statistics in this presentation