Urodynamics is a set of tests and procedures that measure lower urinary tract function. These tests are prescribed by urologists, gynecologists, or urogynecologists, and the results from the tests allow them to look at how a patient's lower urinary tract is working. The bladder, sphincters, and urethra (all parts of the lower urinary tract) work together to hold and release urine. Most urodynamic tests are concerned with measuring the ability of your bladder to hold and drain urine completely.
Urodynamics is currently the only form of testing that allows physicians to fully assess lower urinary tract function. Urodynamics is a continuous test ("uro" for urine; "dynamics" for ongoing activity), which is why it is commonly used as robust predictive data on lower urinary tract function and is essential to guide treatment decisions.
Testing in urodynamics ranges from simple observations to specific measurements using sophisticated apparatuses. The physician decides what type of urodynamic test should be done based on the physical exam, patient's health information, and lower urinary tract symptoms (LUTS). This critical procedure provides healthcare professionals with essential information to properly diagnose and treat urogenital complications. It is a somewhat complex procedure requiring a high level of specialization and is usually performed by a qualified specialist known as a "Urodynamics Nurse."
Why Is Urodynamics Testing Recommended?
Urodynamic tests are important to help physicians see if a patient's lower urinary tract is causing them problems, such as urinary leakage due to involuntary contractions. Healthcare professionals may recommend urodynamic tests for patients that have some of these symptoms:
- Frequent urination
- Difficulties in initiating a urine stream
- Painful urination
- Recurrent infection of the urinary system
- Strong and sudden urges to urinate
- Difficulties in entirely emptying the bladder
- Urine leakage
- Excessive use of abdominal muscles in an abnormal urinating pattern.
- Urine obstruction with back discomfort and constipation
- Inability to pass urine even after surgical intervention.
Urodynamics Tests
There are many different types of urodynamic tests a healthcare professional can order, depending on the condition of the patient and what function they are trying to measure or monitor. A complete urodynamics test often includes the following:
- Uroflowmetry
- Cystometric test
- Pressure flow study
- Electromyography
- Leak point pressure measurement
- Post-void (PVR) residual measurement
- Video urodynamic tests (not always part of typical procedures)
Urodynamics testing is quite complex and requires trained specialists and sophisticated instruments to carry out. There are two primary approaches to performing urodynamics testing within a hospital or medical practice. The two approaches are:
- The Vertically Integrated Approach
- The Turn-Key Approach
The Vertically Integrated Approach
The vertically integrated approach is a cost and time-intensive method where a hospital or medical practice buys all of the necessary equipment, software, supplies, personnel, and training.
A hospital or medical practice that uses this approach does everything in-house. For example, the hospital or practice buys, installs, maintains, and continually calibrates the equipment. They install, maintain, and frequently update the software needed for interpretation. They hire and train staff and also retrain staff when staff leaves. They buy and inventory disposables and maintain a quality control process to ensure safe testing and accurate results. This approach requires that the physician perform the interpretation of test results.
The Turn-Key Approach
The Turn-Key approach to urodynamics testing is the perfect alternative to the vertically integrated approach. This approach involves using a provider that offers urodynamics testing.
Here, the hospital or medical practice outsources urodynamics testing to a reputable firm. The firm or service provider is responsible for providing all of the necessary equipment, materials, software, and trained personnel. The service provider is also responsible for the purchase, installation, maintenance, and calibration of their equipment. They hire and train their own staff, install and update their software, buy and inventory disposables, and maintain their quality control process.
In addition, the firm is responsible for performing urodynamics testing at any location the hospital or medical practice chooses on an agreed schedule (usually a repeating monthly schedule). The firm does everything relating to urodynamics testing for the medical practice or hospital. So, the hospital or medical practice doesn't have to get and maintain sophisticated urodynamics instruments, software, inventory, or staff.
Vertically Integrated Approach Vs. Turn-Key Approach
While the vertically integrated approach may be beneficial to the growth of a practice in the long run (other things being equal), it remains a huge financial risk. Medical practices or hospitals shoulder-high financial burdens and risks because it is impossible to project into the future and determine whether urodynamics patient testing volumes will deliver a sufficient return on investment of time and money. With the turn-key approach, however, the hospital or practice does not have to factor in these costs and variables.
Also, suppose the practice or hospital has many sites. In that case, vertical integration becomes even more difficult because it necessitates having equipment and trained employees available at each location, which means more money and more time. In fact, human capital can be considered the most critical limiting element in providing urodynamics. It is not cost-effective to have a physician perform the duties of a urodynamics nurse because their expertise is usually required in other areas. Opting to train their own urodynamics nurses may require time, effort, money, and other resources. Plus, if the trained nurse decides to leave the hospital or practice, they may have to go through the process all over again. Rinse, repeat.
The turn-key approach, however, frees the hospital from these commitments. This makes the turn-key approach ideal for hospitals and practices with single or multiple locations. This helps to ensure that practices and hospitals shoulder lower financial burdens and risks. Furthermore, the service provider's service is provided at a far lower cost than Medicare and private insurance payment rates, allowing the practice or hospital to make healthy profits.
Should You Do Everything In-House?
There are several reasons why hospitals and practices feel that the best way to go about urodynamics testing is to do it in-house. For one, hospitals and practices think "this is the way they have always done it or seen it done," partly due to legacy compliance rules in health care (that may affect other things but not urodynamics).
Many hospitals or practices also prefer to do urodynamics testing in-house because they believe it guarantees the originality of the results. However, developing a urodynamics testing program is not as easy as it might seem. Moreover, the hospital or medical practice will have to factor in the cost of updating software or the robust quality control process to ensure high-quality metrics. Outsourcing urodynamics testing to a reliable, quality-centered vendor provides a path to deliver quality results.
Another reason is that most hospitals and medical practices (especially small medical practices) think they can do it cheaper. In some cases, they can, but in many cases, they can't. This misconception that they can do it cheaper is because they have not fully considered all cost line items, leaving out major cost components (such as the full cost of replacing a skilled urodynamics nurse when they leave, or downtime due to equipment outages). A hospital practice could be in a bind if they must incur costs they didn't factor into their financial analysis.
They also leave out major cost components like instituting a robust QC process to ensure all their urodynamic studies hit high-quality metrics. At Brighter Health Network, we do this for all our urodynamics procedures, but we have never seen a hospital or practice include this as a cost when they are looking to do urodynamics internally. Therefore, doing urodynamic testing in-house may be cost and time-intensive and may not always be best suited to hospitals and practices.
Using the Turn-Key Approach: Brighter Health Network
Brighter Health Network (BHN) is a turn-key, on-site medical service provider that offers several services tailored to meet the needs of hospitals or medical practices. Everything that is needed to do urodynamic testing is included in BHN's comprehensive urodynamic testing services, including equipment, software for performing the test, software for interpreting the results, required disposable consumables, and nurse staffing. BHN also offers interpretation services, in which a large bulk of the tests are analyzed for hospitals and practices, saving them time and money.
The following are some of the benefits you stand to gain if your hospital or medical practice adopts BHN's comprehensive services for your urodynamic testing needs:
- You won't have to spend money on purchasing expensive, sophisticated urodynamic equipment.
- You won't have to devote time and resources to training a urodynamic nurse since BHN offers trained nurses to fill these positions. BHN also bears the burden of staff turnover, which is immensely helpful.
- The multiple supplies and disposables required for urodynamics testing do not need to be purchased or kept on hand since BHN will take care of all supplies.
- The test findings will be interpreted for you by a qualified provider that reads thousands of tests each year. This saves you time and ensures you have access to consistent, well-documented results.
- BHN urodynamics test results also go through BHN’s proprietary QC process, which include automatic verification by proprietary software and peer reviews perform by BHN’s QC staff. This takes the quality of the test results to highest level.
Vertically integrating may work well for your organization if you have significant resources and a large capital budget. However, the turn-key approach may be best suited for your hospital or practice as it will take the burden of running this cost-intensive operations off your shoulders. You should strongly consider this option for your urodynamics testing. Click here to find out how you can go about using the turn-key approach in your hospital or medical practice.
Want to learn how to offer urodynamics testing in your hospital or practice with minimum effort and cost? Click here.
