Urodynamics is a panel of tests relating to the lower urinary tract. It is most commonly used in its entirety; however, it is also possible that one or more of the components will be performed separately if symptoms suggest this is necessary.

Urodynamics is the most reliable way to determine the cause of lower urinary tract symptoms and therefore, the best way to determine which treatment methods are most appropriate.

A Care Pathway is an evidenced-based framework to build a treatment plan upon, beginning with the primary physician, continuing to specialist referrals if necessary, and following the patient through to the end of their treatment (including follow-up care).

They typically follow a common path that starts with patient history, followed by clinical assessment, provisional diagnosis, first line management, specialist management, and follow-up care.

Some examples are listed here:

Whether you are an administrator, owner, or someone who is involved in some way with the running of a medical practice, you are likely going to already know about both asset-light and asset-heavy medical practice designs.

If you are, however, unfamiliar with these terms, then knowing the difference between them can be extremely helpful in weighing up how to design a medical practice and where capital should be allocated.

An asset-heavy medical practice is one with a large amount of capital invested in equipment, the property and building where the practice is located, employees (with a large number of full-time employees), and essentially owns a wide range of assets that allow it to perform as many functions as possible.

An asset-light medical practice on the other hand is one that owns fewer fixed assets, with a minimized quantity of full-time employees that focuses more on using outsourcing vendors to provide patients with a full range of medical and diagnostic treatments.

When it comes to medical practice, the cost of doing business can be vastly different than for other small businesses. While building revenue is important, so is effective customer service and high-quality patient care.

As the model for reimbursement changes, efficient cost management is becoming a key component of the survival and stability of the independent medical practice.

Here, the types of costs associated with medical practices will be discussed, as well as why the variable cost structure is important.

Almost 6 months into Donald Trump’s presidency, there are many unanswered questions regarding the present state of affairs in America.  Among the most daunting questions is what will happen in the United States in regards to healthcare. The phrase "your guess is as good as mine" comes to mind.  In this article, Trump’s administrations effect on urology practices will be discussed.

Research Funding

At the top of President Trump’s proposal to balance the United State’s budget is significant cuts to grant funding for scientists. While Congress ultimately reversed Trump’s cuts to the National Institutes of Health for 2017, it remains to be seen whether the agency will have limited funds for 2018, as Trump proposes.

In 2016, $506 million were awarded to researchers for the study of urologic diseases. In 2017, $522 million is estimated to be used towards urology research. For 2018, Trump hopes to slash $5.8 billion in funding from the NIH, which could dramatically affect research towards urological developments, particularly for prostate health and urinary incontinence.

Health Insurance

A major promise throughout President Trump’s campaign was the repeal of the Affordable Care Act (ACA), which provides people at or below the poverty line, as well as those with pre-existing conditions, an opportunity to purchase health insurance. While a satisfactory replacement for the ACA has not yet been introduced into Congress, a repeal of the current ACA could be both good and bad for urology practices.

The ACA has mandated numerous regulations that some physicians believe have hindered their ability to maintain a close relationship with their patients, particularly due to cumbersome electronic paperwork. Removing this regulation – as well as others – could lead to a more direct connection between patient and physician.

Additionally, deregulation could provide the opportunity for medical companies to promote their products in new ways and with fewer stipulations. The overall result could be enhanced technology from private firms as well as more patient / doctor interaction.

On the other hand, the Trump administration’s proposals could potentially leave millions of Americans uninsured, meaning that fewer patients would be able to afford preventative care and procedures for non-life threatening disorders. Therefore, fewer Americans would be able to receive preventative prostate exams or expensive urodynamic tests for diagnosing disorders such as pelvic organ prolapse, stress incontinence, urge incontinence, pelvic pain, and difficulty urinating.

Fewer Regulations

As a businessman, President Trump has promised fewer regulations in health care, particularly the pharmaceutical industry, which could trickle over to medical devices. For urologists, the deregulation of medical devices could result in more affordability of implants such as transvaginal meshes and similar items.

Additionally, deregulation could reduce the amount of paperwork that needs to be performed, saving urologists time and money. For some physicians, this would be a welcome change under the Trump administration.

USPSTF Reform

The US Preventative Services Task Force (USPSTF) was formed to serve as an independent panel of experts to review the effectiveness of clinical preventative services. In May 2012, the USPSTF recommended against the screening of prostate cancer with prostate-specific antigen.

There has largely been concern regarding the recommendations of the USPSTF and the manner in which it has justified limiting access to routine preventative care. In January, the USPSTF Transparency and Accountability Act of 2017 was introduced to Congress and is backed by the American Urological Association, Large Urology Group Practice Association, and Association of American Colleges and Universities.

With a dramatically decreased focus on regulations and government spending by the Trump administration, this act is likely to be approved, with the possibility of the USPSTF being dismantled entirely. For urology practices, that means a return to annual prostate cancer screenings as well as fewer hesitancies among patients for preventative care.

MACRA

Many physicians have wondered what effect – if any – the Trump administration will have on the Medicare Access and Chip Reauthorization Act (MACRA) that was enacted in 2016. Bipartisan support of MACRA does not take into consideration the push-back from doctors, which are concerned of its consequences.

For instance, a doctor shortage crisis is likely, due to the exodus of doctors from Medicare, as well as due to the struggles caused by implementing this law into independent urological practices. By 2018, half of a doctor’s fees will be directly tied into quality of care and outcome measures, with eventually 90% of reimbursement to be linked with these measurements.

For urologists, who treat patients with disorders that are not widely understood and for which treatment outcomes can be unpredictable, MACRA has potential to be extremely disruptive.

Many urologists hoped that Trump would approach MACRA with the same repeal goals as were promised for the ACA. However, Seema Verma, the Trump-appointed director of the Centers of Medicaid and Medicare Services has openly supported MACRA and even applauded Congress for its enactment. Ultimately, there is little hope for urologists that MACRA will be repealed by the Trump administration.

Despite their prevalence among the aging population, urological disorders are among the most commonly misdiagnosed diseases. Here, five of the most prevalent urology misdiagnoses will be discussed.

Pelvic Organ Prolapse

Pelvic organ prolapse¹ is one of the most common urinary disorders among women, as well as one of the most commonly misdiagnosed. This disorder occurs when a pelvic organ prolapses from normal position and pushes against the vaginal wall.

Urology practices across the U.S. have changed considerably over the last decade. Many practices have merged and increased in size in order to be more competitive and deal the complexities of insurance, Medicare, and Medicaid reimbursements. Additionally, these practices have starting taking on more diagnostic and treatment services that were traditionally done in hospital settings. These servcies include minor surgeries, CT scans, urodynamics testing, and more. A listing of the largest urology practices in the U.S. is provided below: