Karen Nash is a medical reporter and media consultant based in Monroeville, PA.

Karen Nash

Urology Times® reached out to 3 urologists (selected randomly) and asked them each the following question: Do you listen to music in the operating room? What kind?

“I do listen to music and the type depends on what I’m doing. If I’m doing a high-stake portion of a case where I want my heart rate down, I actually listen to—I don’t even know what the genre is—but it’s what you listen to when doing yoga. So if my heart rate is going up and I’m doing something like 

 dissecting out a vaginal canal for gender affirmation surgery, I will use something like Pure Focus or a meditation mix.

Otherwise, indie rock is mostly what I listen to. That’s kind of my wheelhouse. Indie rock is my favorite by far. I would say in the last 5 years, my favorite is a group is one called Bon Iver.

If you ask me what music adds to the operating room, I would have to think. It’s a really good question. It calms me down and it shields me from a lot of the noise that could be distracting. My focus is reconstructive surgery and 80% of my practice is transgender surgery.

I think music can alter my emotional state and put me in a better frame of mind that lets me see more possibilities.”

“I listen to whatever my staff actually wants to listen to, except I say ‘no rap’—whatever they like—but no rap, and we’re okay. Usually during my robotic cases, we listen to music. They plug in their iPhones or the smartphones and stream whatever service they have, or whatever playlists they have, which is mostly classic rock, contemporary rock, some country.

I have some input, but they play what they want to play because if they’re happy, I’m happy.

Music keeps everything a little bit lighter in the OR. Silence can make the day drag on and increase stress levels. Music has been shown to decrease stress levels. Having it on all the time is good.“Usually, they play a mix of music, so most of what they play I like. I have a very diverse taste in music. I listen to blues, rock-and-roll, old stuff new stuff, country—more of a country rock. If I were to say who my favorite is—I’d have to say, it’s the group Boston. They came out with their first album in the 70s, and it’s probably my favorite album.

To be honest, nobody ever really chooses Boston for the OR, but I like a lot of music. If I’m sick of something I’ll tell them, but that rarely happens. They’re all younger, in their 20s and 30s. When I’m doing robot cases, I generally have the same crew. I know they want to listen to rap. They’ll start talking about a song, but they’ll say, ‘you wouldn’t like it.’ I’ll ask, ‘why? Because they drop F-bombs and call women derogatory names?’ They say ‘yeah,’ so there you go. I have 2 daughters so why would I want to listen to music when they talk that way?”

“I do listen to music in the OR. Honestly, I let my scrub tech and circulating nurse pick whatever they want to listen to. I’m not very picky.

I probably let them choose as an overall morale thing. I’m just not really very picky provided that it’s nothing too intense. As long as it’s regular music, I can listen to just about any genre, so I let them decide as a morale booster. The kind of music depends on who’s in the OR with me. We usually listen to a radio station. Sometimes it’s a country station, sometimes it’s pop. I listen to all sorts of music: 80s, 90s, country. I’m good with any of them.

My favorite artist is probably Michael Jackson, not that he comes up often on the stations we listen to.

I think music in the operating room relaxes everybody. I think if everybody is in a high tense mood, it makes the case harder and mistakes get made. If people are relaxed, they are more communicative and we seem to have a better flow. I think music leads to better results. I don’t think there are any studies on that, but I feel we get in a better flow. Overall, the days we listen to music versus the days we don’t, we just seem to get better results in the end. It just seems to be a better day.”

Articles

"I listen to whatever my staff actually wants to listen to, except I say ‘no rap’ " says one urologist.

Urologists discuss their music preferences for the OR

Urology Times® reached out to 3 urologists (selected randomly) and asked them each the following question: Is your urology practice prepared for evaluation/management coding changes in 2021?

"My office manager, who used to be a biller, thinks these changes may simplify billing issues and benefit urology as a specialty overall. I have no experience with how the rules are going to change. I have an electronic medical record [EMR] I trust and that does a fantastic job of generating the right codes for me. We’ve already been alerted to an electronic update coming for the changes.

I don’t know how it will affect surgeries, but from the brief description I have, outpatient visit coding will be maximized. My reimbursement patterns are about 50-50 between surgery and office-based work. So if surgery is affected equally in the negative direction as outpatient is affected in the positive direction, it will probably be a wash for me. Again, it’s just a guess. I rely on my business person and my EMR, which we pay a hefty fee for, to keep these things running well.

We are all naturally skeptical because we are rarely rewarded for an advantage at any time when these changes are made. Urology usually seems to get the short end of the stick. The trend year after year is for a decrease in reimbursement per unit of effort. But this one seems like a potentially reasonable one.”

“I’m an employed physician in a large company. A team does our coding through a systemwide 

EMR, so when codes change, I won’t have access to deleted ones. From that standpoint, there’s not much prep.

I expect it to be ready but don’t know that I’m confident. I’m based on relative value units [RVUs], so whatever the code is, the code is. Am I convinced they’ll be 100% accurate in doing everything? No. But I’m not necessarily worried because I’m RVU based, not cash based.

The higher evaluation/management [E/M] should be helpful for me. I don’t do a lot of big open cases anymore, so I’m not a heavy surgical volume generator of my RVUs. I tend to make more in the office; it shouldn’t be a significant change.

It was different when I operated my own practice because I was responsible for the adjustments. Being employed, that burden falls on somebody else. EMRs have actually made it easier; you can’t put in the wrong codes because they no longer exist.

It’s not like going 10 years without change and suddenly getting one. Come January 1 every year, there’s going to be change somewhere.

With EMRs, as long as coders know a day or 2 ahead of time, they’ll probably be able to make the adjustment because all they have to do at the corporate level is implement an update, which is almost immediate. My understanding is that with the new codes, almost all office visits are going to fall into the same category, so what you have to do to qualify for that code will be more general. It should be a little easier for us.”

“I’m finding that hospital systems are just as clueless as most private practices are. It’s going to 

be a slow process for hospitals to give the proper information to their physicians so that when we’re moving on to the new coding system, we’re not doing extra work.

Fortunately, I’ve been able to educate myself, but I’m finding a lot of my colleagues don’t even know there’s a change coming, and it may be to their benefit, and to their patients’, by reducing the documentation workload. Physicians simply aren’t educated enough on it.

I’m certain it’s not going to be organized by the end of the year, partly because we’re just climbing out of this health crisis and have been focused on surviving that. The E/M changes obviously benefit office-based work, but a lot of doctors, especially those who are procedure heavy, don’t realize that.

Now, I’m director of robotic surgery here, so I’m pretty procedure heavy, but I also have a very busy clinical practice. There will be a drop in my production in terms of surgery and procedures, but I hope my office-based practice will make up for that.

Most hospital-employed physicians probably won’t notice a change for several months, maybe a year. Once administrators realize compensation doesn’t align with the current production, hospital-employed physicians will start feeling it in contract renegotiations. Private practice will need to make adjustments more quickly because they’ll see it on a day-to-day basis. There will definitely be some surprises.

Hospital administrators just don’t know. We’ve had discussions, but nobody realizes this is happening.”

“It’s going to be a slow process for hospitals to give the proper information to their physicians so that when we’re moving on to the new coding system, we’re not doing extra work," says one urologist.

Is your urology practice prepared for evaluation/management coding changes in 2021?

Urology Times reached out to 3 urologists (selected randomly) and asked them each the following question: Besides the expansion of telemedicine, how has the coronavirus disease 2019 (COVID-19) pandemic affected your practice?


“For a while, the hospital was not allowing elective surgeries, so we had to cancel procedures considered elective. A lot of patients wanted to stay home, and they canceled their appointments. There were some days we didn’t see a full day of patients, and a couple [of] days when we just closed the office because people wanted to stay home.

I respected that decision, …and worked on other projects so I could make good use of the time. That was probably March and April. By May, we basically had a full load of patients and it’s been very busy in the past few months.

I didn’t have any patients who suffered adverse consequences because of the delays. The urgencies we took care of just as we normally would. Some of the elective follow-up visits we postponed, then they came back a few months later and we’re getting caught up.

We’re taking it in stride. We don’t overbook to the point where we’re overwhelmed, and we’re not exhausting ourselves. We’re catching up.

As I said, none of my patients suffered because of the delays. The people who had true emergencies we took care of, and people who had things that could be electively postponed, we postponed, and now we’re getting back to normal.”

“I’m a transplant surgeon as well as a urologist. We took a big step back when we first had [COVID-19]–positive patients [as] we were concerned about 2 things: Seattle had some of the first documented cases in the US, so we put a moratorium on living-donor transplants which were elective procedures. Then we cut way back on deceased-donor transplants because we [had additional concerns]. First, we worried about immunosuppressing patients who might then be exposed to COVID-19. Second, a lot of our patients come from outside the Seattle area—Montana, Alaska, Idaho. We didn’t want to bring people from low-frequency COVID-19 places into Seattle. That had a pretty significant impact on the transplant side of our practice.

Any time a patient doesn’t get an organ, you can say there’s a detrimental effect, but if you need a kidney, you can live on dialysis. Nobody we’re aware of died because he couldn’t get a transplant.

We’ve restarted both programs. Now that we know more about COVID-19, we realize most transmission is not hospital-acquired; people are getting it in the community. So we feel safe having people come in and stay 3 to 5 days.

We’ve been fortunate; just 1 transplant patient died of COVID-19. She was 6 months out from transplant; she and her mom both contracted it in the community. They came into the hospital and succumbed to the disease. Most of our transplant patients have comorbidities—diabetes, hypertension, [or] they’re elderly––we’ve had no new transplant patients develop it.

We still did cancer surgery. There wasn’t a day I didn’t do something in the operating room, but my clinical practice was down by 50% to 60% for a couple months. We’ve gone back to close to our normal practice now. Volumes are just down about 20%.”

“The most obvious impact is that we all had a shutdown. I practice at the Minneapolis VA hospital. We’re continuing at reduced capacity. So that’s a major thing.

We have a more finite capacity and fixed resources at the VA. The government doesn’t just allow people to work overtime. Work stops at a certain time of day. We’re more restricted than the private sector, so there’s a backlog of cases. Surgery dates we can offer are somewhat in the distant future, making the backlog longer than is already usual at the VA.

I don’t think any patients were actually harmed. I think it’s more psychological. I’m talking mainly about prostate cancer. Once you’re diagnosed with any cancer and have chosen a certain path, it’s hard to understand that you have to wait another couple months to have it taken care of. Patients who were really urgent, however, [were taken care of]. It’s just the additional burden to waiting. We care for many older patients with comorbidities and they’re certainly worried about getting COVID-19.

We’ve had a few patients who had to cancel surgery because they developed COVID-19. Patients of mine developed [it] through community spread, not within the hospital, and they’ve all done OK.

We are catching up. Nobody I’m aware of is overwhelmed; we always have lots of work and stress, but it’s what we’re here for, isn’t it? It’s part of our social contract as physicians.”

"We’re taking it in stride. We don’t overbook to the point where we’re overwhelmed, and we’re not exhausting ourselves," says one urologist.

Besides the expansion of telemedicine, how has COVID-19 affected your practice?

Urology Times reached out to 4 urologists (selected randomly) and asked them each the following question: Is carrying cyber insurance needed in a medical practice?

“We have insurance for our EMR and computer system in case we break down, but we’ve also carried cyber insurance for at least 7 years. It covers us for ransom, as well as potential penalties if personal data is compromised.

Attacks are increasing across the world. Health care providers are prime targets due to personal data with which we’re entrusted. We have an in-house IT department working 24/7 to make our electronic medical records and our internet exposure as safe as possible from cybercrime, but cybercrime is ongoing, so cyber insurance will be normal for practices as time goes on.

In any medical practice, the first step in protecting themselves is to be as strong as possible—from password protection to firewalls and ongoing surveillance for scams.

Both financial and medical information security is important. From the HIPAA standpoint, it could be devastating if medical records were victimized to a cyber attack. Then there’s ransom that’s been seen in multiple businesses that has a huge financial impact.

Depending on the size of the practice, the amount of cash flow you’re out on a daily basis could be minimal, but HIPAA violation fines could be massive.

Government agencies can judge whether enough was done to protect against attacks. Our practice tries to maintain as tight security as possible, but that bar is constantly changing.”

“I have a Mac. They have pretty good internet security. They keep changing things based on what’s happening, so I’m not worried somebody could take us hostage and try to close down my 

I don’t see a need to insure against a cyber attack. My office has its own firewall system. I’m confident hackers can’t get through it.”

“When I think about security for medical records and electronic medical records, we’re a private practice group and it just hasn’t come up in our group.

We have IT people that we pay a lot of money to and they take care of all our security needs. If something does break so that we can’t log on, we call them and they’re here. They also work on our personal computers, so we’ve never had an issue. We feel we’re well protected by our IT professionals that maintain all that equipment in the office.

We haven’t discussed hackers. We have a huge practice, but there are only 3 of us, which is unusual in today’s landscape. Maybe that protects us also.

We’re extremely busy—we do every procedure in urology and see a ton of patients weekly, but cyber security hasn’t really been an issue because our IT guys protect us.

The strongest protection is a good IT system to keep security strong. We pay a decent amount of money, so we take this seriously. We have two guys who are here periodically to make sure we have no issues.”

“We were held for ransom. It’s a crazy story. We were transitioning from a local IT group we’d had for 10 years, to a new group, when one morning we got an email that said, ‘Get ready to have a bad day.’

We had a Russian-based attack. All of our data was encrypted. They said they’d give us back our data for $24,000 in bitcoins. We said, ‘Before we do that, we want to make sure you can do what you say you can do.’ The funny thing was, they said, ‘Oh, we’re sorry, the guy who unencrypts these files is on vacation.’ We said, ‘What the heck is this?’

We ended up paying a US-based encryption company more than $70,000 to fix it. Our new IT company took full responsibility, even though it was probably not their fault. We think a virus was sitting in our computers for weeks before being activated.

We lost probably 2 to 3 weeks of revenue because we were down to paper. We had 2 insurance policies—1 via our medical malpractice and another from insurance on our building that enabled us to reclaim some losses.

Actually, we recently paid a company to attack us. Before the electronic medical records (EMR) company would return our data, we needed to make sure we were secure.

When the penetration results came, we were stable, but the EMR company had 3 issues needing repair.

I would absolutely advise practices to carry actual cyber insurance—100%! We do carry specific cyber insurance now.

It’s interesting the hackers were not interested in patient medical or financial data …just in holding us hostage/demanding ransom.”

"We had a Russian-based attack. All of our data was encrypted. They said they’d give us back our data for $24,000 in bitcoins," says one urologist.