State of the specialty: Reimbursement plunge still urologists' number one headache


Declining reimbursement remains urologists' number one concern, ahead of increasing overhead, increasing government regulations, and other issues, according to the 2008 Urology Times State of the Specialty Survey

Robotic surgery, once restricted to large academic centers, continued to establish itself in the mainstream of urology. Practice consolidation was widespread. A shortage of urologists spurred increased reliance on physician extenders in many practices.

Despite the rapid pace of these developments, one factor remained unchanged: the downward spiral of urologists' reimbursement. For the third straight year, declining reimbursement was the issue that urologists were most concerned about, according to results of the 2008 State of the Specialty survey, an exclusive study from the editorial and research staffs of Urology Times.

Data from the survey also revealed the following: About 4% of respondents' surgical procedures are now done robotically-still a small percentage, but double the number found in the 2006 survey. Nearly one-fifth (18%) of respondents plan to merge with another urology group in the next 5 years. And, 5 years from now, more than half (57%) expect to be making greater use of physician extenders than they do now.

Conducted online, the survey was designed to identify clinical and business trends in urology practice, gauge urologists' satisfaction with their work, and project future developments in the specialty. The 95% confidence interval was ±8.3%. (Also see, "How the survey was conducted," .)


Given the history of diminishing physician reimbursement that began with the introduction of the Medicare fee schedule in 1992, it comes as little surprise that declining reimbursement topped the list of issues that respondents were concerned about. Overall, 89% of respondents reported being extremely or very concerned about declining reimbursement. This was followed by a number of related socioeconomic issues: increasing overhead (83%), increasing government regulations (77%), increasing malpractice premiums (67%), negotiating contracts with payers (58%), and pay for performance (54%).

In 2009, the reimbursement slide will continue. Payment to urologists is expected to be flat overall.

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