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State of the Specialty survey: Top pain points are revenue drop, prior auth
Richard R. Kerr
Declining reimbursement for their work and the burden of prior authorization are nearly universal concerns of U.S. urologists, an exclusive Urology Times survey has found.
Declining reimbursement for their work and the burden of prior authorization are nearly universal concerns of U.S. urologists, an exclusive Urology Times survey has found.
Other pain points for urologists also relate to the non-clinical, business side of practice: increasing overhead/overhead management, increasing government regulations, new payment models (eg, bundled payments), quality metrics/reporting requirements, and smaller/narrow insurance networks.
Given a list of potential issues of concern, almost all urologists say they were either very concerned or concerned about declining reimbursement and prior authorization requirements (98% and 97%, respectively). This was followed by increasing overhead/overhead management (92%), escalating government regulations (90%), new payment models (86%), quality metrics and reporting requirements (85%), smaller/narrow insurance networks (80%), and the growing number of patients with high-deductible insurance (79%).
Among those participating in MIPS, 47% say they report MIPS data directly to the Centers for Medicare & Medicaid Services via their electronic health record, 15% report data using the AQUA Registry or other QCDR, and 6% use a third-party vendor. About 10% of urologists say their practice has had to appeal its MIPS score at least once, and of those, 3% were successful, 4% were not, and 38% were not sure yet of the outcome of their appeal.
When asked how well they understand the choices regarding MIPS and APMs, nearly half of urologists (49%) report that they don’t understand them very well at all. Forty percent understand these options somewhat and 11% understand them very well. Forty percent currently participate in the AUA Quality Registry (AQUA Registry) or another Qualified Clinical Data Registry (QCDR), the survey found.
Asked to characterize their opinion of value-based care, most respondents (64%) chose the option, “It’s a good idea in theory, but much harder to execute in practice.” Eighteen percent said value-based care is a bad idea that will not succeed, 14% need to do more research before forming an opinion, and 2% said it’s good for both the health care system and patients.
“It’s ridiculous; no one wants to take care of the difficult or non-compliant patient population,” one respondent wrote in a fill-in option. “We need good doctors, not more regulation.”
As the New Year approaches, the most frequently cited initiative for 2020 was to hire a new urologist (21%). Other plans include retirement from the practice of urology (10%), reduction in workload/partial retirement (8%), seeking a medical job in a non-clinical setting (6%), doing locum tenens work (6%), merging with another urology group/groups (6%), and becoming a hospital-employed urologist (4%).
Burnout was reported by 53% of survey respondents, a sharp increase over the 33% reported in the 2018 State of the Specialty survey. Factors listed as “very much” contributing to burnout were use of EHRs (66%), falling revenue and/or rising overhead (60%), prior authorizations (48%), and unappreciative patients/unreasonable patient expectations (43%). With a high rate of burnout, it may come as little surprise that only 41% of urologists would choose medicine as their career if they were starting out today, although 78% would choose urology.
The State of the Specialty survey was rolled out in 2006 and has been conducted by Urology Times annually since then. It quantifies the pressing issues facing urologists, trends in the work force and retirement, workload, and practice type and size, among other topics. The majority of respondents are in the age 45-59 (50%) or 60-65 age group (22%). Most are in private practices of seven or fewer physicians (36%) or employed by a hospital or health system (25%).
When urologists were asked how many hours per week they send working practice administration (eg, answering audits, obtaining pre-authorizations, filling out forms), 61% said they devoted 1-9 hours on these tasks.
70% of respondents said they agree or strongly agree with the statement "Telemedicine has a viable future in urology," while 57% said they disagree or strongly disagree with the statement "I would favor a single-payer health insurance system."
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