Panelists Dr. Evan Goldfischer, MD, MBA; Alan Walker, MHSA, FACMPE; and Allison Griffin discuss urology employment issues. Specifically, the panel covers physician recruitment, physician burnout and resilience, and staff recruitment and engagement, emphasizing employment paradigm shifts and creative, proactive solutions to today’s staffing challenges.
Read MoreEvan R. Goldfischer, MD, MBA, FACS, urologist and Director of the Research Department at Premier Medical Group in Poughkeepsie, New York, discusses hospital service line agreements and the process of negotiating beneficial pay for call contracts. He begins by explaining physician health system alignment and how alignment can look different depending on how much autonomy a physician desires. Dr. Goldfischer explains that hospitals want to partner with urologists because they need urologic specialization for a wide variety of patients and do not know how to effectively manage service lines, and that urologists should desire partnership because it reduces the incentive for internal urology departments and gives urologists the opportunity to improve the condition of their practice. He also states that there is a great deal of benefit to patients due to access to well-trained and educated specialists. Dr. Goldfischer also describes how call coverage and quality improvement service arrangements function to benefit a hospital, and outlines the call coverage responsibilities, including 24/7 coverage 365 days a year, unassigned inpatients, daily rounds, and more. He then details call coverage compensation in terms of flat fee coverage. Dr. Goldfischer explains the variables involved in deciding flat fees such as extent of burden, extent of treatment, fair market value, and probability of providing uncompensated care. He details quality based payment strategies and how to collect evidence on the positive changes a physician has made as part of a hospital as a way to prove value. Dr. Goldfischer concludes by stating that physicians understand their specialty and should be compensated for achieving higher quality work and lower costs.
Read MoreEvan R. Goldfischer, MD, MBA, FACS, urologist and Director of the Research Department at Premier Medical Group in Poughkeepsie, New York, and President-Elect of LUGPA, discusses how a medical practice can adapt to telehealth by adopting certain procedures for patients, doctors, and staff. He suggests that even if COVID-19 goes away, telehealth is here to stay because it produces high satisfaction rates amongst patients, is good for periods of inclement weather, can allow for weekend and evening billing of patient calls, can extend a practice to other regions, can be used for inpatient consults, and can be used for ER visits. Dr. Goldfischer acknowledges that working with new telehealth technology can be challenging for staff and recommends that staff are made familiar with the technology so that they in turn can instruct patients on its use. He also recommends that telehealth visits are scheduled during a dedicated block of time and aren’t interspersed with inpatient visits, that charts are prepped with all necessary lab results and notes, and that there is no need for a physical exam or any in-person sample collection. He also encourages video over audio visits. Dr. Goldfischer says that schedulers can help patients prepare for a telehealth visit by testing a patient’s ability to use the necessary technology and by having family members or nursing home staff present with the patient for the visit 10 minutes of the appointment. He suggests that doctors prepare by having 2 computers set up (1 for video and 1 for the electronic medical record), reviewing records ahead of time, being in a quiet and isolated room to preserve confidentiality, looking professional and not being distracted, and checking computer connectivity ahead of time. Dr. Goldfischer stresses the importance of focusing on the patient, engaging family members, taking in the patient’s surroundings, and making sure that the patient is engaged during the appointment. He recommends scheduling any follow-ups immediately after the visit and sending a letter or copy of the office notes if the doctor is unsure whether the patient processed all the information.
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Evan R. Goldfischer, MD, MBA, CPI, CPE, Co-Founding CEO and Founding Director of Research for Premier Medical Group of the Hudson Valley, and Secretary of LUGPA, details how to effectively manage a clinical research program. He examines why clinical research is important and how it has changed over the years, with the biggest changes in 2020 being more training, more paperwork, and more time and difficulty negotiating budgets. Dr. Goldfischer discusses the importance of integrating the research program with the cancer clinic, as well as how the staff must work together to ensure a program’s success. He stresses the importance of clinical research involving everyone in the practice. In a follow-up Q&A with E. David Crawford, MD, Dr. Goldfischer discusses practical changes to research brought on by COVID-19.
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Peter J. Rossi, MD, a radiation oncologist with Kaiser Permanente and Valley View Hospital in Glenwood Springs, Colorado, and Steven J. Frank, MD, a professor of radiation oncology at the University of Texas MD Anderson Cancer Center, present important updates on brachytherapy for the treatment of prostate cancer. Dr. Rossi notes that radiation-resistant tumors can be treated with well-executed brachytherapy, and highlights the level-one evidence for prostate brachytherapy over other treatments. He also discusses some drawbacks to brachytherapy, particularly toxicity, and how they can be addressed. Dr. Frank follows, discussing MRI-assisted radiosurgery (MARS) and highlighting the strengths of MRI over CT scans and ultrasounds in brachytherapy. He also outlines the findings of a study he led regarding the use of MRI-assisted brachytherapy, emphasizing that the quality of MRI imaging allows for higher quality of care and largely avoids the problem of toxicity. Dr. Frank also discusses the difference between MRI-guided and MRI-assisted therapy, and highlights important steps to avoid certain negative outcomes.
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