Latest Videos Archives

Private Equity and Value-Based Care: Is There a Future?

Posted by Edward S. Cohen, MD | Apr 2022

Edward S. Cohen, MD, CEO of Genesis Healthcare Partners in San Diego, California, looks at how private equity can help independent urology practices provide value-based care and remain financially viable. He begins by emphasizing the importance of value-based care, noting that the United States currently spends more on healthcare than any other country, and does not get the best value for the money spent. Dr. Cohen also observes that Medicare’s value-based payment model trajectory is supposed to get to capitation, meaning that practices will not be paid for how many procedures they perform but for how many patients they manage. He then considers the various difficulties facing independent practice, such as increasing difficulty in remaining viable, increasing cost of doing business, the need to have other income streams to maintain viability, and the need to be competitive with the employed physician market. Dr. Cohen argues that independent practitioners need a “seat at the table,” and he suggests that private equity is a good, viable way to do so. He claims that private equity can provide capital, improve management, help with expansion of ancillary revenue streams, allow for consolidation, and provide leverage in the community, all while allowing independent private practice to maintain its identity. Dr. Cohen stipulates that practices need to find the right partner with an aligned vision, but argues that when practices and private equity form good partnerships, they can help independent practice thrive and form a counterbalance to large hospitals.

Combining Therapy with SBRT and Brachytherapy

Posted by Richard G. Stock, MD | Apr 2022

Richard G. Stock, MD, Professor of Radiation Oncology and Director of Genitourinary Radiation Oncology at the Icahn School of Medicine at Mount Sinai in New York City, discusses the efficacy of SBRT and brachytherapy for treating patients with prostate cancer. He explains that combined SBRT and brachytherapy seems to be particularly helpful for intermediate-risk cancer, with studies showing about a 90% biochemical control rate. Dr. Stock then goes over the rationale for combined SBRT and brachytherapy, noting that brachytherapy combined with external beam radiation therapy (EBRT) at standard fractionation demonstrates excellent and safe outcomes for both intermediate- and high-risk prostate cancer, and SBRT appears to be comparable or better than standard fractionation without increased toxicity. He summarizes the findings of several different studies, explaining that with low-dose-rate brachytherapy and SBRT, researchers are seeing very similar results to using standard fractionation with brachytherapy. Dr. Stock also looks at a recent trial with high-dose-rate brachytherapy with SBRT which found a favorable early toxicity profile and encouraging cancer control outcomes. He concludes that the combination of SBRT and brachytherapy is promising, and the initial clinical impression is that patients tolerate the treatment well.

ExactVu™ Micro-Ultrasound for Diagnosis of Prostate Cancer

Posted by Priya N. Werahera, PhD | Apr 2022

Priya N. Werahera, PhD, Research Associate Professor in the Departments of Pathology and Bioengineering at the University of Colorado Anschutz Medical Campus, discusses the advantages of using the ExactVu micro-ultrasound platform to diagnose prostate cancer. First, he considers whether MRI imaging can be considered standard of care, arguing that it cannot be seen as such since many cancers are MRI-invisible, it is not cost effective, the technology remains in evolution, and there is high interobserver variability among radiologists. Dr. Werahera then turns to micro-ultrasound, explaining that the new ExactVu system is a 29 MHz machine which provides real-time imaging of prostate cancer lesions, has a high resolution of 70 microns, and can provide both lateral and axial resolution. He cites a meta-analysis which shows that micro-ultrasound is a relatively convenient and cost-effective method of real-time imaging which is highly sensitive in detecting clinically significant prostate cancer. Dr. Werahera then discusses a study at the University of Colorado comparing micro-ultrasound lesions vs. histopathology data of mapping biopsy which found that PRIMUS scores 4-5 have 100% sensitivity at the patient-level and 80% sensitivity at lesion-level for diagnosis of ≥ Gleason Grade 2 prostate cancer lesions. There were 2 undiagnosed Gleason Grade 2 lesions, both of which were small and located anteriorly. Dr. Werahera concludes that ExactVu micro-ultrasound has the potential to improve current imaging standards since it has comparable screening performance to MRI and comparable biopsy performance to MRI fusion, while also allowing for easier, more effective micro-ultrasound/MRI fusion. He also notes that ExactVu micro-ultrasound may enable widespread focal therapy due to its high accuracy in finding satellite lesions and lesion boundaries.

Impact of Rising Costs on Healthcare

Posted by Gregory F. Murphy, MD | Apr 2022

Congressman Gregory F. Murphy, MD, a practicing urologist and the Representative from North Carolina’s 3rd District, discusses rising costs and their impact on healthcare in the United States with E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego. Rep. Murphy notes that the United States as a whole is currently experiencing far higher rates of inflation than it has seen in several decades, but he also highlights how healthcare in particular has seen rising costs for the past 30 years. He explains that physician debt coming out of medical school in the early 1990s was around $50,000, and is now closer to $225,000, but physician pay has increased very slowly. Rep. Murphy observes that consumer prices and hospital costs have also increased massively since the early 1990s. He blames this in part on overregulation from the government. Dr. Crawford mentions the hardships faced by small practices, many of whom have shrinking bottom lines and are being bought by venture capital firms. Rep. Murphy and Dr. Crawford opine about the difficulties new doctors and incoming medical students face in a system that seems to value them less and less, and they emphasize the need to protect medical doctors’ interests through legislation.

Pathologist’s Perspective on Biopsy Results: Transperineal Mapping vs. Fusion Biopsy

Posted by M. Scott Lucia, MD | Apr 2022

M. Scott Lucia, MD, Professor and Vice-Chair of the Department of Pathology and Director of Anatomic Pathology of the Prostate Diagnostic Laboratory at the University of Colorado Anschutz Medical Campus (CAMC) School of Medicine, compares transperineal mapping and MRI-targeted fusion biopsy to systematic biopsy for identifying prostate cancer. He explains that there is overwhelming data indicating that 12-core systematic biopsy is only about 50-65% accurate. Dr. Lucia also notes that TRUS-guided transrectal biopsy is inaccurate, often missing and under-grading significant tumors. He then introduces transperineal template-guided mapping biopsies (TTMB) as a potentially superior alternative, explaining that the PROMIS Trial demonstrated that template biopsy consistently outperforms systematic biopsy and also highlighting that template biopsy has greater concordance with results from prostatectomy. Dr. Lucia says that another option is MRI-targeted fusion biopsy, which the PRECISION trial found to have more accurate detection than systematic biopsy. He also notes that the combination of fusion biopsy and systematic biopsy performs better than either one alone. Dr. Lucia then poses the question of whether MRI-targeted fusion biopsy or TTMB is superior, and he considers data on this from several studies. He concludes: that traditional transrectal biopsy schemes are inaccurate for identifying significant cancer; that TTMB and MRI-guided targeted biopsy offer improved pathological accuracy over TRUS-guided biopsy; that TTMB offer improved pathological accuracy over MRI-fusion biopsies; and that combined systematic biopsy and MRI-guided biopsy is useful for determining eligibility for focal therapy.