Practice Management

2025 Medicare Part D Changes: Physician’s Perspective

by Neal D. Shore, MD, David S. Morris, MD, FACS and Mark N. Painter, CPMA, MBS | Oct 2024

Mark N. Painter, CPMA, MBS, Managing Partner, Consulting LLC, CEO, PRS Urology Service Corporation, Vice President of Coding and Reimbursement Information and CEO Relative Value Studies, Inc. is joined by Neal D. Shore, MD, FACS and David S. Morris, MD, FACS to discuss the physician’s perspective on the upcoming Medicare Part D updates. They share the benefits of these changes and the possible hardships as well.

In this third part of this series, Mark briefly highlights the Medicare Part D changes, such as the reduction of the maximum out-of-pocket expenditure and the Medicare Prescription Payment Plan (MPPP) or “smoothing option”, that the first part of this series covers in more detail. Neal D. Shore, MD, FACS and David S. Morris, MD, FACS then join Mark to share their point of view as physicians on how they are planning to maneuver these changes in the best way. David S. Morris, MD, FACS discusses how he thinks these changes will give a positive outlook to a patient’s finances, for example with the smoothing option or through grants. Also, Neal D. Shore, MD, FACS shares how offices have to prepare to help patients through the process of understanding and taking advantage of these upcoming updates.

This 15-minute discussion concludes with all speakers agreeing that the financial burden on the patient is key when it comes to medications, but they are cautiously optimistic that these upcoming changes will benefit patients, although many will still rely heavily on grants and funding to get the medications they need. Both physicians share in their hope that the upcoming Medicare Part D changes will be a step in the right direction to making healthcare more accessible to all patients and a reminder: Open Enrollment begins October 15, 2024, and runs through December 7, 2024.

2025 Medicare Part D Changes: Preparing Your Office and Patients

by Mark N. Painter, CPMA, MBS and Michael Burnett, COO | Oct 2024

Mark N. Painter, CPMA and Michael Burnett, Chief Operating Officer at Kansas City Urology Care, discuss upcoming 2025 Medicare Part D changes and how it will affect urology patients. This 12-minute discussion goes into detail of each new update to Medicare Part D, how it can affect patients who are in need of grants, subsidies or assistance, and how urology practices can aid patients in adopting and taking advantage of these new updates.

2025 Medicare Part D Changes: Overview of the 2025 Plan

by Mark N. Painter, CPMA, MBS | Oct 2024

Mark N. Painter, CPMA, Managing Partner, Consulting LLC, CEO, PRS Urology Service Corporation, Vice President of Coding and Reimbursement Information and
CEO Relative Value Studies, Inc. reviews upcoming 2025 Medicare Part D changes and what they aim to achieve. This 13-minute discussion goes into detail of each new update to Medicare Part D, including the reduction of the maximum out-of-pocket expenditure, the Medicare Prescription Payment Plan (MPPP), and “Likely to Benefit Letter” and how these can affect different patients, including those that are eligible for grants or subsidies.
Dr. Pohlman then brings up emerging complementary tests that mitigate the weaknesses of PSA alone, like the EpiSwitch® Prostate Screening (PSE) Blood Test. He explains that the EpiSwitch® PSE combines five epigenetic biomarkers with a standard PSA test in prostate cancer screening. He briefly discusses how the simplified test can be implemented in practice and how the test results are quickly and clearly delivered in patient-friendly formats to facilitate shared decision-making.

Dr. Pohlman then discusses the validation processes behind the EpiSwitch® PSE test, including its high accuracy, specificity, sensitivity, and positive/negative predictive values, which reduce the need for unnecessary prostate biopsies. He presents data supporting the benefits of using non-invasive biomarker tests like the EpiSwitch® PSE test in prostate cancer screening prior to MRI and/or prostate biopsy.

Dr. Pohlman concludes by presenting case studies where the EpiSwitch® PSE test would have prevented unnecessary biopsies and MRIs. He discusses his practice’s success in using the EpiSwitch® PSE tests to screen for prostate cancer without defaulting to invasive testing.

Simplified Management of Male Genital Pain

by Ryan P. Terlecki, MD, FACS | Aug 2024

Ryan P. Terlecki, MD, FACS, presents a focused and practical approach to managing male genital pain, emphasizing simplification in both diagnosis and treatment. In this presentation, he stresses the importance of thorough patient history and physical examination and introduces a streamlined diagnostic framework to identify the underlying causes of genital pain.

Dr. Terlecki advocates for an intake questionnaire, physical exam, and lab work, focusing on symptom relief and quality of life as primary treatment goals. He reviews various medical causes of symptoms and possible treatment solutions, including referrals to other health practitioners, such as pain management specialists, orthopedists, or even alternative medicine providers. His insights provide a clear and actionable framework for urologists seeking to improve outcomes for patients suffering from this often debilitating condition.

Managing Screen Time Isn’t Just for Kids: Tips to Break the Spell

by Catherine A. Matthews, MD, FACS, FACOG, FPMRS | Aug 2024

Catherine A. Matthews, MD, FACS, FACOG, FPMRS, addresses the pressing issue of excessive screen time, emphasizing its impact on adults as well as children. She discusses the physical and psychological consequences of prolonged screen use, including eye strain, disrupted sleep patterns, decreased physical activity, and increased stress and anxiety. Dr. Matthews also discusses the psychological impact of screen time, noting that excessive use is linked to higher levels of stress, anxiety, and depression.

Dr. Matthews concludes by drawing clear parallels between addiction and screen time in children and adults. She provides practical tips for reducing screen time and increasing interpersonal interaction.

APC Pathways – The Large Urology Group Practice Model

by Jeffrey M. Spier, MD and Travis Mendel, MD | Aug 2024

Jeffrey M. Spier, MD, and Travis Mendel, MD, discuss the use of Advanced Prostate Cancer (APC) Pathways within large urology group practices. Dr. Spier begins by reviewing the impact of oral options and other advances in treatment collaboration between APC patients and their physicians which led to the formation of large urology group practices.

Dr. Spier then discusses the factors which contribute to the success of large urology groups in treating patients with APC, with an emphasis on improved quality of care. He highlights the importance of combining real-world clinical intelligence with a multidisciplinary approach for continuous improvement in the quality of care received by patients.

Dr. Mendel takes over from Dr. Spier by explaining the differences between clinical guidelines and clinical pathways. He presents examples of treatment pathways for various stages of APC, with a focus on the impact of PSMA-PET.

Dr. Mendel concludes by discussing the potential use of these pathways in creating better AI treatment aids for physicians. Dr. Spier ends the presentation with an emphasis on the positive impact of a multidisciplinary team.

YouTube Surgeons – The Role of Video Learning in Urology

by Ryan P. Terlecki, MD, FACS | Aug 2024

Ryan P. Terlecki, MD, FACS, explores current resources for lifelong learning and metrics for measuring success for urologic surgeons. He begins by reviewing the skills and technology-based challenges facing urologists today.

Dr. Terlecki explores the evolution of expectations and goals of medical education across generations. He reviews the history of surgical training from the Halsted Model to present day educational standards for continuous professional education, including the increasing ubiquity of video in daily practice.

Dr. Terlecki concludes by highlighting the benefits and dangers of using videos to train, provided that feedback from an expert source is incorporated in the training. He illustrates different models for trainees and established surgeons to improve their performance using a combination of expert insights and video analysis.

Cognitive Bias in Practice and Training

by Justin J. Badal, MD | Jul 2024

Justin J. Badal, MD, examines the impact of cognitive bias in medical training and practice on clinical decision-making, diagnostic accuracy, and patient outcomes. He begins by defining cognitive bias, and analyzing common biases, including:

Representativeness Bias
Misconception of Regression Bias
Availability Bias
Adjustment and Anchoring Bias

Dr. Badal demonstrates examples of the impact of each bias in diagnostic testing, clinical decision-making, and patient outcomes. He concludes by making recommendations for counteracting cognitive bias in practice with evidence that bias training improves overall clinician performance.

Success with Sacral Neuromodulation

by Robert J. Evans, MD, FACS | Jul 2024

Robert J. Evans, MD, FACS, provides practical guidance on successfully incorporating sacral neuromodulation (SNM) into a urology practice. He begins by discussing proper documentation strategies to avoid SNM being rejected by insurance.

Dr. Evans then shares his approach to patient education and engagement. He presents the available options for SNM devices and implantation procedures. He outlines the ideal patient profile for staged versus peripheral nerve evaluation procedures, and he discusses the level of patient engagement required for rechargeable versus non-rechargeable SNM devices.

Dr. Evans concludes by providing guidance on troubleshooting. He presents common technical issues and patient experiences with SNM devices. For each issue, he presents solutions which can be implemented in-office.

In-Office Procedures and the ‘Scope’ of Practice for APPs

by Terran W. Sims, NP, MSN, ACNP-C, CNN, COCN-C | Jun 2024

Terran W. Sims, NP, MSN, ACNP-C, CNN, COCN-C, discusses how to prepare and incorporate advanced practice providers (APPs) like nurse practitioners and physician assistants in urologic procedures. Ms. Sims begins by listing office procedures APPs might encounter, focusing on cystoscopy, stent removal, and difficult catheter insertion. She continues by posing a guiding question for her discussion: what is the best fit for APPs in practice?

Ms. Sims then briefly reviews differences in the scope of practice for APPs across the U.S., noting important state licensure requirements and highlighting the increasing presence of APP participation in urologic procedures. She emphasizes the American Urological Association’s (AUA) and Society of Urologic Nurses and Associates’ (SUNA) support for APP involvement, and utilizes cystoscopy as an example by detailing data that show increased levels of patient satisfaction as APPs have performed greater numbers of cystoscopy procedures.

Ms. Sims concludes by addressing the primary obstacles to additional APP role expansion: the lack of training and lack of standard curriculum. She encourages urologists to overcome these obstacles and invest in APPs by providing training, instilling confidence, and maintaining mentorship. She reiterates the benefits of APP involvement, including increased cost-effectiveness, profit margins, and team productivity.

The Business of Medicine: What Residency and Fellowship Failed to Teach Me

by Colin E. Kleinguetl, MD | Jun 2024

Colin E. Kleinguetl, MD, shares insights regarding some of the practical knowledge gaps faced by urologists in residencies and fellowships. In this presentation, he outlines areas that those entering a residency or fellowship should be familiar with ahead of time, including:

Types of Practice
Practice Management
Tips and Tricks for Medical Coding
Contract Evaluation
Financial Management

Practical Steps for Clinical Efficiency Relative to Physician Burnout

by Ryan P. Terlecki, MD, FACS | Apr 2024

Ryan P. Terlecki, MD, FACS, offers actionable steps to keep a clinical practice efficient in the face of the epidemic of physician burnout. In this presentation, he discusses how the first step in keeping an efficient and effective practice is to develop a familiarity with:

The Differences Between Efficiency and Effectiveness
The Role of Planning, Consistency, and Reevaluation in Quality Improvement
Management Strategies Which Prioritize Workflow and Well-Being

Dr. Terlecki frames burnout management around a few key principles for efficient and effective clinical practice. He provides real-world examples and applications of these steps to combat and compensate for physician burnout in both practice and academic settings.