Urology Practice Succeeds With Transparency, Upfront Payment Model

Timothy A. Richardson, MD

It may be true that most people do not enjoy staff meetings, but the partners at Wichita Urology, the largest independent urology practice in Wichita, Kansas, have built their success over 60 years partly by holding frequent meetings, which they say build camaraderie and make it possible to address needs quickly.

Meetings, they say, create a transparency that prevents employees from being broadsided by any changes. “All the physicians come together at the board meetings. Even if you’re not yet a partner you still attend, and we hold board meetings 3 times a month,” said Twila Puritty, CEO of Wichita Urology. This makes the practice nimbler and, as a result, things that need doing don’t languish on the back burner. “We are able to accomplish a lot of things in a short period of time compared with other groups who don’t meet as frequently,” she said. This collaborative style also allows for everyone’s voice to be heard when practice-changing decisions are made.

Another pillar of the administrative structure at Wichita Urology is a collection model that ensures the physicians are fairly and efficiently paid for their hard work, Puritty explained. The practice requires payment upfront for elective surgeries—before the procedures take place. “We used to write off thousands of dollars for elective surgeries that patients didn’t pay for after receiving surgery. So, we adopted a policy that surgeries would be classified as either urgent or elective, and if they’re elective the surgery isn’t scheduled until the patient pays the out-of-pocket amount,” Puritty said. It was felt that these nonessential unpaid surgeries were not only an inefficient practice but also cost physicians time that they could have spent at home with their families.

History of the Practice

Under the revised policy, the cost of the elective surgery is explained to patients, and numerous attempts are made to ensure payment is received upfront. The surgery will usually be rescheduled until that requirement is met. However, it sometimes happens that the practice will do an elective procedure without payment and accept the unpaid bill as a cost of doing business.Wichita Urology has grown organically, without merging with any other urology groups. It was founded by 3 urologists in 1955 and now has 9 physician partners. The support staff numbers 92 employees, including 84 who are full time and 8 who are part time. Although the practice has many employees, its efficiency is high, and this enables clinicians there to see a high volume of patients, Puritty said. From 2016 to 2017 the group saw 19,427 patients.

Wichita Urology is spread out over 3 offices in the south-central Kansas metropolis. The main office on the east side of town is large enough to have 3 clinics operating at once. By contrast, their west-side office offers just 1.

Physicians at the practice see adult and pediatric patients with all stages of prostate, bladder, and kidney cancer. “We have individuals from first diagnosis to those who walk in with metastatic disease. We not only get referrals for end-stage disease, we see every type,” said Timothy A. Richardson, MD, a physician partner.

The urology group participates in many clinical trials for prostate cancer and a smaller number for patients with renal or bladder cancer. Wichita Urology also enrolls patients in trials for general urologic disorders, such as overactive bladder and benign prostatic hyperplasia. There are no medical oncologists on staff, but the practice works closely with a local medical oncology group to address patients’ needs for chemotherapy or other specialized cancer treatments. Following outside care, patients usually return to Wichita Urology to resume treatment.

The practice often can provide in-house treatment for a wide spectrum of a patient’s needs. For example, the practice can provide surgical interventions for patients with resectable cancers. “For prostate cancer, we take care of those patients from diagnosis. If they need chemotherapy, we send those on, but we still try to manage everything else,” Richardson explained.

In 2014, Wichita Urology opened an office that is dedicated to radiation therapy. The availability of radiation oncologists enhances the practice’s ability to treat patients in-house. The practice also has an outreach program for about 15 communities. Wichita Urology physicians travel to those offices regularly for clinics that may be held multiple times per week.

Advanced Prostate Cancer Clinic

Wichita Urology’s commitment to these outreach clinics often stems from hospital requests for urology coverage, according to Puritty. It is not always possible to provide support for these outside clinics, either because of a lack of staff or because a location is too far from Wichita Urology’s offices. “We can’t always say yes,” she said.One of the most important additions to Wichita Urology is their advanced prostate cancer clinic, which they opened in 2017 to address the increasing complexity of advanced prostate cancer care. Richardson serves as the lead physician and “champion” of that clinic. “Advanced prostate cancer has become so convoluted and confusing. There are more therapies being approved every day.” To address patients’ need for access to quality care and Wichita Urology’s need for efficiency of operations, an advanced prostate cancer clinic was developed that could work with just 1 or 2 doctors, Richardson said.

Wichita Urology strives to offer patients cutting-edge technologies and treatments, but its doctors also want to ensure that patients get the most appropriate care. Puritty said an example of this is a current initiative to start dispensing catheters directly to patients. She said group discovered that a vendor they worked with previously was dispensing catheters based on what made good financial sense to the vendor rather than what was most appropriate for patients’ needs.

The physicians pay close attention to the many drugs in development and look forward to being able to give their patients therapies that offer better outcomes. “There are about 300 drugs in development now, and there are a lot of drugs on the horizon that are going to be approved for us to use earlier and in different situations,” Richardson said. He anticipates that some of those drugs will become available as soon as the first or second quarter of this year.

Richardson and his colleagues also recognize the value that genetic counseling can bring to cancer treatment. They currently offer several genetic tests to patients with prostate cancer. The practice works with several genetic counselors, including one who is associated with a hospital in Wichita and another with whom patients can speak by phone.

The practice is also investigating telemedicine and how it can reduce the distances their physicians have to travel. Because they serve so many clinics across Kansas, including some that are hours away from Wichita, telemedicine would allow physicians to treat patients remotely who may not have been reachable before. “The travel burden on a busy urologist can be a killer on their productivity,” Puritty said.

Wichita Urology is vigilant about monitoring changes in payers’ payment policies, and practice members are confident that their in-house efficiencies will protect them from the potential revenue losses that can result from payment policy changes. “There are all these conversations about reimbursement, such as the Medicare Access and CHIP Reauthorization Act and the Meritbased Incentive Payment System, and how are we going to be impacted—negatively or positively.” Purrity said that internal policy changes can help to offset external pressures. The practice’s decision to aggressively pursue payment upfront for elective surgeries is one such example, she said.