The wave of challenges urology leaders faced in the past year accelerated changes that will shape the market in 2021 and beyond. We've detailed four trends urology leaders need to understand how to respond to:
- Continuing growth in outpatient sites of care
- Increasing telehealth adoption
- Emerging technologies for common urologic conditions
- Worsening urologist shortage
Continued growth of services performed in ASCs and offices.
How has the market changed?
The shift to outpatient settings in urology has largely already occurred. Some high acuity procedures such as major bladder and kidney procedures have remained inpatient; however, the majority of urology procedures are now performed outpatient. Today, urology volume growth is concentrated in ASCs and office settings, as opposed to HOPDs. We predict urology volume growth will further concentrate in ASCs and office settings: we're projecting 12% volume growth in these settings across the next five years, compared to 6% in HOPDs.
How can you respond?
To diagnose how quickly your organization may need to change its site of care strategy, analyze market-specific growth projections by site of care for urology services and the percent of urology procedures your organization currently performs in an HOPD versus ASC. Then, create a site of care prioritization strategy for urology procedures, considering the possibility of moving more procedures into an ASC or other outpatient setting. For example, organizations often route lower acuity patients to ambulatory network sites to create convenient access points for urology services and to open hospital capacity for higher acuity cases. Be sure to collaborate with your urologists to determine patient eligibility criteria and to create care pathways to ensure your new site of care strategy is streamlined and safe.
Telehealth will play a larger role going forward following the Covid-19 spike in virtual visit adoption.
How has the market changed?
Historically, telehealth was not widely used in urology, but urologists' usage of telemedicine nearly tripled during the pandemic. It was especially successful for managing some common urological conditions, including erectile dysfunction, infertility, uncomplicated urinary stones, uncomplicated urinary infections, and urinary incontinence. While the rates of telehealth adoption may decrease slightly from pandemic levels, virtual visits are likely to play a larger role in urology in the future.
How can you respond?
Start off by setting a goal for your telehealth services. What do you hope to achieve with this additional tool? With an unclear reimbursement outlook, it's important to assess the value of telehealth in the context of specific use cases and service line goals, rather than solely as a replacement for in-person care. Then, work with your physicians to determine when and for which services telehealth is most appropriate. Lastly, collaborate with a urologist telehealth champion to create virtual visit workflows, overcome clinician skepticism, and to ensure your telehealth program is designed with vulnerable populations in mind. For more best practices on telehealth implementation, see our "Telehealth Resource Library."
New treatment advancements emerge targeting common urologic conditions
Advanced treatment options such as robotic surgery and other minimally invasive surgery techniques are commonly used in urology. These have decreased the popularity of inpatient procedures like prostatectomies, cystectomies, and nephrectomies. New technologies are continuing to emerge, such as AI-assisted brachytherapy placement, urine screening tests (MyProstateScore), and FDA-approved hydrogels (such as Contura's) and IV therapies (such as pembrolizumab). These new technologies equip urologists with more tools to combat and improve the treatment of common urologic conditions like prostate cancer, bladder cancer, and stress urinary incontinence, and help avoid the need for surgery.
How can you respond?
First, discuss with your urologists how these treatment options may benefit your patient population. Specifically, determine the percent of patients who would be both clinically eligible and covered by insurance for these treatments. Second, consider how these treatments could impact patient volumes by attracting net new volumes and/or freeing up capacity for more acute cases. Third, assess if these new technologies align with the outpatient procedures your organization commonly performs, with your organizational goals, and with positive projected growth forecasts in your market. Lastly, consider the level of investment required to offer these new treatments and how the reimbursement compares to reimbursement for surgery. Weigh these factors against each other to determine the right course of action for your urology program. This could range from investing in these advancements today, to pursuing partnerships to make new treatments more accessible to your patients, to monitoring and regularly reevaluating the efficacy and reimbursement for these innovations.
The urologist shortage makes effective physician engagement more important than ever
How has the market changed?
As of 2019, there are 13,044 practicing urologists in the United States, which translates to less than 4 per 100,000 people. The majority (90%) of these providers work in metropolitan areas, leaving 62% of the nation’s counties without a practicing urologist. The shortage of urologists in the United States has led to increased efforts to engage younger surgeons interested in urology and minimize physician burnout. At Baylor College of Medicine, the resident wellness program was created to lower burnout risk for urology residents. The program improved physicians' wellness scores according to the Mayo Clinic Well-Being Index by more than 50%, indicating decreased levels of distress. Additionally, the American Urological Association and Urology Care Foundation announced a new program in April 2021 that will support three urology residents per year from underrepresented backgrounds. Their goal is to foster strong research training and address the increasing shortage of urology surgeon-scientists, especially from underrepresented backgrounds.
How can you respond?
Foster a network of support services for physician well-being like limited EHR time, increased ratio of patient time, better food choices at work and home, and room for personal health (like exercise breaks). With physician burnout reaching epidemic levels, it has also become a top priority for health care executives. View this on-demand presentation, "Combating Physician Burnout," to identify and help you address the key drivers of burnout at your organization.