Check this thread out!
Is Urology undergoing the same procedure cuts as ortho?
The OP cited needing to see 30-40+ patients to make a decent profit, with some hand surgeons making more clinic than in the OR (not sure how true that may be)
Do you see a future in Urology where sitting in clinic prescribing drugs will be more profitable than doing OR procedures?
also i know that Urology has many in office procedures which raises over-head by A LOT if i am not mistaken, do you think PP and doing in office procedures will be sustainable in the future with if urology undergoes reimbursement cuts?
So this is a constant issue in all fields of medicine. Medicare (and then private insurers) take something that you do, and then cut the reimbursement for it, so to make the same income you did before you now need to do more of procedure X, see more patients, etc.. The counter to this is that new procedures and billing codes are constantly being generated, which tend to reimburse better then older procedures that have slowly been cut to the bone.
Urology certainly has been subject to this in the past. TURPs used to pay several thousand dollars from Medicare and now pay closer to 500. You used to be able to buy medications wholesale like lupron to administer in clinic and then charge list price for it and make a ton on the difference (Medicare got rid of this in the 90s). Generally speaking if there is something that pays much better then average for the time it takes, Medicare will eventually put a target on it and cut it, sometimes overly so to the point of it being a money loser.
Most things in Urology are reasonably stable and hasn't had any big cuts for a while. We actually got a miniscule boost in diagnostic cysto and a few other things. A few of our newer procedures, like urolift reimburse pretty well. We haven't really had a target on our back the way that Ortho/Nsgy Spine, interventional pain, radonc, et al have. I'm sure our time will come again, it is how things work in medicine. A nice thing about Urology is that roughly speaking, clinic and OR time pay pretty similarly, at least how it is structured in my practice, so I don't feel the need to push one over the other. It's a good position to be in, because if MEdicare shifts more funds from procedural codes to E&M (clinic evaluation) codes or vice versa we will be just fine either way. For example it is estimated that the recent increase in E&M codes at the expense of some procedural codes boosts the average urologist medicare reimbursement by 6-8%.
Urology procedures in clinic definitely raise overhead, but also dramatically increase billing of technical (non-physician) fees. If you are in a well run clinic that minimizes expenses from broken scopes, sterilization, etc and negotiates good reimbursements from insurers they are a major money maker. If you break scopes all the time it may cost you money. I can't see our main clinic procedures (cysto and prostate biopsy) being cut much in the future, as they are pretty reasonable RVU values for the time/cost involved and there would be a ton of push back from our advocacy groups, but who knows.
