one was urology—cystoscopy—which placed 17th


The 2017 VMG Health MultiSpe- cialty ASC Intellimarker report stated that urology cases represented only 6 percent of the total case mix for ASCs in the US. It also found that urology cases generated the fourth highest median net revenue per case for ASC specialties at about $2,400 per case, behind orthopedics, otolaryngology and podiatry. For-profit ASCs want lines of services that have high net rev- enue per case and growth potential. That is urology in a nutshell. There is an incredible opportunity

for ASCs to be the site that provides the highest level of safe, compassionate, cost-effective outpatient urologic care. From a timing standpoint, the stars are aligned for urology ASC services.

Untapped Potential: Urology in the Surgery Center Setting

One-on-one with an ASC urologist INTERVIEWED BY ROBERT KURTZ

the surgery center division of Chesa- peake Urology Associates in Baltimore, Maryland. Summit ASC comprises 16 single-specialty urology ASCs located throughout Maryland.


Q: How is urology doing in the ASC setting? Brad Lerner: Very well, and I believe urology is uniquely positioned to be successful in the ASC arena. There is an increasing national emphasis on changing the site of ser- vice for surgical cases from inpatient to outpatient settings. Most urological services are already outpatient. Many are high-volume, short-duration and low-cost procedures. In the Medicare Payment Advi- sory Commission’s (MedPAC) March 2019 report to Congress concerning

rad Lerner, MD, CASC, is the medical director of Summit ASC,

Q: What are the most significant recent developments impacting urology in the ASC setting? BL: From a clinical standpoint, there have been many significant advance- ments. We are using new technology, doing surgeries with smaller inci- sions and using minimally invasive and other techniques that lower the risk of bleeding. For example, consider monopo- lar transurethral resection of prostate (TURP), which was historically the surgical treatment for benign pros- tatic

enlargement and obstruction. Brad Lerner, MD, CASC

Medicare payment policy, the fed- eral body included some noteworthy points concerning urology. Urology comprised only 3 percent of single- specialty ASCs. While MedPAC did not provide a number, it intimated that urology comprised a very low percentage of involvement in multi- specialty ASCs.

On the list of the 20 most frequently provided ASC services in 2017, only


This was an inpatient procedure with an increased risk of bleeding. Our treatment options now include

using different types of energy, such as laser and plasma vaporization, as well as the prostatic urethral lift and hot water vaporization procedure to treat the obstruction. These procedures can be performed on an outpatient basis with intravenous sedation or general anesthe- sia and with very low bleeding risk. Another significant clinical devel- opment concerns treatment of urinary tract stones. Much of the traditional treatment that has occurred in the hos-

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