The Urology Group, one of the largest single specialty groups of urologists in the United States, is a prime example of how consolidation can be good for medical consumers.

 Since 1996, The Urology Group has provided medical and surgical care of the urinary tract for men and women at a mix of neighborhood offices and surgical care centers. 

"Our goal is to be better, faster, and more cost effective than anyone else in everything we do," says Gary Kirsh, MD, president of The Urology Group. He has helped the independently owned group grow to 38 physicians at 12 locations in Greater Cincinnati. 

When The Urology Group formed 20 years ago, it was clear to healthcare experts that the trend in medicine was consolidation. The small, independent practice was fading away, especially in the tech-driven specialties. 

A small office simply could not handle the logistics or leverage the capital needed for a business infrastructure of accounting, insurance, computerized medical records and, of course, the increasingly sophisticated equipment. 

Consolidation has taken a couple of forms. Hospital groups have absorbed physician practices, providing those doctors with an office infrastructure. For example, in Cincinnati, it’s estimated 80 percent of physicians now work for one of five hospital groups. The other model has been consolidation into large physician groups independent of the hospital systems. Many believe the independent groups have generally provided more efficient, less expensive care in their specialties. 

The Urology Group is a classic case study of how consolidation into a nimble, independent group has led to a solid, integrated business, as well as a medical model that benefits consumers. 

"Not only is this an effective business model, but it’s good for patients and the community," Kirsh says. "Instead of having urologists fragmented around town, we’re able to create a real center of excellence from a clinical standpoint."

The urology specialists and subspecialists in the group offer an array of skills to treat urological conditions such as bladder control, cancer, female urology issues, kidney stones and men’s sexual health. 

The Urology Group’s three-year-old, 55,000-square-foot Norwood Ambulatory Urological Surgical Center has become the mothership for the organization. The location performs 14,000 outpatient surgeries a year as well as thousands of imaging procedures, diagnostic tests and other treatments.

"It is the largest urology-dedicated, independently operated outpatient surgery center in the United States," Kirsh says. 

Among the services offered at the Norwood campus:

• A pathology lab that performs more than 2,000 biopsies a year for prostate cancer. It also performs a highly specialized DNA test for bladder cancer that allows a patient’s cancer to be followed more accurately. And it has a pathologist with advanced certification in urological pathology.

• State-of-the-art imaging services that Kirsh says are significantly less expensive than those performed at a hospital. "Because we are independent, we can serve all hospital systems while still coordinating care with those institutions."  

• A robust clinical research department that works with pharmaceutical, biotech and medical device companies to test new treatment techniques in dozens of ongoing clinical trials. 

• The only physicians group in the Tristate to offer CyberKnife specifically for prostate cancer. CyberKnife is a treatment that offers increased accuracy and efficiency for radiation therapy. "In most cases we can deliver a radiation therapy in five days instead of eight weeks," Kirsh says. 

• An "advanced prostate cancer" clinic focused on treating cancer that has spread beyond the prostate with access to clinical trials for those patients. 

• A device called a lithotripter to break up kidney stones using high-energy shock waves, supplemented by ultrasound to better identify the location of stones. 

• A specialized clinic that focuses on female urology for overactive bladder, pelvic pain and incontinence. 

The Urology Group also has relationships with most area hospitals where its specialists are some of the most prominent names in advanced robotic cancer surgery. 

Kirsh believes the consolidation of urological services into a focused, vigorous independent group makes for more efficient care than can be provided by larger entities with more bureaucratic structures.  

 "It’s hard for the large systems to make urology as efficient as we have as an independent group totally dedicated to building this specialty," says Kirsh. "After all, urology is a small specialty of medicine. It is better for the community if urologic care is centralized in a state-of-the-art organization that can streamline care and measure outcomes." 

Other independent physician groups in the area would likely make a similar argument when it comes to their various specialties such as orthopedics, oncology, gastroenterology, neurology and optometry. For these independents, the public relations problem is that average medical consumers – and some corporate HR departments – are not aware of the differences between the large independent groups and the hospital systems. 

To that end, 18 local physician groups have formed the Independent Physicians Collaborative (IPC) designed to boost brand recognition to patients, insurance companies and large employers.  IPC also wants to make sure employers include independent groups among the network choices in health insurance plans. 

"This is not a super group to compete with the hospital systems," Kirsh says. "The purpose is to give those groups a forum to compare notes and to form relationships with commercial payers and employers in the market. We want to remind them that the premier groups are independent and there is an advantage. They can provide services to employers and insurance payers that are more cost effective."  

Kirsh, who is a national leader in urology practice policy as president of the Large Urology Group Practice Association, believes the push for a more holistic fee structure based on successful outcomes for patients, rather than the current fee-for-service system, will drive more healthcare consolidation. That means healthcare organizations will have to provide more sophisticated metrics to measure patient outcomes, something a large independent group like The Urology Group is well suited to provide. 

 "For that to happen," he says, "we have to have a system that has the data, analytical and medical sophistication to look for value-based outcomes we can measure. The Urology Group has a well-integrated business and medical model that can handle such demands." 

The Urology Group serves Greater Cincinnati with 12 convenient offices in Ohio, Indiana and Kentucky. You can reach them at 513.841.7400 or visit their website at www.urologygroup.com.