1. OPTIMIZING A UROLOGY OFFICE PRACTICE JUAN A REYNA MD PRESIDENT EMERITUS-UROLOGY SAN ANTONIO PRESIDENT ELECT- LUGPA (AIUG)

2. Who Are We? I just resigned as the president and CEO of USA. I began the practice by myself in 1981 in the heart of San Antonio We grew one by one and later by merger and acquisition to 30 urologists, 8 clinics, a major cancer center and almost 200 employees I am president-elect of LUGPA I am also on the board of AICC

3. Starting Point Will optimization improve the quality, access and convenience to your patient The optimizations should be integral to improving the care of your patient. It has to be more than just about the money As you begin to optimize and integrate be careful to garner support and in the current political environment be ready to defend and protect them

4. Do Not Forget That We Are A Service Industry Everyone of you has your own style of communication and interacting with the patient Have your ever measured your patient’s level of satisfaction The most critical thing to do is make sure that your entire organization is meeting your patient’s needs. You may think you are a great doctor but your staff may be turning people off or is it you

5. QUESTIONS TO ANSWER WHO IS GOING TO TAKE CHARGE? WHEN IS THE BEST TIME TO DO THIS? WHAT DO YOU ALREADY HAVE? WHAT IS YOUR STRUCTURE? WHO IS GOING TO DO THIS WITH YOU?

6. WHO IS GOING TO TAKE CHARGE OF THE PROCESS Many urologist are not skilled in the area of optimization and development If this in is your skill set, go for it If not, get some help (AUA, MGMA, MBA, LUGPA) Consider starting with a business plan for the next 2, 3 or 5 years. Setting goals are important NO PAIN, NO GAIN.............NO HELP

7. When Is The Best Time To Optimize and Develop a Plan Well, if you have not done it in the last 2 years, you are already behind. In fact, it should be an ongoing process There are few things that you can do that will not cost you money. So be prepared for some capital outlay and you may want to consider a yearly budget and some dedicated staff people I truly feel that the new ACA with all its shortcomings will provide opportunities. Every crisis has brought us opportunities

8. What Do You Have Already? Aside from an efficient and courteous staff, pleasant surroundings and some basic equipment Is your EMR in place. Talk about a game changer. Few advances in our offices have caused the level of whining early on. Now, we cannot live without it and it actually brought each of us an extra $18,000 (ACA) Do you have a web site Do you participate in social media (Linked In, Facebook and twitter)

9. People Are Looking An amazing number of patients will google you and then go to your site to see what you actually provide or do not provide Other professionals will want to know who you know and what you know. Bragging is OK People are documenting their experience in your office in a very public way and in potentially less than flattering tweets

10. People Are Wanting One stop shopping when possible Do you have a lab or at least do your own blood draws Do you have full ultrasound capability to include biopsies and/or do you have CT. Conventional X-ray is a lost leader in this area Do you have a surgery center

11. Specialty Wants Do you do infertility Do you have laparoscopic and robotic surgeon Do you have females in your practice/are they specialized Do you do the big cases or refer out Do you match your demographic* Do you provide radiation therapy/cancer center Do you have your own lithotriptor

12. Specialty Wants Do you do significant volumes of prosthetics Do you employ or contract with a radiation oncologist Do you provide urodynamics. Our NP who runs this for us bills more than any doctor in the group all while going back and getting her doctorate degree Do you provide neuro modulation implants or PTNS

13. Internal Wants Do you have a pathology lab Do you participate in research/clinical trials Do you have a competent administrative team Are you working harder because your compensation methodology promotes productivity If you are, do you have a work flow analysis to facilitate appropriate changes to the clinic

14. WHAT IS YOUR STRUCTURE How is that working for you What is your geographic approach. Ivory Tower vs city wide clinics Governance model. CEO/COO with board support or board centric with President picked by the board What drives your decision for new partners. Have you had someone examine your time to next visit

15. How Big Do You Want To Be Single urologist vs small group vs large urology group I have had all 3 opportunities Large group provides for the addition of ancillary services. We like to call these integral services in an integrated model to optimize services for your patient while benefitting from the revenue of these services “Mas peros, mas pulgas” larger can be advantageous but has its complexities New mindset: it has to be about the group

16. Integrate Model This model has allowed us to provide more services in house with the overall result being a happier, more compliant patient We are at the point that these services now represent a significant portion of our income Monitor closely such that others will not accuse you of self referring for monetary gain only The data we have shows no difference between how often we use these service vs non integrated urologists

17. Conclusion For maximum optimization consider the integrated model Do it first to take better care and provide convenience for your patients We have truly optimized our office practice while having a happier patient and maintaining a high quality level of care

18. THANK YOU QUESTIONS?