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    Urology, gynecology collaboration addresses rising demand


    What do you see as barriers to full integration of all physicians involved with full-time care of patients with pelvic floor disorders?

    In 2000, Dr. Jerry Blaivas wrote an editorial called “Herding cats” that covered this exact issue (Neurourology and Urodynamics 2000; 20:1). The two big barriers he identified were territory and money. While these are not as problematic today as they were then, they are still problems going forward.

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    Territory is difficult because you have to navigate the waters between the generalist and the specialist within urology and within GYN and then navigate between urology and GYN. If there’s limited territory, that can be challenging. But as we discussed earlier, the territory is really expanding in this field. There are lots of patients with these problems.

    Dr. Blaivas thought the money problem could be solved by having us work together and share income the way we do within our individual departments now. That would be the ideal way for that to happen, but in an academic medical center, where funds flow along departmental lines, that’s challenging. It’s challenging to figure out how providers are going to be reimbursed, how physicians will be compensated, and how to gather resources, space, and staff.

    There are also practical barriers. How do we take call for each other? If I’m a urology practice and I want to expand my FPMRS services by hiring a gynecologist who has finished an accredited training program, how do I fit that person into my call schedule?


    How would the conversion of the volume-based model of financing U.S. health care into a value-based model in which quality indicators will lead the path for financial incentives benefit female pelvic medicine?

    There are data from other diagnoses that have multi-system effects—multiple sclerosis, spina bifida, obesity, and diabetes—demonstrating that a multidisciplinary approach to those problems is beneficial in terms of quality outcomes. Pelvic floor disorders certainly apply to that. I think that female pelvic organ reconstructive surgery is well poised to do this because the goal of such collaborations as the Pelvic Floor Disorders Network and the Urinary Incontinence Treatment Network was to work together to develop large, prospective data-driven answers to some of the key questions. Because we have a history of doing that, we’re going to be well poised to figure out the quality indicators for our specialty going forward.

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    UW is one of the pioneer sites for the AUGS Pelvic Floor Disorders Registry, which is a multicenter, prospective cohort study looking at surgical versus medical treatment of patients with pelvic organ prolapse. It examines effectiveness, quality of life, and safety of therapy. I wouldn’t be able to participate in that if I wasn’t in a multidisciplinary program. Having that collaborative approach really helps.


    A multidisciplinary program seems like a great fit if you’re going to pay based on quality rather than volume; the multidisciplinary group would squeeze out providers who are not in the group because their quality is going to be so much higher.

    Absolutely. In the study from Kirby that you mentioned, while demand for care increased over the time covered by the study, the number of surgeries actually didn’t increase commensurate with that, which I think goes to show that surgery is not always the quality answer. In a volume-based model, surgery is always the answer.

    Next: "To have an FPMRS service line, first and foremost you have to have the human capital."

    Philip M. Hanno, MD, MPH
    Philip M. Hanno, a Urology Times editorial consultant, is professor of urology at the University of Pennsylvania, Philadelphia.


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