Dr. Arpeet Shah
speaker
84 appearances
1 recordings
1 series
first heard Sep 2024
last heard Sep 2024
Dr. Arpeet Shah’s voice in public audio — every appearance, attributed to the second.
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Appearances
And if they don't feel that, then they're really happy with you.
Yeah, I mean, those are difficult to measure always, but there's a variety of ways that we can make sure that it happens. So in terms of clinical excellence, take, for example, Eurocuffs. You know, we spend a lot of time educating our advanced practice providers with Eurocuff. The folks at SRS who developed Eurocuff help with that educational process, and that partnership is really important.
And we'll have periodic maybe the annual Eurocuff test where we're having our advanced practice providers go through Eurocuff studies, answer several questions about them so we can identify those who need more education, right? So that's just one part of clinical excellence. You know, we can talk about prostate cancer and active surveillance and kind of all the things, you know, we can go through.
But making sure that you have a kind of a robust program, a pathway, and then a way to monitor that pathway compliance. And so there's another thing, you know, we make sure that when patients are seen with BPH that they get an AUA symptom score. And if they have an AUA symptom score above 8, which means moderate to severe symptoms, that at least a discussion is being had about
medications, diagnostic testing, right? And if they refuse, they refuse, but we're going to be monitoring that and tracking that with our advanced practice providers to make sure that they are following the pathways.
I wish we had something in our EHR. Right now it's laborious, but we think it's important. So we have clinical navigators who are nurses or MAs who specialize in different disease states. Our clinical navigator will not only talk to patients to make sure that they're following up. Let's say we have a BPH navigator. They'll remind them, hey, you have your Eurocuff next week.
Make sure you drink plenty of fluids before you come. They're the ones who are doing the Eurocuff test, right? So this is somebody that the patient knows they've talked to. Now they see them doing the Eurocuff test. Those are the same navigators who work with our advanced practice providers and our disease state experts.
And they're the ones who are actually checking in and giving us the data on compliance. So It's laborious right now. I think as EMRs get smarter, as AI comes in and really builds into EMRs, we're going to be able to do that more easily.
When we talk about the other things like compliance, that goes into compliance, but also documentation, doing coding audits, making sure the charts are documented appropriately, giving that feedback back to our advanced practice providers. Say, hey, you're not coding this correctly. We need to change this. We need to make some more educational opportunities in terms of compliance and billing.
And then making sure, you know, the most important thing, we talk about patient attrition in disease states, but there's a lot of attrition with advanced practice providers. You know, a lot of practices say, I hire an advanced practice provider. I get them trained up. They learn urology. And then they leave for another job. And that is a failure on the practice and the program, right?
We have to make sure that we're having discussions with the advanced practice providers that we're making sure that we hit their career goals, right? Whether their career goals are to be able to work part-time, spend time with their family, because a lot are mothers. And then once their kids go to school, to be able to go back to full-time, we have to develop a program that fits that model.
If they start getting bored with their daily run-of-the-mill urology and they want to, you know, be participating in advanced prostate cancer clinic, well, what are ways we can integrate that knowledge and get that to them and build out that program? So we just have to have this constant communication and a real emphasis on the people who are part of the practice.
And so those are kind of all the ways that we look at this. I mean, we can go a million different directions from that. But the four pillars of productivity, they have to be productive. They have to generate income for a practice. They have to see patients. That's how the job exists.
But if they want to do something in a particular field, we got to make sure they do it in a compliant way and that they're getting the education needed to do that. And question, are there, the APPs are training all our APPs or right now? Yes and no, you know, that's the goal, right?
We want, you know, while I sit at the head of our APP program, I would love for me to pass this on to another APP, right? And so that's the goal. Yeah, Nicole, you know, a couple more years. But, you know, that's kind of how we start.
It starts with me. And then we certainly have our APPs visit. We're not all in one clinic and one site. So we want to make sure that they go through the various locations. If there is an APP that they want to shadow, we make that happen and we make sure that everybody's learning from everybody. And so I'm not in the office every day.
So the days I'm in the office, I really, especially at the beginning, I like to have that hands-on, one-on-one conversation. time with a new app but you know the other days when i'm not in the office we're pretty flexible
Yes. BPH is always bread and butter. I'd tell her never leave it, but certainly women's health is a big need. The other thing that I think we, you know, I think the evolution of utilizing an APP is going to be with procedures. Pretty soon, we're going to be having so many procedures that a urologist, as a physician, as a surgeon, is not going to have bandwidth to do them all.
So it might be, it might start with cystoscopy, cystostent removal, truss, and then kind of building that. We have a lot of our nurse practitioners will do testopels, they'll do hydrocele aspirations and sclerosis in the office. And I think that continues to engage and grow them as practitioners.
Actually, absolutely. You know, what our rate limiting step at this point is space. It's still how many rooms we have. We can always get more systems, you know, and there's disposable systems if we need to. We try not to utilize disposables, but, you know, it's just just space. And then, you know, there's a shortage of staff across the country.
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