Integrated Practice Units in Urological Oncology – Lessons from Harvard Business School

Eugene B. Cone, MD

Fellow, Combined Harvard Program in Surgical Urological Oncology

PGY 7

01/22/2020

Eugene B. Cone, MD

One of the highlights of practicing as a surgical urological oncology fellow at Mass General Brigham is the readily available multidisciplinary care. Unfortunately such care is often described as only possible in the “Ivory Tower” of academic medicine. Dedicated Multi-D clinics are far less efficient as measured by patient throughput than their single-specialty counterparts (at least for urologists), and resource intensive to coordinate and staff within a single hospital.

One of our cases in the Harvard Business School’s Value Based Healthcare Delivery course centered on the Martini Klinic, an Integrated Practice Unit (IPU) focusing on prostate cancer in Germany. Working through this case was a highlight of the course for me, as it prodded me to more closely examine the logistics of multidisciplinary care and how it could be applied in the US.

The Martini Klinic’s IPU brings together surgical, medical, and radiation oncologists, along with care coordinators, nurses, and specialized therapists in one physical plant, all focusing on the care of patients with prostate cancer. By focusing at scale on one disease (~2500 prostatectomies per year), they are able to economically centralize all relevant resources while achieving better-than-benchmark oncologic and functional outcomes – a win-win for clinicians and patients.

As a clinician with direct responsibility for the care of prostate cancer patients, this has been inspirational, and I am now hard at work trying to map out what this type of model might look like in the US’s current fee-for-service environment. At its core would be leveraging regional referral network to centralize the care of prostate cancer, achieving scale and optimizing outcomes. As I begin to research my future job and practice opportunities, the lessons learned in HBS classrooms and studying the Martini Klinic specifically will guide me going forward.