Editorial Comment for Tosoian et al.

The financial aspects of medicine are increasingly more pertinent in our contracting health finance environment and will continue to have a direct impact on our practice. Although hospital profitability is not an immediate concern for many clinicians, it has an indirect effect on our practice ultimately. Therefore, studies such this one by Tosoian and colleagues are timely and important. These investigators have described in simplified form the complex finances of ureteroscopy.

Although their mathematical model may differ from institution to institution— depending on payer mix, surgeon practice patterns, laser ownership vs rental, presence of repair contracts vs fee for individual repairs—it is encouraging that the procedure is viable financially within certain caveats. They specifically highlight that inpatient care for ureteroscopy threatens the financial return, but outpatient surgery remains profitable. Because inpatient ureteroscopy is occasionally indicated, it is imperative to understand how to mitigate the costs associated with it. Equally, maintaining high collection rates will also sustain the return on investment with an inpatient admission.

Last, and most important to this study, is the threat that repairs have on financial returns. These authors have nicely shown that repairs erode at return but potentially not enough to diminish the profitability of their business.