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Bringing up-to-par the reimbursement rates for specialized procedures in women's healthcare has helped ensure its long-term quality, says Dr. Robert L. Harris, a Jackson specialist and leader in the American Urogynecologic Society.

Taking on the duties of secretary-treasurer in the fall of 2006, Harris previously chaired the society's coding committee. In that role, he worked with colleagues to seek changes at the federal level and through the American Medical Association in an effort to erase inequalities between payment rates for corresponding procedures in men and women.

"We've been able to change a lot of our codes that have been undervalued for female care," Harris said. "When you look at women's healthcare, it has to be a level playing field for physicians to want to take care of those patients and want to go into ob/gyn."

In the further subspecialty of urogynecology, Harris and his partner, Dr. Steven Speights of Southeast UroGynecology, are two of only a few such physicians in the Southeast. The network of fellowship-trained urogynecologists includes a mere 500 or so physicians around the world, Harris said.

Women from as far away as Texas, Kentucky and Florida travel to the Jackson clinic. There, Harris and Speights see some 1,500 new patients and perform 600 to 800 surgeries each year.

Their setting in the Women's Specialty Center brings together four fields — gynecologic oncology, reproductive medicine, maternal-fetal medicine and urogynecology — in a single location near Baptist Medical Center.

At Southeast UroGynecology, the focus is on the care of women dealing with problems such as incontinence, pelvic pain, pelvic organ prolapse, chronic bladder inflammation and recurrent urinary tract infections.

"The most common patient we see is a woman anywhere from 30 to 80 years old who just can't control her bladder function when she goes to play tennis or lift her children," Harris said.

In exploring nonsurgical remedies, nurse practitioner Jackie Williams directs the practice's bladder and pelvic muscle rehabilitation unit. When surgery is needed, most of the procedures performed by Harris and Speights can now be done on an outpatient basis through minimally invasive techniques.

Among common procedures are laproscopic supracervical hysterectomy for uterus removal without a large abdominal incision; Gynecare TVT® (tension-free vaginal tape) slings to correct stress urinary incontinence; and Prolift® to restore prolapsed organs to their proper positions.

Although Southeast UroGynecology is the only facility in Mississippi with board-certified specialists who are fellowship-trained in urogynecology, modern telemedicine has allowed them to share their expertise beyond their immediate area through the Bladder Health Network.

Partnerships with regional clinics allow the specialists to remotely interpret the results of urodynamic bladder testing performed around the region.

"We've been able to finger out into other parts of the state using Web-based procedures to get there," Harris said. "It's been a positive thing for both us and our referring doctors."

Going forward, hopes for collaboration include helping more-rural physicians convert to electronic record keeping systems. Harris and Speights also give talks on incontinence and bladder dysfunction to internists and family practice physicians around the state and region.

In addition, Harris is among physicians who are turning their attention to improving education for caregivers of female nursing home residents — some 85 to 90 percent of whom cannot control their bladder or bowel function.

"This is one of those things that may not have anything to do with my practice, but has to do with bladder healthcare for women in general," Harris said.
"We're thinking about not just your ambulatory women, but also those whose quality of life has declined even more because they're suffering in silence."


May 2007

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