BackTable OBGYN – Détails, épisodes et analyse

No money, no mission. Understanding coding is the key to funding care and making your practice sustainable. In this episode of BackTable OBGYN, host, Dr. Mark Hoffman, chats with Dr. Jon Hathaway, associate professor at IU School of Medicine and coding specialist. They discuss the intricacies of medical billing, the impact of coding knowledge on revenue, and the systemic gaps in residency training regarding financial literacy. ---SYNPOSISDr. Hathaway shares his journey from mastering coding to becoming a national expert, providing a crash course on CPT, RVU, and ICD codes, and emphasizing the importance of accurate billing for the sustainability of healthcare practices. The episode offers valuable insights into the challenges and opportunities in medical coding and the broader financial aspects of healthcare.---TIMESTAMPS00:00 - Introduction 02:03 - Dr. Hathaway's Journey into Coding04:11 - Understanding the Financial Side of Healthcare07:10 - The Disconnect in Healthcare Payments11:26 - The Complexity of Medical Billing18:11 - The Role of CPT, RVU, and ICD Codes24:03 - The Process of Approving New Procedures32:38 - Understanding the Value Update Process33:47 - Case Study: Cystoscopy in Hysterectomy Codes35:26 - Survey Participation and Its Impact36:12 - Roles and Responsibilities in ACOG38:12 - Challenges of RVU-Based Compensation42:08 - Specialty-Specific RVU Valuation48:42 - Comparing OB and GYN Reimbursements50:02 - Envisioning an Ideal Healthcare System55:10 - Maximizing Billing Efficiency59:46 - Final Thoughts

The future of gynecologic surgery is less invasive, more precise, and closer than you think. In this episode of the BackTable OBGYN podcast, host Dr. Mark Hoffman welcomes Dr. Noam Smorgick, Director of Minimally Invasive Gynecologic Surgery at Shamir Hospital in Israel. They discuss Dr. Smorgick’s journey into the field of OBGYN and her innovative approaches to intrauterine adhesion management and hysteroscopic surgery for complex pathologies.---SYNPOSISTopics include the advantages of hysteroscopic management over traditional methods, the importance of maintaining fertility, the nuances of the Israeli healthcare system, and the development of new surgical instruments and procedures. The episode also highlights shared decision-making in patient care and looks ahead to the future direction of gynecologic surgery. Dr. Smorgick shares insights from recent studies and her experiences, making it a valuable listen for practitioners and anyone interested in gynecologic surgery advancements.---TIMESTAMPS00:00 - Introduction02:05 - Dr. Smorgick’s Journey to Medicine05:01 - Insights into Israeli Healthcare System10:20 - Intrauterine Adhesions and Hysteroscopic Management11:28 - Research on Retained Products of Conception15:07 - Comparing Management of Pregnancy Loss22:02 - Future Directions in Hysteroscopic Surgery23:46 - Infertility Treatments in Israel25:50 - Managing Uterine Septums and Adhesions28:03 - Shared Decision Making in Surgery32:03 - Techniques and Tools for Metroplasty33:08 - Adhesion Prevention Strategies35:35 - Postoperative Care and Follow-Up36:59 - Office Hysteroscopy Procedures38:05 - Reusable vs. Disposable Instruments45:51 - Future of Hysteroscopy---RESOURCESNetherlands Publication: Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/28390688/ Dr. Smorgick’s Publications: A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception: https://pubmed.ncbi.nlm.nih.gov/24997472/ Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?: https://pubmed.ncbi.nlm.nih.gov/37782418/

Menopause isn’t just a diagnosis—it’s a transition, and the way we treat it needs to change. Dr. Kelly Casperson joins Dr. Suzette Sutherland in this urogynecology crossover episode of BackTable to challenge outdated beliefs about menopause and hormone replacement therapy (HRT). They revisit the impact of the 1990s Women’s Health Initiative (WHI) study and explain how its findings—especially around synthetic hormones—were widely misinterpreted and continue to adversely influence patient and provider decisions today. --- SYNPOSIS Dr. Casperson breaks down the differences between the hormones used in WHI and the safer, more targeted options available today. The conversation explores the broad benefits of modern HRT, including reduced risks of cardiovascular disease, osteoporosis-related fractures, and even dementia. Beyond the science, the episode also addresses the urgent need for better medical education and updated guidelines around menopause care.Dr. Casperson and Dr. Sutherland make the case for empowering patients through informed consent and better clinician training. They also discuss Dr. Casperson’s upcoming book, The Menopause Moment, which aims to equip women with the tools and knowledge to navigate this life stage with confidence. --- TIMESTAMPS 00:00 - Introduction02:50 - Focus on Menopause and Hormone Replacement Therapy04:20 - The Women's Health Initiative (WHI) Study05:39 - Understanding Risks and Misconceptions12:43 - Reevaluation of the Women’s Health Initiative Study18:31 - Impact of Media and Physician Education19:58 - Current State of Hormone Therapy22:17 - Broader Implications and Future Directions27:17 - Evaluating FDA Warnings and Gender Bias in Hormone Treatments29:49 - The Impact of Hormone Therapy on Women's Health32:11 - Risks of Not Using Hormones35:44 - Hormones and Brain Health: Debunking Myths40:41 - The Timing Hypothesis and Long-Term Hormone Use46:32 - Advocacy and Education for Menopause Awareness48:04 - Conclusion and Upcoming Resources --- RESOURCES PBS: The M Factor: Shredding the Silence on Menopause:https://www.pbs.org/show/the-m-factor-shredding-the-silence-on-menopause/ The Menopause Moment by Dr. Kelly Casperson: https://kellycaspersonmd.com/the-menopause-moment-book/ Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia:https://pmc.ncbi.nlm.nih.gov/articles/PMC10625913/

In this episode, Dr. Ian Fields joins Dr. Mark Hoffman at the mic to discuss the role of the microbiome in obstetrical and gynecological conditions. --- SHOW NOTES Dr. Ian Fields completed a fellowship in Female Pelvic Medicine & Reconstructive Surgery and received a Master of Clinical Research degree from Oregon Health & Sciences University. His research focuses on changes in the urinary microbiome and their association with lower urinary tract symptoms. Dr. Fields begins the episode by describing the microbiome as “all of the things outside of our cells that make up the human body,” which includes bacteria, viruses, and fungi. He explains that the microbiome may play a role in how humans maintain states of health, in addition to having large impacts on the pathophysiology or development of disease states. Dr. Fields references the Human Microbiome Project, a United States National Institutes of Health research initiative that was aimed to improve the understanding of microbiota in relation to human health and diseases. The physicians then transition to cover the role of the microbiome, specifically in the field of obstetrics and gynecology. Dr. Fields explains that the most studied condition is bacterial vaginosis. From a urogynecology perspective, he expresses a particular interest in urinary tract disorders, such as urinary incontinence, recurrent urinary tract infections, and interstitial cystitis. Dr. Fields emphasizes to listeners that urine is not sterile. In addition, he highlights how the use of vaginal estrogen increases the presence of lactobacillus within the genital microbiome, and thus is beneficial in the settings of genitourinary syndrome of menopause and recurrent menopause. Dr. Fields concludes the episode by briefly addressing other areas of study regarding the microbiome in the field of obstetrics and gynecology. For example, studies have revealed a link between vaginal microbiota and risk of preterm birth, as well as neonatal gut microbiota and the mode of delivery. Ultimately, Dr. Fields states that the microbiome is an underfunded and understudied aspect of medicine, and he urges listeners to acknowledge the large potential the field has. --- RESOURCES The Human Microbiome Project: https://hmpdacc.org/hmp/overview/ Brubaker L, Nager CW, Richter HE, Visco A, Nygaard I, Barber MD, Schaffer J, Meikle S, Wallace D, Shibata N, Wolfe AJ. Urinary bacteria in adult women with urgency urinary incontinence. Int Urogynecol J. 2014 Sep;25(9):1179-84. Wolfe AJ, Toh E, Shibata N, Rong R, Kenton K, Fitzgerald M, Mueller ER, Schreckenberger P, Dong Q, Nelson DE, Brubaker L. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol. 2012 Apr;50(4):1376-83. Hoffman C, Siddiqui NY, Fields I, Gregory WT, Simon HM, Mooney MA, Wolfe AJ, Karstens L. Species-Level Resolution of Female Bladder Microbiota from 16S rRNA Amplicon Sequencing. mSystems. 2021 Oct 26;6(5):e0051821. Richter HE, Carnes MU, Komesu YM, Lukacz ES, Arya L, Bradley M, Rogers RG, Sung VW, Siddiqui NY, Carper B, Mazloomdoost D, Dinwiddie D, Gantz MG; Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Association between the urogenital microbiome and surgical treatment response in women undergoing midurethral sling operation for mixed urinary incontinence. Am J Obstet Gynecol. 2022 Jan;226(1):93.e1-93.e15. Fettweis, J.M., Serrano, M.G., Brooks, J.P. et al. The vaginal microbiome and preterm birth. Nat Med 25, 1012–1021 (2019).

In this episode, Dr. Mark Hoffman invites Dr. Cheryl Iglesia to shed light on the topic of cosmetic gynecology. --- SHOW NOTES Dr. Iglesia is the Director of the Section of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, as well the current President of the Society of Gynecologic Surgeons. In addition to being involved with a consensus document regarding cosmetic gynecology, Dr. Iglesia has contributed numerous studies to the growing field and hopes to educate other providers on the topic. The episode begins with Dr. Iglesia sharing how she became passionate about cosmetic gynecology. Her experience initially began with a weekend course in California learning about topics such as “laser vaginal rejuvenation” and “designer laser vaginoplasty,” which were early marketing terms used for the field. After multiple years of training and education within a field filled with gray areas and limited evidence-based medicine, she later helped develop a consensus document about cosmetic gynecology procedures, which provides clarification for patients and opportunity for future research studies. Dr. Iglesia then describes the field of cosmetic gynecology, which includes the elective intervention to alter the aesthetic appearance of the external genitalia or modify the genital organs. These elective, functional procedures may be performed in the absence of any pathology (e.g., no incontinence, prolapse, etc.) with the goal of improving a person’s quality of life (e.g., sexual function). She describes two pillars of the field, including cosmetic (e.g., labiaplasty) versus functional (e.g., surgical tightening of the vagina for vaginal laxity) procedures. The physicians then address the concerns of societal pressure, agreeing that the goal is to help patients make well-informed, ethical decisions, which requires discussing goals with patients. After discussing the field as a whole, Dr. Iglesia then highlights different procedures and technologies. For example, a fractionated laser may be used to stimulate tissue growth and may be utilized for diagnosis such as genitourinary syndrome (GSM) of menopause or lichen sclerosis. In addition, she briefly mentions aesthetic procedures, including a clitoral frenulum reduction (frenulectomy) or clitoral amplification with platelet rich plasma or the O-Shot. She addresses that a lot of the procedures and technologies are proprietary, have limited evidence, and are not risk-free. Ultimately, Dr. Iglesia states that there is a need for more data, urging the need for future level I trials. --- RESOURCES Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. Joint Report on Terminology for Cosmetic Gynecology. Int Urogynecol J. 2022 Jun;33(6):1367-1386. Li FG, Maheux-Lacroix S, Deans R, Nesbitt-Hawes E, Budden A, Nguyen K, Lim CY, Song S, McCormack L, Lyons SD, Segelov E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA. 2021 Oct 12;326(14):1381-1389. Paraiso MFR, Ferrando CA, Sokol ER, Rardin CR, Matthews CA, Karram MM, Iglesia CB. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: The VeLVET Trial. Menopause. 2020 Jan;27(1):50-56. Burkett LS, Siddique M, Zeymo A, Brunn EA, Gutman RE, Park AJ, Iglesia CB. Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):968-978. Cosmetic Gynecology and the Elusive Quest for the “Perfect” Vagina: https://journals.lww.com/greenjournal/Citation/2012/10000/Cosmetic_Gynecology_and_the_Elusive_Quest_for_the.34.aspx

In this episode, Drs. Maya Hammoud and Helen Morgan of the University of Michigan join Drs. Amy Park and Mark Hoffman to discuss the OB/GYN residency application process. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/MeFKJY --- SHOW NOTES Dr. Maya Hammoud is Chief of Women’s Health Division and Associate Chair for Education at the University of Michigan. Dr. Helen Morgan is the Director of Residency Preparation Courses at the University of Michigan. Together, Drs. Hammoud and Morgan are leading the $1.7 million American Medical Association (AMA) Reimagining Residency Grant for Association of Professors of Gynecology and Obstetrics (APGO) Right Resident, Right Program, Ready Day One. The episode begins with Drs. Hammoud and Morgan sharing a call to action regarding the need to transition the emphasis of applying to residency from the lens of individual achievements to that of an individual’s competency as a future physician. The two physicians share what inspired them to contribute to making changes in the realm of OB/GYN, including personal experiences from advising medical students at the University of Michigan to their own family members. During this time, they address pitfalls of the current system, including the financial expenses for applications. The group then transitions to describe the 5-year grant that led to the development of Right Resident, Right Program, Ready Day One. The program addresses 2 components: (1) the application process itself, and (2) students’ readiness for residency. The physicians cover the topic of “application fever” (i.e., the large increase in the number of applications that each student submits), and how the field of OB/GYN has adopted “program signaling” with the hope to mitigate this ongoing trend. Drs. Hammoud and Morgan also address topics such as growth mindset, holistic review of applications, importance of coaching for preparation for residency, and the increasing popularity of OB/GYN as a specialty. Lastly, the group highlights other aspects of the residency application process, including methods to ensure an equitable review process, the need to increase diversity in the field, the standardized letter of evaluation (SLOE), and best practices to facilitate transition to residency. During this conversation, Drs. Hammoud and Morgan share about the residency preparation courses that are available for medical students at the University of Michigan.

In this episode, Drs. Amy Park and Mark Hoffman welcome Dr. Angela Chaudhari, Chief of Gynecology and Gynecologic Surgery at Northwestern Memorial Hospital, to share her experience promoting a culture of physician wellness as the Director of the P2P Network for Physician Peer Support. --- SHOW NOTES Dr. Chaudhari discusses how her inspiration to advocate for physician wellness began when she herself was experiencing feelings of burnout. Initially an open ear for colleagues on an individual level, Dr. Chaudhari was later trained on the topic of wellness through the Scholars of Wellness Program and received her Organization Leadership and Coaching Certificate at Northwestern University. Dr. Chaudhari then explains that, through the program, volunteers from both medical and non-medical backgrounds are trained to provide support for those experiencing adverse events, “compassion fatigue,” and discriminatory patient experiences. In addition, peers are also available to provide feedback or education. Specific metrics for the program include retention, wellbeing scores, and culture surveys to identify “pain points'' within the Institution. Next, the doctors discuss the topic of “work-life integration,” rather than work-life balance, and how to promote this in your own practice. While acknowledging that it may be difficult to advocate for yourself and set boundaries early on in your career, the group emphasizes the role of mentorship and how this can empower trainees/learners to take action sooner rather than later. The episode ends with a discussion on creating culture in your workplace. The doctors express sentiments that maintaining an intentional, positive outlook and treating all colleagues with respect is a key aspect in promoting wellness. In addition, they encourage listeners to acknowledge difficult situations and to share personal experiences to further promote an environment of support and growth. --- RESOURCES Define Measure Analyze Improve Control (DMAIC) Process: https://asq.org/quality-resources/dmaic Stolarski A, Moseley JM, O’Neal P, Whang E, Kristo G. Retired Surgeons’ Reflections on Their Careers. JAMA Surg. 2020;155(4):359–361. doi:10.1001/jamasurg.2019.5476

In this episode, Dr. Jessica Branham, a board-certified obstetrician-gynecologist affiliated with Highlands ARH Regional Medical Center invites listeners to learn about practicing OB/GYN in a rural setting. As a Kentucky native who was born and raised in Eastern Kentucky, Dr. Branham shares her personal experiences and the challenges that she has faced caring for a population that often requires the most medical attention, yet has the least access to resources. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/29D37F --- SHOW NOTES The episode begins with Dr. Branham describing her day-to-day work schedule. As she shares the workflow of her clinic and OR days, as well as call shifts, she emphasizes how her patients’ care is typically subject to herself as their sole medical provider (e.g., handling a postpartum hemorrhage without access to Interventional Radiology). Due to this, Dr. Branham routinely thinks multiple steps ahead in regard to her patients’ care in order to decide if she can continue herself or if the patient has to be transported to a higher-acuity center. Dr. Branham then transitions to discuss the challenges that she faces as a physician practicing in a rural setting. Using personal anecdotes and published data, she emphasizes barriers such as decreasing numbers of OB/GYNs choosing to practice in rural areas, as well as the weather conditions dictating whether or not a patient may be transported via helicopter or ambulance to an alternative hospital. In addition, she covers the impact of the opioid use epidemic that largely impacts the Appalachian region. Lastly, Dr. Branham ends the episode by sharing why she passionately chooses to practice in rural Kentucky, despite the challenges she may face: her dedication to serving patients who are often in the most need of medical care. She also describes current systems in place to help improve care for her patients, including the Blue Angels Program, which provides telehealth visits with Maternal Fetal Medicine specialists at the University of Kentucky and traveling ultrasound clinics to specific areas in rural Kentucky counties. --- RESOURCES The Blue Angels Program: https://kytelecare.med.uky.edu/kytelecare-telehealth-mobile

In this episode, Dr. Cara King, the Fellowship Director for Minimally Invasive Gynecologic Surgery at Cleveland Clinic and a member of the Board of Directors of the Academy for Surgical Coaching, discusses the topic of surgical coaching and its benefits for physicians, trainees, and learners. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/8NpBpF --- SHOW NOTES Dr. King begins the episode by describing surgical coaching as an act of asking open-ended questions, determining where a “coachee” is currently at, identifying their goals, and then empowering them to make specific actions that are needed to close this gap. During the discussion, she emphasizes the importance of prioritizing self-assessment as a coach. Dr. King then explains how to find a surgical coach through the Academy for Surgical Coaching. The process requires a “coachee” to complete a form that identifies their personal goals, and then the “coachee” is paired with a coach from the pool of physicians from various specialties. Coaching experiences are performed through various platforms (e.g., in-person, video-based, etc.) and are ideally conducted for 3-, 6-, or 12-month periods. Dr. King also covers how outcomes and metrics are evaluated, describing the differences between technical and non-technical (e.g., judgment) skills. The doctors transition to emphasize the importance of incorporating coaching into a surgeon’s practice. Dr. King shares 2 methods to do so, including (1) replacing 1-hour of grand rounds or meetings with 1 hour of coaching sessions, as well as (2) integrating coaching at the level of national societies (e.g., American Association of Gynecologic Laparoscopists). The doctors go on to highlight also incorporating coaching at the level of medical schools and residency in order to instill the mentality of continual improvement early on in a physician’s career. The episode ends with Dr. King sharing the steps to becoming a surgical coach through the Academy for Surgical Coaching, which includes a paid certification program. --- RESOURCES Atul Gawande, “Personal Best”: https://www.newyorker.com/magazine/2011/10/03/personal-best The Academy for Surgical Coaching: https://surgicalcoaching.org Greenberg CC, Byrnes ME, Engler TA, Quamme SPR, Thumma JR, Dimick JB. Association of a Statewide Surgical Coaching Program With Clinical Outcomes and Surgeon Perceptions. Ann Surg. 2021 Jun 1;273(6):1034-1039.

In this episode, Dr. Bagrodia discusses cultivating a healthy culture inside and outside of the operating room with Dr. Chris Kane, Dean of Clinical Affairs at UCSD and CEO of the UCSD Physician Group. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/rVQG40 --- SHOW NOTES First, the doctors discuss the definition of culture, which Dr. Kane defines as the norms of behavior and relationships within an organization. Culture can include dress code, meeting rules, and punctuality. Most of the time, institutional culture is established in an unspoken way. Dr. Kane emphasizes the importance of having a conscious strategy to create a healthy culture and reiterates that trust is a crucial foundation for motivating cultural changes. Next, the doctors discuss helping team members find meaning in their work. Dr. Kane recommends that surgeons share patient gratitude with their other colleagues who are not frontline medical workers. He acknowledges his staff’s contributions during meetings and expresses his gratitude through written notes. He also recommends communication training for everybody on his team. Then, he shares tips for assessing organizational culture. He believes that it is most important to ask team members what they think the overarching goal of the institution is and to assess the attrition rate through exit surveys. He emphasizes that behavioral norms matter most, as department leaders often lead by example. One detrimental practice is favoritism, which Dr. Kane regards as disrespectful to other team members. Additionally, he shares his personal experiences with changing cultures at different institutions and utilizing change management theories. Finally, Dr. Kane shares general leadership advice. He highlights the importance of creating a patient-centered environment, leading by influence rather than authority, and the power of positivity.