Nathan Graham

PGY-3 at @UChicagoUro via @UmichMedAdmiss

[Justin Dubin, MD @justindubinmd]

TO ALL UROLOGISTS (sorry for long tweet but please give it a read)

The @CMSGov has once again changed some of the RVU values for surgeries and now while I do not perform as many BPH surgeries as I have in the past, I as well as the MAJORITY of practicing urologists, especially generalists are dedicated to the daily care of patients with benign prostatic hyperplasia (BPH). For decades, Transurethral Resection of the Prostate (TURP) has been the gold standard of surgical management for BPH, and it remains the benchmark in the rapidly evolving treatment landscape. The typical operative time for TURP has not changed and the procedure demands continuous mental focus, physical effort, and advanced technical skill.

The 2026 proposed rule recommends reducing the value of TURP (CPT 52601) to 10.00 wRVU—down from 13.16 in 2025. This constitutes a cut of nearly 25% in reimbursement and represents a serious miscalculation. The intensity and complexity of performing TURP have not diminished. The work required remains unchanged and should be recognized accordingly.

I have seen on several urology forums and chat groups how upset most urologists rightfully are about this, but little has been offered for fixing it. Here is an idea - not by me, but by my friend and excellent Urologist Dr. Michael Tradewell (@doctorT_urology) . His idea which I endorse, is below:

I urge CMS to maintain the 2025 TURP value of 13.16 wRVU and to re-scale the remaining 2026 Section II, E, 4(11) Transurethral Robotic-Assisted Resection of Prostate (CPT Codes 52500, 52601, 52630, 52648, 52649, and 52XX1) wRVU valuations using the proposed 2026 values relative to TURP.

For example, for aquablation (code 52xx1):
10.25 x 13.16 / 10.00 = 13.49

And for HoLEP (code 52649):
13.00 x 13.16 / 10.00  = 17.108

Adopting these values will provide fair and equitable compensation for the broad range of BPH treatments that urologists deliver now and in the years ahead.

Thank you for your consideration.
The proposed cuts to TURP are terrible…
I submitted a comment to the CMS 2026 Proposed Rule. It was easy.

You can do it too.

Go to this link and leave a comment. You can leave your own comment but if you agree with his recommended changes feel free to copy/paste that and/or share.

https://t.co/UOvXs85JTX

The 2026 CMS proposal was released around 14 days ago and today there are only 300 comments… Urologists have numbers, if we all submit to CMS we can hopefully move the needle in the right direction.

Instead of complaining to each other, we have the opportunity to work together and try to help our community by using our voices.

#SaveTURP

[Kevin Chu, MD @kevinchumd]

Absolutely insane that urologists are facing a 25–30% cut to BPH procedure reimbursement while inflation rises and surgical demands stay the same. Urologists have to push back, patients don’t understand the complexities of healthcare financing / reimbursement (complexity designed on purpose). Maybe if every urologist switched to cash only will we stop getting heavy cuts thrown our way. We need to push back. I will be submitting my comment—please do your part. 👇 #SaveTURP #urology

[salaryDr @SalaryDr]

Medicare’s message to doctors: “Do more, get paid less.”
2025 conversion factor: $32.35
2015 conversion factor: $35.93

A decade of cuts while demands explode.

This isn’t reform—it’s sabotage.

In 2025, the Medicare conversion factor will be lower than it was in 2015. A decade later, doctors are getting paid less per unit of work—while inflation, admin burden, and burnout have all skyrocketed.

[Abhinav Sidana @AbhinavSidana]

Postdoc Opportunity – Urology Research at UChicago! 🚨

Join my team to advance Prostate Cancer research!
Key roles: clinical research, trials, data management, manuscript & grant writing.

💰 Salary: $61K-$74K (NIH scale)
📍 Location: University of Chicago
📩 Apply: Send CV & research goals to [email protected]
🔗 More info: https://t.co/qCBEeibtiJ
#Postdoc #Urology #Research #Hiring
@AmerUrological

[Dutch Rojas @DutchRojas]

Today, a physician working at the same productivity level is stuck with $32.36 per RVU—which means, adjusted for inflation, they’re effectively making HALF of what they used to.

Think about that: same work, half the pay.

Meanwhile:
Hospitals get sweetheart site-of-service fees.

Private equity buys up independent practices at fire-sale prices.

@CMSgov @droz @hhsgov @seckennedy
keeps slashing physician reimbursement.

Bureaucrats rake in raises while doctors get the shaft.

In 1992, the Medicare conversion factor was $31.00. Today? $32.36.

That’s a $1.36 total increase in 33 YEARS. If it had just kept up with inflation, it would be over $64.00 today.

Instead, it’s more than 50% below where it should be.

A doc today has to see twice the patients, do twice the procedures, and grind twice as hard just to keep up.

And what does Congress do?

No doc fix in the latest CR.
No relief.
No respect.

Just another reminder that the system values hospitals and middlemen over the people actually delivering care.

Physicians aren’t just underpaid.
They’re being systematically devalued.

@WaysandMeansGOP
@GOPDoctors
Not #healthcare

[UChicago Urology Residency @UChicagoUro]

Happy Match Day and a huge WELCOME to our first class of 4!!! 🥳🥳

@LaHekky @dvelasquezu @pearce_k_med @m_vallejosling

[Michigan Clock 〽️ @MichiganClock]

Ohio State has not beaten Michigan in football for 1827 days. #GoBlue #Michigan #BeatOhio

[Michigan Football @UMichFootball]

'TIS THE SEASON! 〽️

[Michigan Football @UMichFootball]

IT'S GREAT TO BE A MICHIGAN WOLVERINE! 〽️

[UChicago Urology Residency @UChicagoUro]

Kudos to our @UChicagoUrology UroCyclers for a great show out at the 39th annual North Shore Century ride! The matching gear may have boosted our speed 🚴‍♂️

[UChicago Urology Residency @UChicagoUro]

Join us for our Virtual Open House this Thursday 8/29 and next Thursday 9/5 at 7:30pm CST!

Sign up at the link listed on the SAU website or use the QR code below. Zoom link will be emailed prior to each session. Feel free to DM with questions! 📩

https://t.co/1r3QJyusFh

[Wendy Hasson MD @WendyHassonMD]

What it’s like to be in healthcare right now:
“We will pay you $2 for that pie”

“But it costs me $4 in pie ingredients and $2 in human labor to make a pie. We need $6 to break even”

“Sorry, we’ll only pay you $2 for that pie. We suggest you make many more pies that you also sell for $2/pie. New requirement is 6 pies/day”

“But then we are still losing $4 per pie. How does making more pies help us?”

“We just found out flour is on shortage so you’ll have to buy more expensive imported flour and will lose $5 per pie. Or you can consider making pies without flour.”

“But I can’t make pies if we keep losing money on pies. And I can’t make pies without flour”

“We suggest you ditch rolling pins and remove any fruit filling as a cost saving measure. And consider limiting how much time you bake the pie for to use less oven time”

“But then how can I even make a pie that resembles a pie?”

“We appreciate the question and have no response. We empower YOU to solve this problem. We have scheduled 4 meetings to discuss how you can make more pies with less ingredients and less oven time and less labor”

“But it seems the root of the problem here is actually that we don’t get reimbursed fairly for our pies…”

“Don’t say that out loud. Please get back to making pies with no filling and no flour and no rolling pins and be sure to attend the meetings.”

#medtwitter #Pediatrics #insurance

[Brian Gantwerker, MD, FAANS, FACS 🟧🇮🇱 @cscla]

To bring you up to speed today #MedTwitter, hospitals and ASCs get a 3% raise, we get a 3% cut and @uhc committed 8.7B dollars worth of Medicare fraud in 2021 alone. But yes tell us how it’s all the doctors fault. #notaprovider @DOJCrimDiv @DrCorriel @pppforpatients @Suburbanbella @fuzzymittens @MayaBabuMD @neurosurgery

[Ohio State Wexner Medical Center Urology Dept. @OSU_Urology]

Thrilled to welcome @CTuroGam from @UChicagoUro as our future @NCHUrology #pedsurology fellow starting in 2025! Looking forward to an excellent two years!!! @SPU_Urology @AmerUrological #UroSoMe

[The Winged Helmet @TWH_Chris]

Michigan has scored 117 points against Ohio State over the last three meetings, averaging 39 PPG.

Here's all 15 of Michigan's touchdowns from those contests.

Enjoy.〽️

[UChicago Urology Residency @UChicagoUro]

Resident vs Attending Whirlyball, laser tag, and bowling: who are you rooting for?! 🏆 @UChicagoUrology

[Jennifer Livschitz, MD, MS @jenlivschitz]

I keep pinching myself because I still can’t believe it’s real! I matched into my dream program @MDAndersonNews for #RadOnc! I am so unbelievably thankful for my amazing family, friends and mentors who have always been there for me and inspire me daily. Houston, here I come!!

[Dr. Glaucomflecken @DGlaucomflecken]

United Health Group owned company is responsible for cyber attack

Medical practice goes bankrupt due to cyber attack

UHG tells regulators that failure to approve sale of bankrupt practice to UHG will force practice to close.

(Insert hot dog suit meme)

https://t.co/pmRuISF9X4

[UChicago Urology Residency @UChicagoUro]

Our application is now open!!
➡️ https://t.co/sOYWI1zv3Y

Students may also apply to the Underrepresented in Medicine Visiting Clerkship Program (UiMVCP). Accepted students will receive a $2000 stipend from the program. To learn more visit:
https://t.co/np6YVRIhRs