I want to get a bit more into that. Bear with me; I'm a European trying to understand how the US healthcare system works. Speaking to people involved is quite helpful. What are the channels through which you get your patients as a surgeon? What are the channels through which you get referred patients, whether it's the hospital or other urologists?

This is not typical for most urologists who do robotic surgery, and certainly not for gynecologists, general surgeons, etc. They typically get referrals from primary care doctors, whereas I get referrals from other urologists. The longer I've been in practice, the more self-referrals I receive. Patients request me because I may have operated on their family member or coworker.

Does the hospital have a contract with that insurance company then?

The hospitals would prefer if I performed those cases at the hospital because they are more profitable than the Medicare cases, and they have contracts with those insurances too. However, if I perform those surgeries at the hospital, our group misses out on the money, which then goes to the hospital instead of our group.