127 MANAGEMENT PATTERNS OF MEDICARE PATIENTS UNDERGOING TREATMENT FOR UPPER URINARY TRACT CALCULI

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness (I)1 Apr 2013127 MANAGEMENT PATTERNS OF MEDICARE PATIENTS UNDERGOING TREATMENT FOR UPPER URINARY TRACT CALCULI Brian Matlaga, Lisa Meckley, Thomas Byrne, and Jessica Perhanidis Brian MatlagaBrian Matlaga Baltimore, MD More articles by this author , Lisa MeckleyLisa Meckley Marlborough, MA More articles by this author , Thomas ByrneThomas Byrne Marlborough, MA More articles by this author , and Jessica PerhanidisJessica Perhanidis Marlborough, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1506AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Given the rising prevalence of stone disease in the United States coupled with the fact that Medicare is the single largest healthcare payer in the United States, a better understanding of resource utilization in stone management within the Medicare population is urgently needed. At present, ureteroscopy (URS) and shock wave lithotripsy (SWL) are the two most commonly performed stone management procedures; yet our understanding of the re-treatments and ancillary procedures is limited and dated. We conducted this study to identify differences in resource utilization for SWL and URS in a recent sampling of the Medicare population. METHODS A retrospective claims analysis of the Medicare 5% sample was conducted to identify patients undergoing treatment of renal or ureteral calculi with a principal diagnosis of urinary lithiasis between 2009 and 2010. The index date was the date of first fragmentation procedure. Patients were excluded if they had a prior stone treatment within 6 months of the index stone treatment or prior uric acid or cystine stone disease. Outcomes evaluated were (1) a subsequent stone removal procedure within 120 days post index procedure, and (2) stent placement procedures 30 days prior to and 120 days post index date, as well as on the index date. Treatment groups were compared using Chi-Squared tests, T-tests, and relative risks. RESULTS We identified 3885 Medicare eligible patients, of which 2165 (56%) underwent SWL and 1720 (44%) underwent URS. SWL patients were 1.73 times (p=<.0001) more likely to undergo at least one repeat procedure than URS patients, and twice as likely (p=<.0001) to require multiple re-treatments compared to URS. SWL patients were 1.41 times (p=<.0001) more likely than URS patients to have a stent placed prior to index procedure, and 1.33 times (p=0.003) more likely to have a stent placed subsequent to the index procedure. The majority of URS patients (77.8%) had a stent placed at the time of index procedure. CONCLUSIONS Medicare patients undergoing SWL are significantly more likely to require multiple treatments than those undergoing URS. SWL patients are also significantly more likely to require ureteral stent placement as a separate event. As the Medicare program transitions from a volume to value driven system, these procedural trends will be subject to increasing scrutiny. This analysis of Medicare claims data demonstrates the need to characterize optimal treatment patterns, and better understand their economic effects. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e51 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Matlaga Baltimore, MD More articles by this author Lisa Meckley Marlborough, MA More articles by this author Thomas Byrne Marlborough, MA More articles by this author Jessica Perhanidis Marlborough, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...