1689 COMPARISON OF PATIENT SATISFACTION WITH TREATMENT OUTCOMES BETWEEN SHOCK WAVE LITHOTRIPSY AND URETEROSCOPY FOR URETERAL STONES: ANALYSIS IN TERMS OF PATIENT PERCEPTION

Abstract

INTRODUCTION AND OBJECTIVES: Historically, Michigan has had limited urologist investment in lithotripters due to strict Certificate of Need legislation. However, between 2005 and 2006, the ownership landscape changed when two large lithotripsy providers offered partnership shares to urologists in the State for the first time. Those who acquired shares were incentivized to perform shockwave lithotripsy preferentially over ureteroscopy (URS), and rates of URS may have fallen due to technology substitution. We explored this possibility using population-based data. METHODS: From the Michigan files of the State Ambulatory Surgery Database (2004 to 2007), we abstracted discharges for URS performed at hospital-based outpatient departments. We measured differences between patients who underwent URS in the year before (2004) and after (2007) ownership expansion. We calculated annual rates of URS in Michigan and evaluated for significant changes over time. Finally, we compared these rates to those from Florida, which already had a high penetration of physician ownership, over the same time interval. RESULTS: Compared to patients treated prior to ownership expansion, those who underwent URS after ownership expansion were older (P 0.001), less likely to be White (P 0.001), less likely to have private health insurance (P 0.001), and more likely to have a higher Charlson comorbidity index (P 0.001). However, the magnitudes of these differences were small. As Figure 1 shows, rates of URS in Michigan remained relatively stable despite ownership expansion (P 0.129 for the temporal trend); and there were no significant differences in the rates of change of URS between Michigan and Florida during the time of ownership expansion (P 0.479). CONCLUSIONS: The introduction of physician-ownership of lithotripter units in Michigan was not associated with decreased rates of URS. Despite the financial incentives, technology substitution does not appear to occur on a significant scale at the population-level, at least as it pertains to the management of stone disease. Source of Funding: None