MP11-11 PHYSICIAN USE OF SACRAL NEUROMODULATION IN MEDICARE BENEFICIARIES; ARE PHYSICIANS WHO ARE HIGH TESTERS ALSO HIGH IMPLANTERS?

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2014MP11-11 PHYSICIAN USE OF SACRAL NEUROMODULATION IN MEDICARE BENEFICIARIES; ARE PHYSICIANS WHO ARE HIGH TESTERS ALSO HIGH IMPLANTERS? Anne M. Suskind, J. Quentin Clemens, Yun Zhang, Florian R. Schroeck, and Brent K. Hollenbeck Anne M. SuskindAnne M. Suskind More articles by this author , J. Quentin ClemensJ. Quentin Clemens More articles by this author , Yun ZhangYun Zhang More articles by this author , Florian R. SchroeckFlorian R. Schroeck More articles by this author , and Brent K. HollenbeckBrent K. Hollenbeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.426AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is much uncertainty surrounding which patients will respond to sacral neuromodulation (SNM) therapy. For this reason, these procedures are done in a staged fashion, where only the patients who respond to an initial test phase move on to permanent device implantation. Based on this knowledge gap, decisions on SNM testing are largely discretionary at the level of the provider. The purpose of this study was to identify physician level factors associated with SNM testing and to determine whether or not physicians who are high volume testers are also high volume device implanters. METHODS We used a 20% sample of national Medicare claims to identify urologists and gynecologists who performed SNM procedures from 2005 to 2010. We then determined physician-level rates of device testing [number of tests/number of patients with diagnoses of overactive bladder (OAB) or non-obstructive urinary retention] and of device implantation (number of implants/number of tests). We then fit a Poisson model to examine factors associated with device testing. RESULTS The number of physicians performing SNM test procedures tripled from 2005 to 2010. During the same time period, average rates of SNM testing per physician increased from 2.8 tests to 4.9 tests (p<0.01), while rates of device implantation remained stable (p=0.80), see figure. Based on our model, we found that physicians who have a history of lower rates of device implantation were associated with higher rates of device testing (p<0.01). Physicians who had high rates of testing were also less likely to be urologists compared to gynecologists, to perform the test procedure in an ambulatory surgery center or in a hospital-based inpatient or outpatient facility compared to the office setting, and were more likely to test on patients who were older and white, all p values <0.01. CONCLUSIONS Over time, physicians are testing more patients but are not necessarily implanting more devices. In addition, we found that physicians who historically have lower rates of device implantation are associated with higher rates of device testing. Better strategies need to be developed to help reduce rates of unsuccessful testing in the future. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e99-e100 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Anne M. Suskind More articles by this author J. Quentin Clemens More articles by this author Yun Zhang More articles by this author Florian R. Schroeck More articles by this author Brent K. Hollenbeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...