MP19-19 GUIDELINE-DRIVEN CHANGES IN SURGICAL MANAGEMENT OF URETHRAL STRICTURE IN MEDICARE PATIENTS

Abstract

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP19)1 Sep 2021MP19-19 GUIDELINE-DRIVEN CHANGES IN SURGICAL MANAGEMENT OF URETHRAL STRICTURE IN MEDICARE PATIENTS Victoria Edmonds, Raevti Bole, Katherine Theisen, Brian Linder, and Boyd Viers Victoria EdmondsVictoria Edmonds More articles by this author , Raevti BoleRaevti Bole More articles by this author , Katherine TheisenKatherine Theisen More articles by this author , Brian LinderBrian Linder More articles by this author , and Boyd ViersBoyd Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002004.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture disease is traditionally managed surgically, either endoscopically by procedures such as urethral dilation or direct visual internal urethrotomy or by urethroplasty. In 2016, the AUA released guidelines recommending urethroplasty over repeated endoscopic procedures, such as dilation or direct visual internal urethrotomy (DVIU) for recurrent strictures. We investigated changes in Medicare practice patterns for urethral strictures from 2010 to 2018. METHODS: The Centers for Medicare and Medicaid Services (CMS) database was queried for reimbursement and provider-level data related to urethral stricture from 2010 to 2018. Monetary data was adjusted for inflation to 2020 US dollars (USD). Average annual and total number of providers and procedures were calculated for all included procedures. An unpaired student’s t-test was used to compare variables. RESULTS: On average, endoscopic procedures were billed 14,923 times by 1110 providers annually. Urethroplasty was billed an average of 209 times annually by 127 providers. Significantly more endoscopies were performed annually than urethroplasties (9.3 vs. 1.6, p=.02). Average urethroplasty reimbursement was $777 versus $214 for endoscopy ($103 dilation; $326 DVIU). Overall, providers were reimbursed $1893 annually for endoscopies ($1614 dilation; $2172 DVIU) compared with $1310 for urethroplasties. Total endoscopies per year decreased 35% (-44% dilation and -27% DVIU), while total urethroplasties increased 36% (Figure 1). CONCLUSIONS: Providers performed significantly more endoscopic procedures for urethral strictures than urethroplasties under Medicare from 2010 to 2018. Although reimbursement is higher for urethroplasty than endoscopy, providers received greater annual reimbursement for endoscopic management after accounting for procedural volume. Regardless total endoscopic procedures decreased over time. These findings suggest that although Medicare might incentivize repeated endoscopic management over definitive urethroplasty, urologists are nonetheless responding to urethral stricture guidelines. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e335-e335 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Victoria Edmonds More articles by this author Raevti Bole More articles by this author Katherine Theisen More articles by this author Brian Linder More articles by this author Boyd Viers More articles by this author Expand All Advertisement Loading ...