MP76-14 IMPACT OF PRACTICE SETTING AND USE OF PATHOLOGY SERVICES ON VASECTOMY PAYMENTS, 2009–2015

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-14 IMPACT OF PRACTICE SETTING AND USE OF PATHOLOGY SERVICES ON VASECTOMY PAYMENTS, 2009–2015 Vitaly Zholudev, Dattatraya Patil, Christopher Filson, and Akanksha Mehta Vitaly ZholudevVitaly Zholudev More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Christopher FilsonChristopher Filson More articles by this author , and Akanksha MehtaAkanksha Mehta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2582AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vasectomy is an effective method of permanent birth control, safely performed in the office setting. Routine pathologic evaluation of vasal segments is not recommend by current AUA guidelines. Nevertheless, there is variability in practice setting and practice patterns related to vasectomy. We analyzed variation in payments for vasectomies performed in the United States, based on practice setting (office vs. ambulatory surgery center) and use of ancillary pathology services. METHODS We queried the MarketScan Commercial Claims database (2009 to 2015) using appropriate procedure codes to identify privately-insured men who underwent vasectomy in the office or ambulatory surgical centers. Each episode was defined by a 45-day window surrounding the vasectomy date (15 days prior, 30 days after). We captured professional/facility payments, medication charges, and laboratory/pathology fees for each episode, and determined the degree of patient cost-sharing. We compared costs related to practice setting and use of pathology services using ANOVA. We also determined variation in payments across 210 metropolitan areas performing at least 30 vasectomies in 2015. We used SAS v.9.4 (SAS Institute Inc., Cary, NC) for all analyses, with significance set as α =0.05. RESULTS 446,962 men underwent a vasectomy between 2009 and 2015; 81.5% and 18.5% of procedures were performed in the office vs. ambulatory surgery center (ASC) setting, respectively. The number of procedures performed annually decreased from 75,332 in 2009 to 36,897 in 2015. The overall procedure cost increased modestly from an average of $852 in 2009 to $930 in 2015. Procedure costs were highest in the Northeast ($1060). The proportion of vasectomies performed in an ASC remained stable at 18% during the study period. In-office procedures were associated with lower overall costs ($704 vs. $1748) and lower out-of-pocket expenses ($173 vs $339) than those performed in ASC. Vasal segments were submitted for pathologic evaluation in 39% of cases, which increased average payments by 20% in offices and 30% in ASCs. CONCLUSIONS For men undergoing vasectomy, we identified potentially avoidable health care costs of up to $60 million, associated with the use of ambulatory surgical centers and ancillary pathology services. Pathologic confirmation of vasal segments alone added approximately $12 million in avoidable health care costs. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1024 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Vitaly Zholudev More articles by this author Dattatraya Patil More articles by this author Christopher Filson More articles by this author Akanksha Mehta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...