Study Objective Heavy menstrual bleeding is a common condition in women that can severely affect quality of life. For patients who fail or refuse medical management, endometrial ablation has emerged as a mainstay treatment alternative. Traditionally, endometrial ablation has been a heat-based procedure, typically performed in a hospital outpatient setting. A newly FDA-approved cryoablation technology now enables physicians to perform a safe, comfortable, and effective endometrial ablation procedure in the lower resource office setting. Our objective was to assess the budget impact of potential site-of-service and device modality changes for payers and physicians. Design A decision-analytic model was developed to compute differences in annual payer spend and physician revenue for specified current and future site-of-service mixes and device modalities. Per-case reimbursement for the different sites-of-service was determined based on claims data analysis of n=162,943 procedures. Based on expert surveys and interviews, a current site-of-service mix of 90%/10% hospital outpatient vs. office was considered and of 10%/90% for the future scenario. Cost for thermal and cryoablation devices were assumed to be $900 and $1,250, respectively. Physician office margin was computed based on an assumed annual volume of n=72 procedures. Setting N/A Patients or Participants N/A Interventions Endometrial ablation Measurements and Main Results The shift from 90% hospital outpatient to 10% hospital outpatient was associated with $4,025 of per-case savings for payers, at increased physician revenue of $1,657 per case. This added revenue more than off-set the additional device and procedure-related costs to the physician office, leaving a per-case margin of $1,704, an increase of 30.5% over status-quo. Conclusion Under current reimbursement, a shift in site-of-service of endometrial ablation procedures from hospital outpatient to the office and a shift in device modality from thermal to cryoablation would be associated with meaningful savings to payers at a concurrently attractive value proposition to physicians. Heavy menstrual bleeding is a common condition in women that can severely affect quality of life. For patients who fail or refuse medical management, endometrial ablation has emerged as a mainstay treatment alternative. Traditionally, endometrial ablation has been a heat-based procedure, typically performed in a hospital outpatient setting. A newly FDA-approved cryoablation technology now enables physicians to perform a safe, comfortable, and effective endometrial ablation procedure in the lower resource office setting. Our objective was to assess the budget impact of potential site-of-service and device modality changes for payers and physicians. A decision-analytic model was developed to compute differences in annual payer spend and physician revenue for specified current and future site-of-service mixes and device modalities. Per-case reimbursement for the different sites-of-service was determined based on claims data analysis of n=162,943 procedures. Based on expert surveys and interviews, a current site-of-service mix of 90%/10% hospital outpatient vs. office was considered and of 10%/90% for the future scenario. Cost for thermal and cryoablation devices were assumed to be $900 and $1,250, respectively. Physician office margin was computed based on an assumed annual volume of n=72 procedures. N/A N/A Endometrial ablation The shift from 90% hospital outpatient to 10% hospital outpatient was associated with $4,025 of per-case savings for payers, at increased physician revenue of $1,657 per case. This added revenue more than off-set the additional device and procedure-related costs to the physician office, leaving a per-case margin of $1,704, an increase of 30.5% over status-quo. Under current reimbursement, a shift in site-of-service of endometrial ablation procedures from hospital outpatient to the office and a shift in device modality from thermal to cryoablation would be associated with meaningful savings to payers at a concurrently attractive value proposition to physicians.
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Open Access
Oct 1, 2024
Gökhan Aksel + 14
