You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-08 THE IMPACT OF PRE-OPERATIVE PROSTATE IMAGING AND RESIDENT PARTICIPATION ON THE FINANCIAL MARGIN OF AN EPISODE-BASED PAYMENT MODEL FOR ROBOTIC PROSTATECTOMY David Johnson, Aaron Laviana, Jamal Nabhani, Reshma Gupta, Eric Kwok, Christine Ahn, Gerald Kominski, Karim Chamie, Mark Litwin, and Christopher Saigal David JohnsonDavid Johnson More articles by this author , Aaron LavianaAaron Laviana More articles by this author , Jamal NabhaniJamal Nabhani More articles by this author , Reshma GuptaReshma Gupta More articles by this author , Eric KwokEric Kwok More articles by this author , Christine AhnChristine Ahn More articles by this author , Gerald KominskiGerald Kominski More articles by this author , Karim ChamieKarim Chamie More articles by this author , Mark LitwinMark Litwin More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2576AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In response to evolving episode-based payment models, health systems must understand the financial margins under which specific service lines operate. Margins at teaching institutions may be particularly narrow due to the added responsibility of resident education and early adoption of advanced technologies whose value is unclear. We estimate the percent reduction in profit margin under an episode-based payment for robotic prostatectomy (RP) associated with varying utilization of pre-operative multiparametric prostate MRI (mpMRI) and resident participation in the operating room. METHODS Episode costs and reimbursements were calculated to determine the margin for all 160 RPs performed at a single teaching hospital in 2016. The episode spanned the initial urologic oncology consultation preceding surgery and continued 90 days post-operatively. Outpatient costs were calculated using previously described time-driven activity based costing (TDABC). Inpatient hospital costs were calculated using a combination of TDABC and hospital activity based costing. Total reimbursement was calculated using hospital-specific Medicare Diagnosis Related Group and Medicare Fee Schedule amounts for all billed codes within the episode. We determined the impact on financial margin for three combinations of mpMRI utilization (0%, 33%, 100%) and number of residents in the operating room (0, 1, 2) using previously calculated TDABC amounts. Direct Medical Education payments and the impact of resident participation on operative time were not included in these calculations. RESULTS Compared with the reference case of no mpMRI and no resident in the OR, the percent reduction in the margin ranged from 4.8 to 43.0% depending on the utilization of mpMRI and resident participation (Figure 1). CONCLUSIONS Varying degrees of utilization of modifiable cost drivers results in a substantial reduction of margin in a theoretical bundled payment model. Resident education is a core mission for academic centers and this mission may impact margin by 19-43%. Granular analysis of cost and reimbursement informs opportunities for value-based care redesign to help health systems succeed under advanced alternative payment models currently being tested by Medicare. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1021 Advertisement Copyright & Permissions© 2018MetricsAuthor Information David Johnson More articles by this author Aaron Laviana More articles by this author Jamal Nabhani More articles by this author Reshma Gupta More articles by this author Eric Kwok More articles by this author Christine Ahn More articles by this author Gerald Kominski More articles by this author Karim Chamie More articles by this author Mark Litwin More articles by this author Christopher Saigal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...