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67th Annual Meeting Abstracts
Impact of Urologist’s Reimbursement on the Initial Treatment of Prostate Cancer in a Community Practice
Eugene V Kramolowsky1, *Nada L Wood1, *Gayathri Sridhar2
1Virginia Urology, Richmond, VA;2Virginia Commonwealth University, Richmond, VA
Introduction: The purpose of this paper is to determine if a change in urologists’ reimbursement influences the initial treatment for CaP.
Materials & Methods: A private practice tumor registry of 7993 consecutive, newly diagnosed patients with CaP was used to determine initial treatment choices before and after two financial events. 1) Radioactive seed implantation (RASI) moved to a urologist owned ambulatory surgery center (ASC) ($2,130 per case in facility fee) and 2) Medicare fee schedule reduction in the payment for chemical androgen deprivation (ADT) ($2,670 in loss per patient per year) A total of 1,970 consecutive patients with RASI or external beam radiation therapy (EBRT) were divided evenly before and after the availability of the ASC and 962 consecutive patients with primary ADT (PADT) or active surveillance/watchful waiting (WW) were divided evenly before and after Medicare fee reduction. The age, PSA and Gleason scores were compared.
Results: After availability of ASC, patients choosing RASI increased from 529 to 615 [not statistically significant, OR 1.081, 95% CI (0.881-1.326)]. The revenue increased $1,018,140. After Medicare decreased fee schedule for ADT, the patients choosing PADT decreased from 301 to 237 [not statistically significant, OR 0.810, 95 %CI (0.573-1.144)] Resulting decrease in revenue of $632,790.
Conclusions: A change in urologist reimbursement did not change the treatment for their CaP patients. One of the reasons for this outcome may be the salary payment system for the urologist instead of a fee for service model.
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