American healthcare expenditures exceed $4 trillion annually, with prostate cancer (PCa) accounting for $22 billion. Prostatectomy, a common treatment for PCa, incurs significant cost variability. Value-based care (VBC), emphasizing outcomes and efficiency over volume, has emerged as a potential solution. Bundled payment models, such as Medicare's Comprehensive Care for Joint Replacement (CJR), attempt to align financial incentives with quality but face challenges, including patient variability and misaligned incentives. Building on this, the Transforming Episode Accountability Model (TEAM) introduces longitudinal, episode-based bundles for five predefined surgeries. While urologic surgeries are currently excluded, the evolving landscape presents an opportunity to implement prostatectomy-specific bundles. Urology has piloted condition-specific bundles, such as Vanderbilt University's kidney stone bundle and the Large Urology Group Practice Association's (LUGPA) active surveillance bundle for PCa. These initiatives align incentives for comprehensive, guideline-based care but have yet to achieve widespread adoption. We propose a novel prostatectomy bundle that incentivizes urologists to optimize surgical outcomes, reduce complications, and enhance postoperative care. By incorporating disease-specific quality metrics and graded payments based on cancer severity, this model addresses critical barriers, including fair physician compensation and equity in access. Urology, uniquely positioned at the intersection of surgery and office-based care, can lead VBC innovation. TEAM's emphasis on care coordination, equity, and quality offers a promising foundation for refining bundles. With active physician involvement in VBC design, prostatectomy-specific bundles could advance cost, efficiency, and outcomes in PCa care.

Purpose: There are several evidence-based treatment options for localized prostate cancer (PCa). Decisional regret (DR), or regret based on the treatment a patient chooses, is poorly understood in patients with PCa. We describe long-term trends in DR for patients with localized PCa and factors associated with regret. Materials and Methods: We surveyed an established prospective cohort of patients with PCa in North Carolina who were diagnosed between 2011 and 2013. DR was assessed by a validated instrument at 12, 24, 36, 48, 60, 72, 84, and 120 months after treatment or active surveillance (AS). We estimated the overall trend of DR and examined how DR was associated with treatment and demographic data using generalized linear mixed-model regressions. Results: The sample included 1456 men. At 12 months, 88% (n = 1100) of patients did not regret their treatment. With all time points included, DR increased slightly in early months and the speed of increase slowed over time (P = .003 for time, .02 for time-squared). Divorced men were more likely to have DR compared with married men (odds ratio [OR] = 1.5; 95% confidence interval [CI] 0.9-2.7). African Americans (OR = 1.5; 95% CI 1.0-2.1) and those who underwent surgery had significantly more regret (14.6%; 95% CI 11.3-18.0, P = .01) than patients of other racial groups or who underwent AS, respectively. Conclusions: Although DR is low overall in this cohort, being married and AS were associated with lower regret than those who were not married or who underwent surgery, respectively. Understanding factors that affect DR can guide urologists to more effectively direct resources and counseling.

This study describes financial implications of the merit-based incentive payment system for surgical health care professionals.

You have accessJournal of UrologyCME1 Apr 2023MP16-02 WORK PRODUCTIVITY OF PATIENTS UNDERGOING TRIAL OF PASSAGE FOR URETERAL STONES Ian Berger, Alexandria Spellman, Vishnukamal Golla, Michael Lipkin, Gary Faerber, Jodi Antonelli, Charles Scales, and Deborah Kaye Ian BergerIan Berger , Alexandria SpellmanAlexandria Spellman , Vishnukamal GollaVishnukamal Golla , Michael LipkinMichael Lipkin , Gary FaerberGary Faerber , Jodi AntonelliJodi Antonelli , Charles ScalesCharles Scales , and Deborah KayeDeborah Kaye View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stones affect patients of working age and disrupt daily activities. Patient reported outcomes during trial of passage are understudied which hinders counseling and expectation setting. We sought to characterize work productivity losses for patients with a ureteral stone undergoing a trial of passage. METHODS: We identified employed, English speaking patients aged 18-64 years and discharged from Duke University Health System EDs with unilateral ureteral stones on CT scan from February-October 2022. Patients were contacted by phone 4 weeks after discharge and administered the Institute for Medical Technology Assessment Productivity Cost Questionnaire which evaluates three domains of productivity loss over a four-week period: absenteeism (missed work), presenteeism (decreased productivity at work), and volunteerism (help with unpaid work or domestic tasks). Patients were designated as reporting passage of their stone if they noticed it in the toilet or identified a day with symptom resolution that did not return. RESULTS: We enrolled 64 patients who completed the survey. 71% (46/64) had distal stones and 14% (9/64) had symptoms at the time of the survey. 73% (47/64) of patients missed work after discharge (Figure 1), missing a median of 2 days (interquartile range [IQR] 1.0-4.0). 58% (37/64) had pain at work, with a median of 3 days of pain (IQR 1.5-6.5) and a median of 40% reduction in productivity (IQR 20%-50%) on symptomatic days. 38% (24/64) required help with unpaid work for a median of 2.5 days (IQR 1.0-5.8) and median of 3.5 hours per day (IQR 2.0-5.0). 58% (37/64) of patients passed their stone with a median passage time of 3.5 days (IQR 2.0-7.8). Of patients who passed their stone, 68% (25/37) missed work, with a median of 2 days missed (IQR 1-2) or 50% of work days until their stone passed (IQR 21%-83%). Of patients who reported not passing their stone, 74% (20/27) missed work for a median of 4.5 days (IQR 1-7). This was a median of 14% (IQR 3%-22%) of days until surgery or survey completion. CONCLUSIONS: The majority of patients miss work during passage of a ureteral stone. While time off work is less than published rates after ureteroscopy, it is common to miss half of work days until the stone passes. This information may aid patient counselling and help to prevent return ED visits. Download PPT Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e201 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Metrics Author Information Ian Berger More articles by this author Alexandria Spellman More articles by this author Vishnukamal Golla More articles by this author Michael Lipkin More articles by this author Gary Faerber More articles by this author Jodi Antonelli More articles by this author Charles Scales More articles by this author Deborah Kaye More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP48-03 QUALITY MEASURES REPORTED BY UROLOGISTS IN THE MERIT-BASED INCENTIVE PAYMENT SYSTEM Avinash Maganty, Noah Krampe, Anup Shah, and Vishnukamal Golla Avinash MagantyAvinash Maganty More articles by this author , Noah KrampeNoah Krampe More articles by this author , Anup ShahAnup Shah More articles by this author , and Vishnukamal GollaVishnukamal Golla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The majority of urologists are required to participate in merit-based incentive payment system (MIPS) –a Medicare-mandate reporting system in which physicians must track and report quality measures. Medicare adjusts physician reimbursement based on performance across these measures, with the intention to improve the quality of patient care. However, very few MIPS measures are relevant to urology patients and it is unclear what measures urologists are choosing to track and report. METHODS: We performed a cross-sectional analysis of MIPS measures reported by urologists for the most recent performance year. Urologists were categorized by their reporting affiliation (i.e., individual, group, or alternative payment model [APM]). We identified the measures which were most frequently reported by urologists. Among all measures reported, we identified those that were “topped out” (i.e., measures considered indiscriminate by Medicare because high performance is easily achieved) and those which were relevant for patients with urologic conditions (i.e., MIPS urology measures, qualified urologic registry measures, or those relevant to surgical care). RESULTS: 8,297 urologists reported in MIPS during the 2020 performance year, of whom 14% reported as an individual, 56% as a part of a group, and 30% as part of an APM. Among the top 10 most frequently reported measures, none were specific for urologic care (Table 1). 65% of individual urologists, 58% of those in groups, and 92% in APMs reported at least 1 or more “topped out” measures. Only 11% of urologists reported measures that were directly relevant to patients with urologic conditions. CONCLUSIONS: Most measures reported by urologists are not directly relevant to patients with urologic conditions and remain a poor indicator of the quality of urologic care provided. As Medicare transitions MIPS to condition specific quality measures, it will be important for the urology community to develop and submit measures that will be most impactful for patients. Source of Funding: Avinash Maganty is supported by funding from the National Cancer Institute Ruth L. Kirschstein Postdoctoral Award F32 Grant F32 CA275021-01 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e655 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avinash Maganty More articles by this author Noah Krampe More articles by this author Anup Shah More articles by this author Vishnukamal Golla More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION:Most urologists are required to participate in Merit-based Incentive Payment System-an alternative payment model in which physicians must track and report quality measures. However, Merit-based Incentive Payment System measures are urology-specific, and it remains unclear what measures urologists are choosing to track and report. METHODS:We performed a cross-sectional analysis of Merit-based Incentive Payment System measures reported by urologists for the most recent performance year. Urologists were categorized by their reporting affiliation (ie, individual, group, or alternative payment model). We identified the measures most frequently reported by urologists. Among reported measures, we identified those that were specific to urological conditions and those that were "topped out" (ie, measures considered indiscriminate by Medicare because high performance is easily achieved). RESULTS:A total of 6,937 urologists reported in Merit-based Incentive Payment System during the 2020 performance year, of whom 14% reported as an individual, 56% as a group, and 30% as an alternative payment model. Among the top 10 most frequently reported measures, none were urology-specific. Eleven percent of urologists reported measures that were directly specific to urological conditions; 65% of individual urologists, 58% of those in groups, and 92% in alternative payment models reported at least 1 or more "topped out" measures. CONCLUSIONS:Most measures reported by urologists are not specific to urological conditions, and therefore performance within Merit-based Incentive Payment System may be a poor indicator of the quality of urological care provided. As Medicare transitions Merit-based Incentive Payment System to implement specific quality measures, the urological community will need to develop and submit measures that will be most impactful for urology patients.

INTRODUCTION:Rural patients have limited access to urological care and are vulnerable to high local prices. Little is known about price variation for urological conditions. We aimed to compare reported commercial prices for the components of inpatient hematuria evaluation between for-profit vs not-for-profit and rural vs metropolitan hospitals.METHODS:We abstracted commercial prices for the components of intermediate- and high-risk hematuria evaluation from a price transparency data set. We compared hospital characteristics between those that do and do not report prices for a hematuria evaluation using the Centers for Medicare and Medicaid Services Healthcare Cost Reporting Information System. Generalized linear modelling evaluated the association between hospital ownership and rural/metropolitan status with prices of intermediate- and high-risk evaluations.RESULTS:Of all hospitals, 17% of for-profits and 22% of not-for-profits report prices for hematuria evaluation. For intermediate-risk, median price at rural for-profit hospitals was $6,393 (interquartile range [IQR] $2,357-$9,295) compared to $1,482 (IQR $906-$2,348) at rural not-for-profits and $2,645 (IQR $1,491-$4,863) at metropolitan for-profits. For high-risk, rural for-profit hospitals' median price was $11,151 (IQR $5,826-$14,366) vs $3,431 (IQR $2,474-$5,156) at rural not-for-profits and $4,188 (IQR $1,973-$8,663) at metropolitan for-profits. Rural for-profit status was associated with an additional higher price for intermediate- (relative cost ratio 1.62, 95% CI 1.16-2.28, P = .005) and high-risk evaluations (relative cost ratio 1.50, 95% CI 1.15-1.97, P = .003).CONCLUSIONS:Rural for-profit hospitals report high prices for components of inpatient hematuria evaluation. Patients should be aware of prices at these facilities. These differences may dissuade patients from undergoing evaluation and lead to disparities.

Introduction The COVID-19 pandemic spurred telehealth use in US oncological care but there remains limited data on the onco-primary cancer survivorship population. We investigated patterns of telehealth use during the pandemic and factors driving utilization.Methods and Materials Retrospective study of patients aged 21 years and older diagnosed with breast, colorectal, prostate or non-small lung cancer (stages 1–4). The study period evaluated was defined as during COVID-19: March 1, 2020–April 30, 2021. Patient cohorts were defined as “ever telehealth users” and “never telehealth users”. We tested between-cohort differences in baseline characteristics using Pearson's chi-square tests.Results We identified 4931 onco-primary patients. Of these patients 36.7% (n= 1812) were “ever cancer telehealth users” and 63.3% (n = 3119) patients were “never cancer telehealth users.” Among telehealth users, 44.6% were 65 years or older at cancer diagnosis, 24% were Black, 24.1% lived in rural settings and the most common cancer types were breast (40.4%) followed by prostate (30.4%). “Never telehealth user” had similar demographics. Increased telehealth use was seen in those patients with a higher baseline comorbidity burden (RR 1.14; 95% CI 1.06–1.23), prostate cancer (Prostate RR 1.33; 95% CI 1.16–1.54) and advanced stage cancer (RR 1.20; 95% CI 1.08–1.34).Conclusion Telehealth, while not as heavily utilized, remains an important care tool in marginalized rural and Black onco-primary care patients.Implications for Practice This paper highlights baseline use rates of telehealth in the onco-primary patients including more health disparate populations and helps guides future healthcare system investments in this technology.

Value-based payment (VBP) reform remains an increasingly relevant path for health care transformation. VBP aligns financial incentives with higher quality care at a lower cost for patient populations. This bipartisan commitment to VBP remains a top priority for the Centers for Medicare and Medicaid Services (CMS) with a goal to include all Medicare beneficiaries in a VBP model with accountability for total cost of care and quality by 2030. 1 Brooks-LaSure C Fowler E Seshamani M Tsai D. Innovation at the centers for medicare and medicaid services: avision for the next 10 years | health affairs. Health Affairs Blog. 2021; (Published Accessed November 2, 2021)https://www.healthaffairs.org/do/10.1377/hblog20210812.211558/full/ Google Scholar Further, the COVID-19 public health emergency highlighted the dependency of the fee-for-service (FFS) payment system on patient volume. Practices reliant on FFS faced severe financial challenges when in-person visits were not feasible.

BACKGROUND:There is a growing body of academic literature focusing on the significant financial burdens placed on people living with cancer, but little evidence exists on the impact of rising costs of care in other vulnerable populations. This financial strain, also known as financial toxicity, can impact behavioral, psychosocial, and material domains of life for people diagnosed with chronic conditions and their care partners. New evidence suggests that populations experiencing health disparities, including those with dementia, face limited access to health care, employment discrimination, income inequality, higher burdens of disease, and exacerbating financial toxicity. OBJECTIVE:The three study aims are to (1) adapt a survey to capture financial toxicity in people living with dementia and their care partners; (2) characterize the degree and magnitude of different components of financial toxicity in this population; and (3) empower the voice of this population through imagery and critical reflection on their perceptions and experiences relating to financial toxicity. METHODS:This study uses a mixed methods approach to comprehensively characterize financial toxicity among people living with dementia and their care partners. To address aim 1, we will adapt elements from previously validated and reliable instruments, including the Comprehensive Score for Financial Toxicity and Patient-Reported Outcomes Measurement Information System, to develop a financial toxicity survey specific to dyads of people living with dementia and their care partners. A total of 100 dyads will complete the survey, and data will be analyzed using descriptive statistics and regression models to address aim 2. Aim 3 will be addressed using the process of "photovoice," which is a qualitative, participatory research method that combines photography, verbal narratives, and critical reflection by groups of individuals to capture aspects of their environment and experiences with a certain topic. Quantitative results and qualitative findings will be integrated using a validated, joint display table mixed methods approach called the pillar integration process. RESULTS:This study is ongoing, with quantitative findings and qualitative results anticipated by December 2023. Integrated findings will enhance the understanding of financial toxicity in individuals living with dementia and their care partners by providing a comprehensive baseline assessment. CONCLUSIONS:As one of the first studies on financial toxicity related to dementia care, findings from our mixed methods approach will support the development of new strategies for improving the costs of care. While this work focuses on those living with dementia, this protocol could be replicated for people living with other diseases and serve as a blueprint for future research efforts in this space. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/47255.

Introduction:Rural patients lack access to urological services, and high local prices may dissuade underinsured patients from surgery. We sought to describe commercially insured prices for 3 urological procedures at rural vs metropolitan and for-profit vs nonprofit hospitals. Methods:A cross-sectional analysis of commercially insured prices from the Turquoise Health Transparency data set was performed for ureteroscopy with laser lithotripsy, transurethral resection of bladder tumor, and transurethral resection of prostate. Hospital characteristics were linked using the Centers for Medicare and Medicaid Services Healthcare Cost Reporting Information System. Linear modeling analyzed median hospital price and its association with hospital characteristics. Results:Overall, 1,532 hospitals reported urological prices in Turquoise. Median prices for each procedure were higher at rural for-profits (ureteroscopy $16,522, transurethral resection of bladder tumor $5,393, transurethral resection of prostate $9,999) vs rural nonprofits (ureteroscopy $4,512, transurethral resection of bladder tumor $2,788, transurethral resection of prostate $3,881) and metropolitan for-profits (ureteroscopy $5,411, transurethral resection of bladder tumor $3,420, transurethral resection of prostate $4,874). Rural for-profit status was independently associated with 160% higher price for ureteroscopy (relative cost ratio 2.60, P < .001), 50% higher for transurethral resection of bladder tumor (relative cost ratio 1.50, P = .002), and 113% higher for transurethral resection of prostate (relative cost ratio 2.13, P < .001). Conclusions:Prices are higher for 3 common urological surgeries at rural for-profit hospitals. Differential pricing may contribute to disparities for underinsured rural residents who lack access to nonprofit facilities. Interventions that facilitate transportation and price shopping may improve access to affordable urological care.

National Clinician Scholars Program, Duke University, Durham, North Carolina, USA Department of Surgery, Division of Urology, Duke University School of Medicine, Durham, North Carolina, USA Health Services Research and Development, Durham VA Healthcare System, Durham, North Carolina, USA Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA Duke Clinical Research Institute, Durham, North Carolina, USA Duke Cancer Institute, Durham, North Carolina, USA Sanford School of Public Policy, Duke University, Durham, North Carolina, USA

455 Background: Earlier studies on the cost of muscle-invasive bladder cancer treatments are limited to short-term periods of cost. Our study objective is to compare the 2- and 5-year costs associated with trimodal therapy (TMT) versus radical cystectomy (RC) benchmarked against costs for patients who received no curative treatment. Methods: This cohort study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Medicare expenditures were summed from inpatient, outpatient, and physician services within 2 and 5 years of diagnosis to determine total costs Total Medicare costs at 2-and 5-years following TMT versus RC were compared using inverse probability of treatment-weighted (IPTW) propensity score models. Results: A total of 2,537 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002 through December 31, 2009. Total median costs for patients that received no definitive/systemic treatments (RC, TMT, radiotherapy alone, or chemotherapy alone) were $73,780 vs. $88,275 at 2-and 5-years respectively. Total median costs were significantly higher for TMT than RC at 2-years ($372,839 vs. $191,363, p<0.001) and 5-years ($424,570 vs. $253,651, p<0.001), respectively. TMT had higher outpatient median costs than RC (2-yr: $318,221 vs. $100,900; 5-yr: $367,092 vs. $146,561) with significantly higher costs largely associated with radiology, medications, pathology/laboratory, and other professional services. Conclusions: TMT vs. RC was associated with higher long-term costs among patients with muscle-invasive bladder cancer largely driven by outpatient expenditures. Reduction in costs associated with radiology, medications, pathology/laboratory, and other professional services may improve the value of TMT.[Table: see text]

Muhieddine Labban, MD; Prokar Dasgupta, MBBS; Chao Song, MPH; Russell Becker, MA; Yanli Li, PhD; Usha Seshadri Kreaden, MS; Quoc-Dien Trinh, MD

Background: Cancer center accreditation status is predicated on several factors that measure high-value healthcare. However, price transparency, which is critical in healthcare decisions, is not a quality measure included for accreditation. We reported the rates of price disclosure of surgical procedures for 5 cancers (breast, lung, cutaneous melanoma, colon, and prostate) among hospitals ranked by the American College of Surgeon's Commission on Cancer (ACS-CoC). Methods: We identified nonfederal, adult, and noncritical access ACS-CoC accredited hospitals and used the commercial Turquoise Health database to perform a cross-sectional analysis of hospital price disclosures for 5 common oncologic procedures (mastectomy, lobectomy, wide local excision for cutaneous melanoma, partial colectomy, prostatectomy). Publicly available financial reporting data were used to compile facility-specific features, including bed size, teaching status, Centers for Medicare & Medicaid wage index, and patient revenues. Modified Poisson regression evaluated the association between price disclosure and ACS-CoC accreditation after adjusting for hospital financial performance. Results: Of 1,075 total ACS-CoC accredited hospitals, 544 (50.6%) did not disclose prices for any of the surgical procedures and only 313 (29.1%) hospitals reported prices for all 5 procedures. Of the 5 oncologic procedures, prostatectomy and lobectomy had the lowest price disclosure rates. Disclosing and nondisclosing hospitals significantly differed in ACS-CoC accreditation, ownership type, and teaching status. Hospitals that disclosed prices were more likely to receive Medicaid disproportionate share hospital payments, have lower average charge to cost ratios (4.53 vs 5.15; P<.001), and have lower net hospital margins (-2.03 vs 0.44; P=.005). After adjustment, a 1-point increase in markup was associated with a 4.8% (95% CI, 2.2%-7.4%; P<.001) higher likelihood of nondisclosure. Conclusions: More than half of the hospitals did not disclose prices for any of the 5 most common oncologic procedures despite ACS-CoC accreditation. It remains difficult to obtain price transparency for common oncologic procedures even at centers of excellence, signaling a discordance between quality measures visible to patients.

OBJECTIVE:To characterize appointment access for Medicaid-insured patients seeking care at urology practices affiliated with private equity firms in light of the recent national trends in practice consolidation.METHODS:We identified 214 urology offices affiliated with private equity firms that were geographically matched with 231 non-private equity affiliated urology offices. Using a standardized script, researchers posed as an adult patient with either Medicaid or commercial insurance in the clinical setting of new onset, painless hematuria. The primary outcome was whether the patient's insurance was accepted for an appointment. The secondary outcome was appointment wait time.RESULTS:We conducted 815 appointment inquiry calls to 214 private equity (PE) and 231 non-PE-affiliated urology offices across 12 states. Appointment availability was higher for commercially-insured patients (99.0%; 95% CI: 98.1%-99.9%) vs Medicaid-insured patients (59.8%; 95% confidence interval [CI]: 55.0%-64.6%) (P < .0001). Medicaid acceptance was higher at non-PE affiliated (66.8%; CI 60.4%-73.2%) than PE-affiliated practices (52.1%; 95% CI 45.0%-59.2%) (P = .003). On multivariable logistic regression analysis, state Medicaid expansion status (odds ratio [OR] 2.20; CI 1.14-4.28; P = .020) was independently associated with Medicaid appointment availability, whereas PE-affiliation (OR 0.55; CI 0.37-0.83; P = .004) was independently associated with lower Medicaid access. Appointment wait times did not differ significantly for commercially-insured vs Medicaid patients (19.2 vs 20.1 days; p = .59), but PE-affiliated practices offered shorter mean wait times than non-PE offices (17.5 vs 21.4 days; P = .017).CONCLUSION:Access disparities for urologic evaluation in patients with Medicaid insurance at urology practices and were more pronounced at private equity acquired practices.

Although integrated health care has largely been associated with increases in prices and static or decreased quality across many disease states, it has shown some successes in improving cancer care. However, its impact is largely equivocal, making consensus statements difficult. Critically, integration does not necessarily translate to clinical coordination, which might be the true driver behind the success of integrated health care delivery. Moving forward, it is important to establish payment models that support clinical care coordination. Shifting from a fragmented health system to a coordinated one may improve evidence-based cancer care, outcomes, and value for patients.

You have accessJournal of UrologyCME1 May 2022MP26-15 RURAL HOSPITAL LOCATION IS ASSOCIATED WITH HIGHER REPORTED PRICES FOR URETEROSCOPY WITH LASER LITHOTRIPSY AMONG COMMERCIALLY INSURED PATIENTS Ian Berger, Vishnukamal Golla, Marcelo Cerullo, Yuqi Zhang, Michael E. Lipkin, Gary J. Faerber, Deborah R. Kaye, and Charles D. Scales Ian BergerIan Berger More articles by this author , Vishnukamal GollaVishnukamal Golla More articles by this author , Marcelo CerulloMarcelo Cerullo More articles by this author , Yuqi ZhangYuqi Zhang More articles by this author , Michael E. LipkinMichael E. Lipkin More articles by this author , Gary J. FaerberGary J. Faerber More articles by this author , Deborah R. KayeDeborah R. Kaye More articles by this author , and Charles D. ScalesCharles D. Scales More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002569.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Price negotiation between hospitals and insurers is influenced by market competition factors. For rural hospitals, decreased inter-hospital competition may favor hospital negotiating power. However, price differences between rural and metropolitan hospitals for urologic surgeries have not been studied. Our objective was to evaluate prices for ureteroscopy with laser lithotripsy (URS) between rural and metropolitan hospitals in the context of urologist density. METHODS: The Turquoise Health Price Transparency dataset contains publicly available prices from reporting hospitals. We abstracted prices for commercial payers for URS (CPT 52356). We averaged prices across payers by hospital. County level urologist and population density were obtained from the 2019 Area Health Resource File and aggregated into Health Service Areas (HSA) defined by the National Center of Health Statistics. Rural-Urban Commuting Area (RUCA) codes were used to classify each hospital as rural versus metropolitan. Facility features were obtained from the 2019 Centers for Medicare and Medicaid Services Healthcare Cost Reporting Information System and Wage Index. A generalized linear model with gamma distribution and log link evaluated the association of mean price of URS with RUCA classification, controlling for urologist density and facility features. RESULTS: A total of 659 hospitals reported prices for URS with a median rate of $6,161 (interquartile range $3,836 – $10,338). Rural hospitals comprised 24% (158/659) of facilities. Among HSA with a hospital reporting a URS price, 25th percentile of urologist density was 1.6 per 100,000 persons, 50th was 2.5, and 75th was 3.6. Controlling for hospital factors and urologist density, the price for URS was 26% higher (p=0.004) at rural versus metropolitan hospitals and for profit hospital price was 34% higher versus non-profit (p<0.001) [Table 1]. Price was 32% lower in the Northeast compared to West region (p<0.001). CONCLUSIONS: URS prices are higher at rural hospitals. Rural hospitals may face decreased competition for negotiating prices with insurance companies. Higher prices in these areas may exacerbate disparities for rural patients who may struggle to afford health care. Source of Funding: Duke University Bass Connections © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e445 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ian Berger More articles by this author Vishnukamal Golla More articles by this author Marcelo Cerullo More articles by this author Yuqi Zhang More articles by this author Michael E. Lipkin More articles by this author Gary J. Faerber More articles by this author Deborah R. Kaye More articles by this author Charles D. Scales More articles by this author Expand All Advertisement PDF downloadLoading ...