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Zhu A, Nam CS, Gingrich D, Patel N, Black K, Andino JJ, Daignault-Newton S, Telang J, Dupree JM, Quallich S, Ohl D, Hadj-Moussa M. Short-Term Changes in Vasectomy Consults and Procedures Following Dobbs v Jackson Women's Health Organization. Urol Pract 2024; 11:517-525. [PMID: 38315830 DOI: 10.1097/upj.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION On June 24, 2022, the US Supreme Court issued its decision on Dobbs v Jackson Women's Health Organization (Dobbs). This decision had major implications on female reproductive choices, but also had potential implications on their male counterparts. We sought to determine the association of Dobbs with the number and characteristics of men seeking vasectomy. METHODS A retrospective review was performed to determine the number of vasectomy consults and procedures completed at a single Michigan health system in the 6 months following Dobbs (June 24, 2022-December 24, 2022) vs the same 6-month time frame between 2019 and 2021. Another retrospective review was conducted in the 3 months following Dobbs (June 24, 2022-September 24, 2022) vs the same days in 2021 to determine the number of vasectomy consults completed and to evaluate for differences in the characteristics of these men. RESULTS In the 6 months after Dobbs, there was a 150% and 160% increase in vasectomy consults and procedures completed, respectively, compared to a similar time frame in 2019 to 2021. In the 3 months after Dobbs, there was a 225% increase in new vasectomy consults compared to a similar time frame in 2021. There were no differences in the age, race, religion, median household income, or insurance type of men seeking vasectomy consult pre- vs post-Dobbs. Partnerless men (odds ratio 3.66) and those without children (odds ratio 2.85) were more likely than married men and those with 3 or more children, respectively, to seek vasectomy consult post-Dobbs. CONCLUSIONS Dobbs was associated with a marked increase in vasectomy consultations and procedures at our institution in the state of Michigan. Future studies are needed to determine the long-term implications of Dobbs on vasectomy practices and determine if vasectomy practices differ by states and their respective abortion laws.
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Affiliation(s)
- Alex Zhu
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Catherine S Nam
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Devon Gingrich
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Nik Patel
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Kristian Black
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Juan J Andino
- University of California, Los Angeles, Los Angeles, California
| | | | - Jaya Telang
- Department of Urology, Wayne State University, Detroit, Michigan
| | - James M Dupree
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Susanne Quallich
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Dana Ohl
- Department of Urology, University of Michigan, Ann Arbor, Michigan
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Nam CS, Tooke BP, Strasser O, Hameed MA, Chinnusamy S, Van Til M, Daignault-Newton S, Dupree JM. Antisperm Antibody Levels After Vasectomy Reversal Are Not Associated With Pregnancy Rates or Method of Conception. Urology 2024; 186:154-161. [PMID: 38417465 DOI: 10.1016/j.urology.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To examine the relationship between antisperm antibody (ASA), pregnancy rates, and method of conception following vasectomy reversal, given that before and after vasectomy reversal, patients wonder if ASAs will prevent them from achieving pregnancy and American Urological Association vasectomy guidelines call for additional research to answer this question. METHODS We performed retrospective chart review and phone interview of patients who underwent vasectomy reversal at our institution from 1/1/2000 to 12/31/2018. We excluded patients who underwent vasectomy reversal for pain, or without postoperative semen analysis with ASA. We categorized patients as having low (<50%) or high (≥50%) ASA levels using the first postoperative semen analysis. Our primary outcome was pregnancy rate, including method of conception. Differences in pregnancy rates were tested using Fisher exact test. RESULTS Two hundred and four patients were chart reviewed. Median age at time of surgery was 40years and median obstruction interval was 7.3years. Median partner age was 32years. One hundred sixty-four (80%) patients underwent bilateral vasovasostomy. Eighty-five patients (42%) had low (<50%) ASA levels and 119 (58%) had high (≥50%) ASA levels. Sixty-seven patients completed phone interviews. Of 27 men with low ASA levels, 19 (70%) achieved a pregnancy with 16 (59%) spontaneous pregnancy. Of 40 men with high ASA levels, 30 (75%) achieved a pregnancy with 16 (40%) spontaneous pregnancy. The Fisher exact test P-value was .2. CONCLUSION ASA levels are not associated with pregnancy rate or method of conception after vasectomy reversal. These findings can improve patient counseling before and after vasectomy reversal.
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Affiliation(s)
- Catherine S Nam
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI.
| | - Benjamin P Tooke
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | | | - Mujtaba A Hameed
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | - Sadhana Chinnusamy
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | - Monica Van Til
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | | | - James M Dupree
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
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Nam CS, Lai YL, Hu HM, George AK, Linsell S, Ferrante S, Brummett CM, Waljee JF, Dupree JM. Less is More: Fulfillment of Opioid Prescriptions Before and After Implementation of a Modifier 22 Based Quality Incentive for Opioid-Free Vasectomies. Urology 2023; 171:103-108. [PMID: 36243141 DOI: 10.1016/j.urology.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/03/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the percentage of patients who filled peri-procedural opioid prescriptions before and after Blue Cross Blue Shield of Michigan (BCBSM) launched a modifier 22 payment incentive for opioid-sparing vasectomies in Michigan on July 1, 2019. METHODS We evaluated BCBSM administrative claims data from February 1, 2018 - November 16, 2020 for men 20 - 64 years old who underwent vasectomy or a control office-based urologic procedure (cystourethroscopy, prostate biopsy, circumcision, and transurethral destruction of prostate tissue.) The primary outcome was the percentage of patients who filled opioid prescriptions 30 days before to 3 days after their procedure. We performed an interrupted time series analysis to estimate changes in the percentage of patients who filled opioid prescriptions in the vasectomy and control group before and after July 1, 1019. RESULTS Our cohort included 4,559 men who had a vasectomy and 4,679 men who had a control procedure. Within each group, demographics and clinical factors were similar before and after July 1, 2019. Before implementation of the modifier 22 policy, 32.5% of men who had a vasectomy filled an opioid prescription whereas only 12.6% of men filled an opioid prescription after July 1, 2019 -a 19.9% absolute reduction and 61.0% relative reduction (P < .001). In the control group, there was no significant change in the percentage of patients who filled opioid prescriptions before and after July 1, 2019 (0.8% absolute increase, P = .671). CONCLUSION Implementation of modifier 22 based financial incentive for opioid-sparing vasectomies was associated with decrease in the percentage of men who filled opioid prescriptions after vasectomy.
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Affiliation(s)
| | - Yen-Ling Lai
- Department of Surgery, Michigan Medicine, Ann Arbor, MI; Michigan Opioid Prescribing and Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Hsou Mei Hu
- Department of Surgery, Michigan Medicine, Ann Arbor, MI; Michigan Opioid Prescribing and Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Arvin K George
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - Susan Linsell
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - Stephanie Ferrante
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - Chad M Brummett
- Michigan Opioid Prescribing and Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, MI; Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Jennifer F Waljee
- Department of Surgery, Michigan Medicine, Ann Arbor, MI; Michigan Opioid Prescribing and Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - James M Dupree
- Department of Urology, Michigan Medicine, Ann Arbor, MI.
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Dupree JM, Kitaevich J, Murali S, Borah L, Castle SK, Kirkland A. WHEN STATES REQUIRE FULLY-INSURED EMPLOYERS TO PROVIDE INSURANCE COVERAGE FOR IN-VITRO FERTILIZATION (IVF), DO SELF-INSURED EMPLOYERS FOLLOW SUIT? Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shami AN, Menke M, Dupree JM, Schon SB. BREAKING IT DOWN: ADHERENCE TO GUIDELINES FOR DNA FRAGMENTATION TESTING IN MALE INFERTILITY PATIENTS. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brady AM, Ohl DA, Dupree JM, Xu M, Sønksen JOR, Jensen CFS. Case of the Month from Herlev and Gentofte University Hospital, Herlev, Denmark: Ablation of spermatogenesis due to acute spinal cord injury: a case report. BJU Int 2022; 130:303-305. [PMID: 35998908 DOI: 10.1111/bju.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/17/2022] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Alyson M Brady
- Assisted Reproduction Laboratory, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dana A Ohl
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - James M Dupree
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Min Xu
- Assisted Reproduction Laboratory, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jens O R Sønksen
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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Jewett A, Warner L, Kawwass JF, Mehta A, Eisenberg ML, Nangia AK, Dupree JM, Honig S, Hotaling JM, Kissin DM. Assisted reproductive technology cycles involving male factor infertility in the United States, 2017–2018: data from the National Assisted Reproductive Technology Surveillance System. F S Rep 2022; 3:124-130. [PMID: 35789711 PMCID: PMC9250125 DOI: 10.1016/j.xfre.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To describe the prevalence and treatment characteristics of assisted reproductive technology (ART) cycles involving specific male factor infertility diagnoses in the United States. Design Cross-sectional analysis of ART cycles in the National ART Surveillance System (NASS). Setting Clinics that reported patient ART cycles performed in 2017 and 2018. Patient(s) Patients who visited an ART clinic and the cycles were reported in the NASS. The ART cycles included all autologous and donor cycles that used fresh or frozen embryos. Intervention(s) Not applicable. Main Outcome Measures Analyses used new, detailed reporting of male factor infertility subcategories, treatment characteristics, and male partner demographics available in the NASS. Result(s) Among 399,573 cycles started with intent to transfer an embryo, 30.4% (n = 121,287) included a male factor infertility diagnosis as a reason for using ART. Of these, male factor only was reported in 16.5% of cycles, and both male and female factors were reported in 13.9% of cycles; 21.8% of male factor cycles had >1 male factor. Abnormal sperm parameters were the most commonly reported diagnoses (79.7%), followed by medical condition (5.3%) and genetic or chromosomal abnormalities (1.0%). Males aged ≤40 years comprised 59.6% of cycles with male factor infertility. Intracytoplasmic sperm injection was the primary method of fertilization (81.7%). Preimplantation genetic testing was used in 26.8%, and single embryo transfer was used in 66.8% of cycles with male factor infertility diagnosis. Conclusion(s) Male factor infertility is a substantial contributor to infertility treatments in the United States. Continued assessment of the prevalence and characteristics of ART cycles with male factor infertility may inform treatment options and improve ART outcomes. Future studies are necessary to further evaluate male factor infertility.
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Atkinson RB, Castillo-Angeles M, Kim ES, Hu YY, Gosain A, Easter SR, Dupree JM, Cooper Z, Rangel EL. The Long Road to Parenthood: Assisted Reproduction, Surrogacy, and Adoption Among US Surgeons. Ann Surg 2022; 275:106-114. [PMID: 34914662 DOI: 10.1097/sla.0000000000005253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to characterize demographics, costs, and workplace support for surgeons using assisted reproductive technology (ART), adoption, and surrogacy to build their families. SUMMARY BACKGROUND DATA As the surgical workforce diversifies, the needs of surgeons building a family are changing. ART, adoption, and surrogacy may be used with greater frequency among female surgeons who delay childbearing and surgeons in same-sex relationships. Little is known about costs and workplace support for these endeavors. METHODS An electronic survey was distributed to surgeons through surgical societies and social media. Rates of ART use were compared between partners of male surgeons and female surgeons and multivariate analysis used to assess risk factors. Surgeons using ART, adoption, or surrogacy were asked to describe costs and time off work to pursue these options. RESULTS Eight hundred and fifty-nine surgeons participated. Compared to male surgeons, female surgeons were more likely to report delaying children due to surgical training (64.9% vs. 43.5%, P < 0.001), have fewer children (1.9 vs. 2.4, p < 0.001), and use ART (25.2% vs. 17.4%, P = 0.035). Compared to non-surgeon partners of male surgeons, female surgeons were older at first pregnancy (33 vs 31 years, P < 0.001) with age > 35 years associated with greater odds of ART use (odds ratio 3.90; 95% confidence interval 2.74-5.55, P < 0.001). One-third of surgeons using ART spent >$40,000; most took minimal time off work for treatments. Forty-five percent of same-sex couples used adoption or surrogacy. 60% of surgeons using adoption or surrogacy spent >$40,000 and most took minimal paid parental leave. CONCLUSIONS ART, adoption, or surrogacy is costly and lacks strong workplace support in surgery, disproportionately impacting women and same-sex couples. Equitable and inclusive environments supporting all routes to parenthood ensure recruitment and retention of a diverse workforce. Surgical leaders must enact policies and practices to normalize childbearing as part of an early surgical career, including financial support and equitable parental leave for a growing group of surgeons pursuing ART, surrogacy, or adoption to become parents.
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Affiliation(s)
- Rachel B Atkinson
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Manuel Castillo-Angeles
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eugene S Kim
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Yue-Yung Hu
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, MA
| | - James M Dupree
- Department of Urology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Zara Cooper
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Erika L Rangel
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Morris JR, Falk O, Samplaski MK, Dupree JM, Kenfield S, Narayanan NP, Matthews WJ, Lamb DJ, Smith J. MOTILITY AND TOTAL MOTILE COUNT DECLINE OBSERVED WITH A NOVEL MAIL-IN SEMEN CRYOPRESERVATION SYSTEM. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Andino JJ, Gonzalez DC, Dupree JM, Marks S, Ramasamy R. Challenges in completing a successful vasectomy reversal. Andrologia 2021; 53:e14066. [PMID: 33866579 DOI: 10.1111/and.14066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
Although a wide array of interventions exist for men seeking fertility after vasectomy, up to 6% of them will elect for a vasectomy reversal. While the widespread adoption of telemedicine promises convenience and improved access, lack of ability to do a physical examination may hinder appropriate counselling. Although vasectomy reversal is successfully completed in most of the men either with a vasovasostomy or a vasoepididymostomy, there could be various reasons for the inability to successfully complete the operation. Our commentary outlines the reasons why a vasectomy reversal is not possible or successful. We also discuss a pre-operative management algorithm in men seeking vasectomy reversal to ensure appropriate counselling with a thorough pre-operative history, physical examination and on occasion, hormonal evaluation.
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Affiliation(s)
- Juan J Andino
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | | | - James M Dupree
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | - Sheldon Marks
- International Center for Vasectomy Reversal, Tucson, AZ, USA
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Dupree JM, Coward RM, Hsieh TC, Tanrikut C, Shin P, Mehta A, Hotaling JM, Pastuszak AW, Williams D, Alukal J, Lipshultz LI, Schlegel P, Walsh TJ, Eisenberg ML, Shin D, Honig S, Nagler HM, Samplaski M, Nangia AK, Sandlow J, Smith JF. The Impact of Physician Productivity Models on Access to Subspecialty Care: A White Paper From the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology. Urology 2021; 153:28-34. [PMID: 33484822 DOI: 10.1016/j.urology.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/06/2020] [Accepted: 01/07/2021] [Indexed: 01/25/2023]
Abstract
Male infertility is a common disease. Male infertility is also a core competency of urology training and clinical practice. In this white paper from the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology, we identify and define different physician productivity plans. We then describe the advantages and disadvantages of various physician productivity measurement systems for male infertility practices. We close with recommendations for measuring productivity that we hope urologists and administrators can use when creating productivity plans for male infertility practices.
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Affiliation(s)
- James M Dupree
- Department of Urology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC and UNC Fertility LLC, Raleigh NC
| | | | | | - Paul Shin
- Department of Urology, Shady Grove Fertility, Washington, DC
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | | | - Daniel Williams
- Department of Urology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI
| | - Joseph Alukal
- Department of Urology, Columbia University, New York, NY
| | | | - Peter Schlegel
- Department of Urology, Weill Cornell Medicine, New York, NY
| | - Thomas J Walsh
- Department of Urology, Men's Health Center at University of Washington Medical Center, Seattle, WA
| | - Michael L Eisenberg
- Department of Urology, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA
| | - David Shin
- Department of Urology, Hackensack Meridan School of Medicine, Nutley, NJ
| | - Stan Honig
- Department of Urology, Yale Urology, New Haven, CT
| | - Harris M Nagler
- Department of Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Mary Samplaski
- University of Southern California, Institute of Urology, Los Angeles, CA
| | - Ajay K Nangia
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | - Jay Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - James F Smith
- Department of Urology, University of California San Francisco, San Francisco, CA
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Pandruvada S, Royfman R, Shah TA, Sindhwani P, Dupree JM, Schon S, Avidor-Reiss T. Lack of trusted diagnostic tools for undetermined male infertility. J Assist Reprod Genet 2021; 38:265-276. [PMID: 33389378 DOI: 10.1007/s10815-020-02037-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/13/2020] [Indexed: 12/15/2022] Open
Abstract
Semen analysis is the cornerstone of evaluating male infertility, but it is imperfect and insufficient to diagnose male infertility. As a result, about 20% of infertile males have undetermined infertility, a term encompassing male infertility with an unknown underlying cause. Undetermined male infertility includes two categories: (i) idiopathic male infertility-infertile males with abnormal semen analyses with an unknown cause for that abnormality and (ii) unexplained male infertility-males with "normal" semen analyses who are unable to impregnate due to unknown causes. The treatment of males with undetermined infertility is limited due to a lack of understanding the frequency of general sperm defects (e.g., number, motility, shape, viability). Furthermore, there is a lack of trusted, quantitative, and predictive diagnostic tests that look inside the sperm to quantify defects such as DNA damage, RNA abnormalities, centriole dysfunction, or reactive oxygen species to discover the underlying cause. To better treat undetermined male infertility, further research is needed on the frequency of sperm defects and reliable diagnostic tools that assess intracellular sperm components must be developed. The purpose of this review is to uniquely create a paradigm of thought regarding categories of male infertility based on intracellular and extracellular features of semen and sperm, explore the prevalence of the various categories of male factor infertility, call attention to the lack of standardization and universal application of advanced sperm testing techniques beyond semen analysis, and clarify the limitations of standard semen analysis. We also call attention to the variability in definitions and consider the benefits towards undetermined male infertility if these gaps in research are filled.
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Affiliation(s)
- Swati Pandruvada
- Department of Biological Sciences, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, 43607, USA
| | - Rachel Royfman
- Department of Biological Sciences, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, 43607, USA
| | - Tariq A Shah
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, 43607, USA
| | - Puneet Sindhwani
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, 43607, USA
| | - James M Dupree
- Department of Urology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48019, USA
| | - Samantha Schon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Tomer Avidor-Reiss
- Department of Biological Sciences, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, 43607, USA. .,Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, 43607, USA.
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Zhu A, Andino JJ, Chopra Z, Daignault-Newton S, Ellimoottil C, Dupree JM. TELEHEALTH FOR MALE-INFERTILITY IS FEASIBLE AND SAVES PATIENTS’ TIME AND MONEY. Fertil Steril 2020. [PMCID: PMC7548545 DOI: 10.1016/j.fertnstert.2020.08.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Andino JJ, Zhu A, Daignault-Newton S, Ellimoottil C, Dupree JM. VIDEO VISITS ALLOW FOR MANAGEMENT OF MALE INFERTILITY ACROSS A BROAD SPECTRUM OF DIAGNOSES. Fertil Steril 2020. [PMCID: PMC7548644 DOI: 10.1016/j.fertnstert.2020.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
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15
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Jewett A, Warner L, Dupree JM, Honig S, Nangia A, Eisenberg ML, Kawwass JF, Hotaling J, Mehta A, Kissin DM. MALE INFERTILITY DIAGNOSES AMONG PATIENTS WHO USED ASSISTED REPRODUCTIVE TECHNOLOGY IN THE UNITED STATES, 2016-2018. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Andino JJ, Dupree JM, Jensen CFS, Palapattu GS, Sønksen J, Wittmann D. COVID and CopMich: comparing and contrasting COVID-19 experiences in the USA and Scandinavia. Nat Rev Urol 2020; 17:493-498. [PMID: 32632304 PMCID: PMC7338095 DOI: 10.1038/s41585-020-0352-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 11/09/2022]
Abstract
On 11 March 2020, the World Health Organization declared SARS-CoV-2 and its associated disease, COVID-19, a global pandemic. Across the world, governments took action to slow the spread and hospitals rushed to accommodate an influx of patients with this highly infectious and lethal disease. The urology departments in Ann Arbor, Michigan, USA, and Herlev and Gentofte, Copenhagen, Denmark — which are linked by the pre-existing CopMich Collaborative — had to respond with massive changes to the organization, staffing and workload of their teams. In this Viewpoint, authors from different urological subspecialties and at different career stages reflect on their experiences during the pandemic. Although their countries’ responses to the COVID-19 pandemic differed radically, the similarities between the responses in Copenhagen and Michigan demonstrate the universal characteristics of medicine and the value of teamwork, flexibility and collaboration. Juan J. Andino is a third-year urology resident at the University of Michigan. He completed his undergraduate and medical degrees, and an MBA at the University of Michigan. Dr Andino is interested in telehealth and health policy and hopes to work at the intersection of these fields to optimize the delivery of urological care. James M. Dupree is an Associate Professor of Urology at the University of Michigan. He completed his residency at Northwestern University and his fellowship in Male Reproductive Medicine and Surgery at Baylor College of Medicine. He also completed a Health Policy Fellowship with the American College of Surgeons. Dr Dupree specializes in the advanced treatment of male infertility, and his research focuses on male infertility and reproductive health policy. Dr Dupree is also the Ambulatory Care Clinical Chief for Urology at the University of Michigan. Christian Fuglesang S. Jensen received his medical degree from the University of Copenhagen in 2015 and is currently enrolled as a PhD trainee working with male infertility at the Department of Urology, Herlev and Gentofte Hospital. Dr Jensen has previously worked at the Department of Urology, University of Michigan, performing research into andrology and male infertility. Dr Jensen serves as chair on the ESSM Scientific Sub-Committee for new technologies and sexual function and is a co-founder and member of the Core Unit of the CopMich Collaborative. Ganesh S. Palapattu is the George F. and Sandy G. Valassis Professor and Chair of the Department of Urology at the University of Michigan. He attended the University of Texas at Austin where he earned a Bachelor of Arts degree in Humanities and then Baylor College of Medicine in Houston, Texas, where he earned his medical degree. Subsequently, Dr Palapattu completed his surgical internship, urology training and chief residency in urology at the David Geffen School of Medicine at UCLA followed by a laboratory research fellowship in Urologic Oncology at the Johns Hopkins Hospital Brady Urological Institute. His clinical interest is in the evaluation and management of men with prostate and kidney cancer. Jens Sønksen received his medical degree from the University of Copenhagen in 1988 and earned his PhD and Doctor of Medical Science in 1995 and 2003, respectively. He is currently Professor of Urology at the University of Copenhagen and Head of the Urological Research Center and Section of Andrology, Herlev and Gentofte Hospital, Denmark. Dr Sønksen is currently serving as Adjunct Secretary General of the European Association of Urology and is a co-founder and member of the Core Unit of the CopMich Collaborative. Daniela Wittmann received her BA Hons at Keele University, Keele, UK, her Master’s in Social Work at Simmons College School of Social Work, Boston, MA and her PhD at Michigan State University. She is an Associate Professor in the Department of Urology and Adjunct Associate Professor at the School of Social Work at the University of Michigan. Dr Wittmann is a leading member of the Brandon Prostate Cancer Survivorship Program at the University of Michigan and serves as the Chair of the Mental Health Committee of the Sexual Medicine Society of North America. She is also a member of the Prostate Health Committee of the Urology Care Foundation.
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Affiliation(s)
- Juan J Andino
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | - James M Dupree
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | - Christian F S Jensen
- Department of Urology, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark.
| | | | - Jens Sønksen
- Department of Urology, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark.
| | - Daniela Wittmann
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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17
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Abstract
Although infertility is now recognized as a disease by multiple organizations including the World Health Organization and the American Medical Association, private insurance companies rarely include coverage for infertility treatments. In this review, the authors assess the current state of care delivery for male infertility care in the United States. They discuss the scope of male infertility as well as the unique burdens it places on patients and review emerging market forces that could affect the future of care delivery for male infertility.
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Affiliation(s)
- Mary Oakley Strasser
- Department of Urology, University of Michigan, 1500 E. Medical Center Drive, SPC 5330 Ann Arbor, Michigan 48109-5330, USA.
| | - James M Dupree
- Department of Urology, University of Michigan, 1500 E. Medical Center Drive, SPC 5330 Ann Arbor, Michigan 48109-5330, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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18
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Shah PK, Linsell S, Qi J, Hafron J, Sarle R, Lane B, Peabody J, Miller DC, Ghani KR, Dupree JM. Limiting Opioid Overprescription after Prostatectomy: How Payer-Provider Collaboration Can Lead to Improved Patient Safety and Reimbursement. ACTA ACUST UNITED AC 2020. [DOI: 10.1056/cat.20.0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Parth K. Shah
- Chief Resident, Michigan MedicineUrologist, USMD Urology
| | | | - Ji Qi
- Senior Statistician, Michigan Medicine
| | | | | | - Brian Lane
- Urologist, Spectrum Health Medical Group – UrologyAssociate Professor, Michigan State University College of Human Medicine
| | - James Peabody
- Urologist, Henry Ford Health System – Vattikuti Urology Institute
| | - David C. Miller
- Chief Clinical Officer, University Hospital/Cardiovascular CenterProfessor of Urology, Michigan Medicine
| | - Khurshid R. Ghani
- Program Director, MUSIC, Michigan MedicineAssociate Professor of Urology, Michigan Medicine
| | - James M. Dupree
- Associate Professor of Urology, Obstetrics, and Gynecology, Michigan Medicine
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19
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Turner KA, Rambhatla A, Schon S, Agarwal A, Krawetz SA, Dupree JM, Avidor-Reiss T. Male Infertility is a Women's Health Issue-Research and Clinical Evaluation of Male Infertility Is Needed. Cells 2020; 9:cells9040990. [PMID: 32316195 PMCID: PMC7226946 DOI: 10.3390/cells9040990] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Infertility is a devastating experience for both partners as they try to conceive. Historically, when a couple could not conceive, the woman has carried the stigma of infertility; however, men and women are just as likely to contribute to the couple’s infertility. With the development of assisted reproductive technology (ART), the treatment burden for male and unexplained infertility has fallen mainly on women. Equalizing this burden requires reviving research on male infertility to both improve treatment options and enable natural conception. Despite many scientific efforts, infertility in men due to sperm dysfunction is mainly diagnosed by a semen analysis. The semen analysis is limited as it only examines general sperm properties such as concentration, motility, and morphology. A diagnosis of male infertility rarely includes an assessment of internal sperm components such as DNA, which is well documented to have an impact on infertility, or other components such as RNA and centrioles, which are beginning to be adopted. Assessment of these components is not typically included in current diagnostic testing because available treatments are limited. Recent research has expanded our understanding of sperm biology and suggests that these components may also contribute to the failure to achieve pregnancy. Understanding the sperm’s internal components, and how they contribute to male infertility, would provide avenues for new therapies that are based on treating men directly for male infertility, which may enable less invasive treatments and even natural conception.
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Affiliation(s)
- Katerina A. Turner
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA;
| | - Amarnath Rambhatla
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA;
| | - Samantha Schon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, L4000 UH-South, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA;
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Stephen A. Krawetz
- Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - James M. Dupree
- Department of Urology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48019, USA;
| | - Tomer Avidor-Reiss
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA;
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
- Correspondence:
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20
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Sukul D, Seth M, Barnes GD, Dupree JM, Syrjamaki JD, Dixon SR, Madder RD, Lee D, Gurm HS. Cardiac Rehabilitation Use After Percutaneous Coronary Intervention. J Am Coll Cardiol 2020; 73:3148-3152. [PMID: 31221264 DOI: 10.1016/j.jacc.2019.03.515] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/21/2019] [Accepted: 03/31/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Milan Seth
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Geoffrey D Barnes
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - James M Dupree
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Michigan Value Collaborative, University of Michigan, Ann Arbor, Michigan; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - John D Syrjamaki
- Michigan Value Collaborative, University of Michigan, Ann Arbor, Michigan; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan
| | - Ryan D Madder
- Division of Cardiology, Spectrum Health, Grand Rapids, Michigan
| | - Daniel Lee
- Division of Cardiology, McLaren Health Care, Bay City, Michigan
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of Cardiology, Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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21
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Herrel LA, Zhu Z, Griggs JJ, Kaye DR, Dupree JM, Ellimoottil CS, Miller DC. Association Between Delivery System Structure and Intensity of End-of-Life Cancer Care. JCO Oncol Pract 2020; 16:e590-e600. [PMID: 32069191 DOI: 10.1200/jop.19.00667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether the type of delivery system is associated with intensity of care at the end of life for Medicare beneficiaries with cancer. PATIENTS AND METHODS We used SEER registry data linked with Medicare claims to evaluate intensity of end-of-life care for patients who died of one of ten common cancers diagnosed from 2009 through 2014. Patients were categorized as receiving the majority of their care in an integrated delivery system, designated cancer center, health system that was both integrated and a certified cancer center, or health system that was neither. We evaluated adherence to seven nationally endorsed end-of-life quality measures using generalized linear models across four delivery system types. RESULTS Among 100,549 beneficiaries who died of cancer during the study interval, we identified only modest differences in intensity of end-of-life care across delivery system structures. Health systems with no cancer center or integrated affiliation demonstrated higher proportions of patients with multiple hospitalizations in the last 30 days of life (11.3%), death in an acute care setting (25.9%), and lack of hospice use in the last year of life (31.6%; all P < .001). Patients enrolled in hospice had lower intensity care across multiple end-of-life quality measures. CONCLUSION Intensity of care at the end of life for patients with cancer was higher at delivery systems with no integration or cancer focus. Maximal supportive care delivered through hospice may be one avenue to reduce high-intensity care at the end of life and may impact quality of care for patients dying from cancer.
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Affiliation(s)
- Lindsey A Herrel
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Ziwei Zhu
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Jennifer J Griggs
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Deborah R Kaye
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - James M Dupree
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Chandy S Ellimoottil
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - David C Miller
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
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22
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Sukul D, Seth M, Dupree JM, Syrjamaki JD, Ryan AM, Nallamothu BK, Gurm HS. Drivers of Variation in 90-Day Episode Payments After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2020; 12:e006928. [PMID: 30608883 DOI: 10.1161/circinterventions.118.006928] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is a common and expensive procedure that has become a target for bundled payment initiatives. We described the magnitude and determinants of variation in 90-day PCI episode payments across a diverse array of patients and hospitals. METHODS AND RESULTS We linked clinical registry data from PCIs performed at 33 Michigan hospitals to 90-day episodes of care constructed using Medicare fee-for-service and commercial insurance claims from January 2012 to October 2016. Payments were price standardized and risk adjusted using clinical and administrative variables in an observed-over-expected framework. Hospitals were stratified into quartiles based on average episode payments. Payment components between the highest and the lowest quartiles were compared with identified drivers of variation (ie, index hospitalization/procedure, readmissions, postacute care, and professional fees). Among 40 925 90-day PCI episodes, the average risk-adjusted 90-day episode payment by hospital ranged between $22 154 and $27 205 with a median of $24 696 (interquartile range, $24 190-$25 643). Hospitals in the lowest and the highest quartiles had average episode payments of $23 744 and $26 504, respectively (difference, $2760). Readmission payments were the primary driver of this variation (46.2%), followed by postacute care (22.6%). Readmissions remained the primary driver of variation in key subgroups, including inpatient and outpatient PCI, as well as PCI for acute myocardial infarction and nonacute myocardial infarction indications. CONCLUSIONS Substantial hospital-level variation exists in 90-day PCI episode payments. Over half the variation between high- and low-payment hospitals was related to care after the index procedure, primarily because of readmissions and postacute care. Hospitals and policymakers should consider targeting these components when developing initiatives to reduce PCI-related spending.
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Affiliation(s)
- Devraj Sukul
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (D.S., M.S., B.K.N., H.S.G.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., J.M.D., A.M.R., B.K.N.)
| | - Milan Seth
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (D.S., M.S., B.K.N., H.S.G.)
| | - James M Dupree
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., J.M.D., A.M.R., B.K.N.).,Michigan Value Collaborative, University of Michigan, Ann Arbor (J.M.D., J.D.S.).,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor (J.M.D.)
| | - John D Syrjamaki
- Michigan Value Collaborative, University of Michigan, Ann Arbor (J.M.D., J.D.S.)
| | - Andrew M Ryan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., J.M.D., A.M.R., B.K.N.).,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor (A.M.R.).,University of Michigan Center for Evaluating Health Reform, Ann Arbor (A.M.R.)
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (D.S., M.S., B.K.N., H.S.G.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., J.M.D., A.M.R., B.K.N.).,Michigan Integrated Center for Health Analytics and Medical Prediction, Ann Arbor (B.K.N.).,Division of Cardiovascular Medicine, Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor (B.K.N., H.S.G.)
| | - Hitinder S Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (D.S., M.S., B.K.N., H.S.G.).,Division of Cardiovascular Medicine, Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor (B.K.N., H.S.G.)
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23
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Dupree JM, Levinson Z, Kelley AS, Manning M, Dalton VK, Levy H, Hirth RA. Provision of Insurance Coverage for IVF by a Large Employer and Changes in IVF Rates Among Health Plan Enrollees. JAMA 2019; 322:1920-1921. [PMID: 31721982 PMCID: PMC6865238 DOI: 10.1001/jama.2019.16055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study investigates changes in in vitro fertilization (IVF) rates among health plan enrollees between 2012 and 2017 after a large US empoloyer (University of Michigan) began providing coverage for IVF in 2015.
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Affiliation(s)
- James M. Dupree
- Department of Urology, University of Michigan Medical School, Ann Arbor
| | | | - Angela S. Kelley
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
| | - Marsha Manning
- Medical Benefits and Strategy, University of Michigan, Ann Arbor
| | - Vanessa K. Dalton
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
| | - Helen Levy
- University of Michigan Institute for Social Research, Ann Arbor
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24
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Li BY, Urish KL, Jacobs BL, He C, Borza T, Qin Y, Min HS, Dupree JM, Ellimoottil C, Hollenbeck BK, Lavieri MS, Helm JE, Skolarus TA. Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program. JAMA Netw Open 2019; 2:e1916008. [PMID: 31755949 PMCID: PMC6902819 DOI: 10.1001/jamanetworkopen.2019.16008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE The Hospital Readmissions Reduction Program (HRRP) is a Centers for Medicare and Medicaid Services policy that levies hospital reimbursement penalties based on excess readmissions of patients with 4 medical conditions and 3 surgical procedures. A greater understanding of factors associated with the 3 surgical reimbursement penalties is needed for clinicians in surgical practice. OBJECTIVE To investigate the first year of HRRP readmission penalties applied to 2 surgical procedures-elective total hip arthroplasty (THA) and total knee arthroplasty (TKA)-in the context of hospital and patient characteristics. DESIGN, SETTING, AND PARTICIPANTS Fiscal year 2015 HRRP penalization data from Hospital Compare were linked with the American Hospital Association Annual Survey and with the Healthcare Cost and Utilization Project State Inpatient Database for hospitals in the state of Florida. By using a case-control framework, those hospitals were separated based on HRRP penalty severity, as measured with the HRRP THA and TKA excess readmission ratio, and compared according to orthopedic volume as well as hospital-level and patient-level characteristics. The first year of HRRP readmission penalties applied to surgery in Florida Medicare subsection (d) hospitals was examined, identifying 60 663 Medicare patients who underwent elective THA or TKA in 143 Florida hospitals. The data analysis was conducted from February 2016 to January 2017. EXPOSURES Annual hospital THA and TKA volume, other hospital-level characteristics, and patient factors used in HRRP risk adjustment. MAIN OUTCOMES AND MEASURES The HRRP penalties with HRRP excess readmission ratios were measured, and their association with annual THA and TKA volume, a common measure of surgical quality, was evaluated. The HRRP penalties for surgical care according to hospital and readmitted patient characteristics were then examined. RESULTS Among 143 Florida hospitals, 2991 of 60 663 Medicare patients (4.9%) who underwent THA or TKA were readmitted within 30 days. Annual hospital arthroplasty volume seemed to follow an inverse association with both unadjusted readmission rates (r = -0.16, P = .06) and HRRP risk-adjusted readmission penalties (r = -0.12, P = .14), but these associations were not statistically significant. Other hospital characteristics and readmitted patient characteristics were similar across HRRP orthopedic penalty severity. CONCLUSIONS AND RELEVANCE This study's findings suggest that higher-volume hospitals had less severe, but not significantly different, rates of readmission and HRRP penalties, without systematic differences across readmitted patients.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Case-Control Studies
- Centers for Medicare and Medicaid Services, U.S./economics
- Centers for Medicare and Medicaid Services, U.S./standards
- Female
- Florida
- Humans
- Male
- Patient Readmission/economics
- Patient Readmission/statistics & numerical data
- Reimbursement Mechanisms/economics
- Reimbursement Mechanisms/organization & administration
- Risk Adjustment
- United States
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Affiliation(s)
- Benjamin Y. Li
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Kenneth L. Urish
- Magee Bone and Joint Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce L. Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chang He
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, University of Michigan, Ann Arbor
| | - Tudor Borza
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
- Department of Urology, University of Wisconsin, Madison
| | - Yongmei Qin
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Hye Sung Min
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - James M. Dupree
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Chad Ellimoottil
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Brent K. Hollenbeck
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Mariel S. Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor
| | - Jonathan E. Helm
- Operations and Decision Technologies, Indiana University Kelley School of Business, Bloomington
| | - Ted A. Skolarus
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
- Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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25
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Habbouche J, Lee J, Steiger R, Dupree JM, Khalsa C, Englesbe M, Brummett C, Waljee J. Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery. JAMA Surg 2019; 153:1111-1119. [PMID: 30140896 DOI: 10.1001/jamasurg.2018.2651] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance In 2014, the US Drug Enforcement Administration moved hydrocodone-containing analgesics from schedule III to the more restrictive schedule II to limit prescribing and decrease nonmedical opioid use. The association of this policy change with postoperative prescribing is not well understood. Objective To examine the hypothesis that the amount of opioids prescribed following surgery is associated with the rescheduling of hydrocodone. Design, Setting, and Participants An interrupted time series analysis of outpatient opioid prescriptions was conducted to examine the trends in the amount of postoperative opioids filled before and after the schedule change. Opioid prescriptions filled between January 2012 and October 2015 were analyzed using insurance claims data from the Michigan Value Collaborative, which includes data from 75 hospitals across Michigan. A total of 21 955 adult inpatients 18 to 64 years of age who underwent 1 of 19 common elective surgical procedures and filled an opioid prescription within 14 days of discharge to home were eligible for inclusion. Main Outcomes and Measures The primary outcome was the trends in the mean amount of opioids filled in oral morphine equivalents (OMEs) for the initial postoperative prescriptions before and after the schedule change date of October 6, 2014, compared using interrupted time series and multivariable regression analyses. Secondary outcomes included the total amount of opioids filled and the refill rate for the 30-day postoperative period. Subgroup analyses were performed by hydrocodone prescriptions, nonhydrocodone prescriptions, surgical procedure, and prior opioid use. Results Data from 21 955 patients undergoing surgical procedures across 75 hospitals and 5120 prescribers were analyzed. Cohorts before and after the schedule change were equivalent with respect to sex (10 197 of 15 791 [64.6%] vs 3966 of 6169 [64.3%] female; P = .69) and mean (SE) age (47.9 [11.2] vs 47.7 [11.3] years; P = .19). After the schedule change, the mean OMEs filled in the initial opioid prescription increased by approximately 35 OMEs (β = 35.1 [13.2]; P < .01), equivalent to 7 tablets of hydrocodone (5 mg). There were no significant differences in the total OMEs filled during the 30-day postoperative period before and after the schedule change (β = 18.3 [30.5]; P = .55), but there was a significant decrease in the refill rate (β = -5.2% [1.3%]; P < .001). Conclusions and Relevance Changing hydrocodone from schedule III to schedule II was associated with an increase in the amount of opioids filled in the initial prescription following surgery. Opioid-related policies require close follow-up to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors.
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Affiliation(s)
- Joe Habbouche
- Department of Surgery, University of Michigan, Ann Arbor
| | - Jay Lee
- Department of Surgery, University of Michigan, Ann Arbor
| | - Rena Steiger
- Department of Surgery, University of Michigan, Ann Arbor
| | - James M Dupree
- Department of Urology, University of Michigan, Ann Arbor
| | - Caitlin Khalsa
- Department of Surgery, University of Michigan, Ann Arbor
| | | | - Chad Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Jennifer Waljee
- Department of Surgery, University of Michigan, Ann Arbor.,Michigan Opioid Prescribing Engagement Network, Ann Arbor
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Modi PK, Kaufman SR, Herrel LA, Dupree JM, Luckenbaugh AN, Skolarus TA, Hollenbeck BK, Shahinian VB. Practice-Level Adoption of Conservative Management for Prostate Cancer. J Oncol Pract 2019; 15:e863-e869. [PMID: 31509481 DOI: 10.1200/jop.19.00088] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE We describe the longitudinal adoption of conservative management (ie, the absence of treatment) for prostate cancer among urology group practices in the United States and identify group practice features that influence this adoption. METHODS Using a 20% sample of Medicare claims, we identified men with incident prostate cancer from 2010 through 2014 and assigned each to his predominant urologist. We linked each urologist to a practice and characterized the practice's organization (eg, solo, single specialty, multispecialty) and ownership of intensity-modulated radiation therapy. For each group, we determined the rate of conservative management within 1 year of diagnosis. We then fit mixed-effects logistic regression models to assess relationships between practice organization and the adoption of conservative management over time, adjusted for patient characteristics. RESULTS We identified 22,178 men with newly diagnosed prostate cancer managed by 350 practices. Practices that increased use the most over time also used conservative management the most in 2010, whereas those that increased use the least used conservative management the least in 2010. Thus, the difference in average use of conservative management between highest- and lowest-use practices widened between 2010 and 2014. Urology groups increased their use of conservative management more rapidly than multispecialty groups. There was no difference in the rate of increase between intensity-modulated radiation therapy owning and nonowning groups. CONCLUSION There is increasing variation among group practices in the use of conservative management for prostate cancer. This underscores the need for a better understanding of practice-level factors that influence prostate cancer management.
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Alyesh DM, Seth M, Miller DC, Dupree JM, Syrjamaki J, Sukul D, Dixon S, Kerr EA, Gurm HS, Nallamothu BK. Exploring the Healthcare Value of Percutaneous Coronary Intervention: Appropriateness, Outcomes, and Costs in Michigan Hospitals. Circ Cardiovasc Qual Outcomes 2019; 11:e004328. [PMID: 29853465 DOI: 10.1161/circoutcomes.117.004328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessments of healthcare value have largely focused on measuring outcomes of care at a given level of cost with less attention paid to appropriateness. However, understanding how appropriateness relates to outcomes and costs is essential to determining healthcare value. METHODS AND RESULTS In a retrospective cohort study design, administrative data from fee-for-service Medicare patients undergoing percutaneous coronary intervention (PCI) in Michigan hospitals between June 30, 2010, and December 31, 2014, were linked with clinical data from a statewide PCI registry to calculate hospital-level measures of (1) appropriate use criteria scores, (2) 90-day risk-standardized readmission and mortality rates, and (3) 90-day risk-standardized episode costs. We then used Spearman correlation coefficients to assess the relationship between these measures. A total of 29 839 PCIs were performed at 33 PCI hospitals during the study period. A total of 13.3% were for ST-segment-elevation myocardial infarction, 25.0% for non-ST-segment-elevation myocardial infarction, 47.1% for unstable angina, 9.8% for stable angina, and 4.7% for other. The overall hospital-level mean appropriate use criteria score was 8.4±0.2. Ninety-day risk-standardized readmission occurred in 23.7%±3.7% of cases, 90-day risk-standardized mortality in 4.3%±0.6%, and mean risk-standardized episode costs were $26 159±$1074. Hospital-level appropriate use criteria scores did not correlate with 90-day readmission, mortality, or episode costs. CONCLUSIONS Among Medicare patients undergoing PCI in Michigan, we found hospital-level appropriate use criteria scores did not correlate with 90-day readmission, mortality, or episode costs. This finding suggests that a comprehensive understanding of healthcare value requires multidimensional consideration of appropriateness, outcomes, and costs.
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Affiliation(s)
- Daniel M Alyesh
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.M.A., D.S., H.S.G., B.K.N.)
| | - Milan Seth
- University of Michigan Medical School, Ann Arbor. Blue Cross Blue Shield of Michigan Cardiovascular Collaborative, Ann Arbor, MI (M.S., H.S.G.)
| | - David C Miller
- Department of Urology (D.C.M., J.M.D., J.S.).,Blue Cross Blue Shield Michigan Value Collaborative, Ann Arbor, MI (D.C.M., J.M.D., J.S.)
| | - James M Dupree
- Department of Urology (D.C.M., J.M.D., J.S.).,Blue Cross Blue Shield Michigan Value Collaborative, Ann Arbor, MI (D.C.M., J.M.D., J.S.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., E.A.K., B.K.N. J.M.D.)
| | - John Syrjamaki
- Department of Urology (D.C.M., J.M.D., J.S.).,Blue Cross Blue Shield Michigan Value Collaborative, Ann Arbor, MI (D.C.M., J.M.D., J.S.)
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.M.A., D.S., H.S.G., B.K.N.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., E.A.K., B.K.N. J.M.D.)
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI (S.D.)
| | - Eve A Kerr
- Ann Arbor Veterans Affairs Center for Clinical Management Research, MI (E.A.K., H.S.G., B.K.N.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., E.A.K., B.K.N. J.M.D.)
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.M.A., D.S., H.S.G., B.K.N.).,University of Michigan Medical School, Ann Arbor. Blue Cross Blue Shield of Michigan Cardiovascular Collaborative, Ann Arbor, MI (M.S., H.S.G.).,Ann Arbor Veterans Affairs Center for Clinical Management Research, MI (E.A.K., H.S.G., B.K.N.)
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.M.A., D.S., H.S.G., B.K.N.).,Ann Arbor Veterans Affairs Center for Clinical Management Research, MI (E.A.K., H.S.G., B.K.N.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., E.A.K., B.K.N. J.M.D.)
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Samplaski MK, Smith JF, Lo KC, Hotaling JM, Lau S, Grober ED, Trussell JC, Walsh TJ, Kolettis PN, Chow VDW, Zini AS, Spitz A, Fischer MA, Domes T, Zeitlin SI, Fuchs EF, Hedges JC, Sandlow JI, Brannigan RE, Dupree JM, Goldstein M, Ko EY, Hsieh TCM, Bieniek JM, Shin D, Nangia AK, Jarvi KA. Reproductive endocrinologists are the gatekeepers for male infertility care in North America: results of a North American survey on the referral patterns and characteristics of men presenting to male infertility specialists for infertility investigations. Fertil Steril 2019; 112:657-662. [PMID: 31351700 DOI: 10.1016/j.fertnstert.2019.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize the referral patterns and characteristics of men presenting for infertility evaluation using data obtained from the Andrology Research Consortium. DESIGN Standardized male infertility questionnaire. SETTING Male infertility centers. PATIENT(S) Men presenting for fertility evaluation. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Demographic, infertility history, and referral data. RESULT(S) The questionnaires were completed by 4,287 men, with a mean male age of 40 years ± 7.4 years and female partners age of 37 years ± 4.9 years. Most were Caucasian (54%) with other races being less commonly represented (Asian 18.6%, and African American 5.5%). The majority (59.7%) were referred by a reproductive gynecologist, 19.4% were referred by their primary care physician, 4.2% were self-referred, and 621 (14.5%) were referred by "other." Before the male infertility investigation, 12.1% of couples had undergone intrauterine insemination, and 4.9% of couples had undergone in vitro fertilization (up to six cycles). Among the male participants, 0.9% reported using finasteride (5α-reductase inhibitor) at a dose used for androgenic alopecia, and 1.6% reported exogenous testosterone use. CONCLUSION(S) This broad North American patient survey shows that reproductive gynecologists are the de facto gateway for most male infertility referrals, with most men being assessed in the male infertility service being referred by reproductive endocrinologists. Some of the couples with apparent male factor infertility are treated with assisted reproductive technologies before a male factor investigation. The survey also identified potentially reversible causes for the male infertility including lifestyle factors such as testosterone and 5α-reductase inhibitor use.
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Affiliation(s)
- Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, California
| | - James F Smith
- Department of Urology, University of California, San Francisco, California
| | - Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital and; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Susan Lau
- Division of Urology, Department of Surgery, Mount Sinai Hospital and
| | - Ethan D Grober
- Division of Urology, Department of Surgery, Mount Sinai Hospital and
| | - J C Trussell
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
| | - Thomas J Walsh
- Department of Urology, University of Washington, Seattle, Washington
| | - Peter N Kolettis
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victor D W Chow
- Department of Urologic Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Armand S Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Aaron Spitz
- Orange County Urology Associates, Laguna Hills, California
| | - Marc A Fischer
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Trustin Domes
- Saskatoon Urology Associates, Saskatoon, Saskatchewan, Canada
| | - Scott I Zeitlin
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Eugene F Fuchs
- Department of Urology, Oregon Health & Science University, Portland, Oregon
| | - Jason C Hedges
- Department of Urology, Oregon Health & Science University, Portland, Oregon
| | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - James M Dupree
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Marc Goldstein
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Edmund Y Ko
- Department of Urology, Loma Linda University, Loma Linda, California
| | | | - Jared M Bieniek
- Tallwood Urology & Kidney Institute, Hartford HealthCare, Farmington, Connecticut
| | - David Shin
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Ajay K Nangia
- Department of Urology Surgery, University of Kansas Health System, Kansas City, Kansas
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital and; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
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Kelley AS, Qin Y, Marsh EE, Dupree JM. Disparities in accessing infertility care in the United States: results from the National Health and Nutrition Examination Survey, 2013-16. Fertil Steril 2019; 112:562-568. [PMID: 31262522 DOI: 10.1016/j.fertnstert.2019.04.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/17/2019] [Accepted: 04/30/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate infertility rates and access to infertility care among women in the United States. DESIGN Retrospective cross-sectional. SETTING Not applicable. PATIENT(S) Women between 20 and 44 years-old who participated in the National Health and Nutrition Examination Survey between 2013 and 2016 and answered questions RHQ074 ("have you ever attempted to become pregnant over a period of at least a year without becoming pregnant?") and RHQ076 ("have you ever been to a doctor or other medical provider because you were unable to become pregnant?"). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Rates of infertility and accessing infertility care. RESULT(S) Women reported infertility at a rate of 12.5% (95% confidence interval, 10.8-14.4). Higher infertility rates were noted with increasing age and body mass index. There were no differences in infertility rates by race/ethnicity, education, income, U.S. citizenship, insurance, or primary location of health care. However, women with less than a high school diploma accessed infertility care less than women with a college degree (5.0% vs. 11.6%). Women with incomes less than $25,000 sought infertility care less than those with incomes above $100,000 (5.4% vs. 11.6%). Non-U.S. citizens accessed infertility care less than U.S. citizens (6.9% vs. 9.4%), and uninsured women reported fewer visits for infertility than insured women (5.9% vs. 9.9%). Women who used the emergency department as their primary medical location reported accessing infertility care less than those who relied on a hospital outpatient unit (1.4% vs. 14.9%). CONCLUSION(S) These nationally representative findings highlight the need to address disparities in access to infertility care.
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Affiliation(s)
- Angela S Kelley
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Yongmei Qin
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Erica E Marsh
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - James M Dupree
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Urology, University of Michigan, Ann Arbor, Michigan.
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Kaye DR, Dunn RL, Li J, Herrel LA, Dupree JM, Miller DC, Ellimoottil C. Variation in Physician-Specific Episode Payments for Major Cancer Surgery and Implications for the Merit-Based Incentive Program. J Surg Res 2019; 236:30-36. [PMID: 30694769 DOI: 10.1016/j.jss.2018.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/22/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nearly 1.5 million clinicians in the United States will be affected by Centers for Medicare and Medicaid Services' (CMS) new payment program, the Merit-based Incentive Program (MIPS), where clinicians will be penalized or rewarded based on the health care expenditures of their patients. We therefore examined expenditures for major cancer surgery to understand physician-specific variation in episode payments. METHODS We used Surveillance, Epidemiology and End Results-Medicare data to identify patients aged 66-99 y who underwent a prostatectomy, nephrectomy, lung, or colorectal resection for cancer from 2008 to 2012. We calculated 90-d episode payments, attributed each episode to a physician, and evaluated physician-level payment variation. Next, we determined which component (index admission, readmission, physician services, postacute care, hospice) drove differences in payments. Finally, we evaluated payments by geographic region, number of comorbidities, and cancer stage. RESULTS We identified 39,109 patients who underwent surgery by 1 of 7182 providers. There was wide variation in payments for each procedure (prostatectomy: $7046-$40,687; nephrectomy: $8855-$82,489; lung resection: $11,167-$223,467; colorectal resection: $9711-$199,480). The largest component difference in episode payments varied by condition: physician payments for prostatectomy (29%), postacute care for nephrectomy (38%) and colorectal resections (38%), and index hospital admission for lung resections (43%) but were fairly stable across region, comorbidity number, and cancer stage. CONCLUSIONS For patients undergoing major cancer surgery, 90-d episode payments vary widely across surgeons. The components driving such variation differ by condition but remain stable across region, number of comorbidities, and cancer stage. These data suggest that programs to reduce specific component payments may have advantages over those targeting individual physicians for decreasing health care expenditures.
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Affiliation(s)
- Deborah R Kaye
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
| | - Rodney L Dunn
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jonathan Li
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - David C Miller
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
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Cron DC, Hwang C, Hu HM, Lee JS, Dupree JM, Syrjamaki JD, Chung KC, Brummett CM, Englesbe MJ, Waljee JF. A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals. Surgery 2018; 165:825-831. [PMID: 30497812 DOI: 10.1016/j.surg.2018.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/25/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Postoperative opioid prescribing is often excessive, but the differences in opioid prescribing between teaching hospitals and nonteaching hospitals is not well understood. Given the workload of surgical training and frequent turnover of prescribers on surgical services, we hypothesized that postoperative opioid prescribing would be higher among teaching compared with nonteaching hospitals. STUDY DESIGN We used insurance claims from a statewide quality collaborative in Michigan to identify 17,075 opioid-naïve patients who underwent 22 surgical procedures across 76 hospitals from 2012 to 2016. Our outcomes included the following: (1) the amount of opioid prescribed for the initial postoperative prescription in oral morphine equivalents and (2) high-risk prescribing in the 30 days after surgery (high daily dose [≥ 100 oral morphine equivalents], new long-acting/extended-release opioid, overlapping prescriptions, or concurrent benzodiazepine prescription). Teaching hospital status was obtained from the 2014 American Hospital Association survey. Multilevel regression was used to adjust for patient and procedural factors and to perform reliability adjustment. RESULTS The amount of opioid prescribed per initial opioid prescription varied 4.7-fold across all hospitals from 130 oral morphine equivalents to 616 oral morphine equivalents. Patients discharged from teaching hospitals filled larger initial opioid prescriptions overall compared with nonteaching hospitals (251 oral morphine equivalents versus 232 oral morphine equivalents; P = .026). Teaching hospitals had higher risk-adjusted rates of high-risk prescribing compared with nonteaching hospitals (13.7% vs 10.3%; P = .034). CONCLUSION In Michigan, surgical patients discharged from teaching hospitals received significantly larger postoperative opioid prescriptions and had higher rates of high-risk prescribing compared with nonteaching hospitals. All hospitals, and particularly teaching institutions, should ensure that adequate resources are devoted to facilitating safe postoperative opioid prescribing.
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Affiliation(s)
- David C Cron
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Charles Hwang
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Hsou M Hu
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Jay S Lee
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - James M Dupree
- Department of Urology, University of Michigan Medical School, Ann Arbor
| | - John D Syrjamaki
- Department of Urology, University of Michigan Medical School, Ann Arbor
| | - Kevin C Chung
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | | | - Jennifer F Waljee
- Department of Surgery, University of Michigan Medical School, Ann Arbor.
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Kirk PS, Borza T, Dupree JM, Wei JT, Ellimoottil C, Caram MEV, Burkhardt M, Heidelbaugh JJ, Hollenbeck BK, Skolarus TA. Potential Savings in Medicare Part D for Common Urological Conditions. Urol Pract 2018; 5:351-359. [PMID: 30555855 DOI: 10.1016/j.urpr.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Millions of patients take prescription medications each year for common urological conditions. Generic and brand-name drugs have widely divergent pricing despite similar therapeutic benefit and side effect profiles. We examined prescribing patterns across provider types for generic and brand-name drugs used to treat 3 common urological conditions, and estimated economic implications for Medicare Part D spending. Methods We extracted 2014 prescription claims and payments from Medicare Part D and categorized oral medications used to treat 3 urological conditions, namely benign prostatic hyperplasia, erectile dysfunction and overactive bladder. We examined claims and payments for each medication among urologists and nonurologists. Lastly, we estimated potential savings by selecting a low cost or generic drug as a cost comparator for each class. Results There were significant differences in prescribing patterns across these conditions, with urologists prescribing more brand-name and expensive medications (p <0.001). The total potential savings related to prescriptions of more expensive and nongeneric drugs in 2014 was $1 billion (benign prostatic hyperplasia $348,454,910, erectile dysfunction $10,211,914 and overactive bladder $698,130,833). These potential savings comprised 53% of the total spending for these medications in 2014. Conclusions Within Medicare Part D the potential savings associated with generic substitution for higher cost and nongeneric drugs for 3 common urological conditions surpassed $1 billion, with urologists more likely to prescribe brand-name and more expensive drugs. Increasing low cost and generic drug use where available evidence of efficacy is equivocal represents a promising policy target to optimize prescription drug spending.
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Affiliation(s)
- Peter S Kirk
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Tudor Borza
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - John T Wei
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Megan E V Caram
- Division of Hematology & Oncology, Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Mary Burkhardt
- University of Michigan Health System, Pharmacy Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Joel J Heidelbaugh
- Department of Family Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Ted A Skolarus
- Dow Division of Health Services Research, Department of Urology VA Ann Arbor Healthcare System, Ann Arbor, Michigan, VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Brescia AA, Syrjamaki JD, Regenbogen SE, Paone G, Pruitt AL, Shannon FL, Boeve TJ, Patel HJ, Thompson MP, Theurer PF, Dupree JM, Kim KM, Prager RL, Likosky DS. Transcatheter Versus Surgical Aortic Valve Replacement Episode Payments and Relationship to Case Volume. Ann Thorac Surg 2018; 106:1735-1741. [PMID: 30179625 DOI: 10.1016/j.athoracsur.2018.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/15/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has increased in volume as an alternative to surgical aortic valve replacement (SAVR). Comparisons of total episode expenditures, although largely ignored thus far, will be key to the value proposition for payers. METHODS We evaluated 6,359 Blue Cross Blue Shield of Michigan and Medicare fee-for-service beneficiaries undergoing TAVR (17 hospitals, n = 1,655) or SAVR (33 hospitals, n = 4,704) in Michigan between 2012 and 2016. Payments through 90 post-discharge days between TAVR and SAVR were price-standardized and risk-adjusted. Centers were divided into terciles of procedural volume separately for TAVR and SAVR, and payments were compared between lowest and highest terciles. RESULTS Payments (± SD) were higher for TAVR than SAVR ($69,388 ± $22,259 versus $66,683 ± $27,377, p < 0.001), while mean hospital length of stay was shorter for TAVR (6.2 ± 5.6 versus 10.2 + 7.5 days, p < 0.001). Index hospitalization payments were $4,374 higher for TAVR (p < 0.001), whereas readmission and post-acute care payments were $1,150 (p = 0.001) and $739 (p = 0.004) lower, respectively, and professional payments were similar. For SAVR, high-volume centers had lower episode payments (difference: 5.0%, $3,255; p = 0.01) and shorter length of stay (10.0 ± 7.5 versus 11.1 ± 7.9 days, p = 0.002) than low volume centers. In contrast, we found no volume-payment relationship among TAVR centers. CONCLUSIONS Episode payments were higher for TAVR, despite shorter length of stay. Although not a driver for TAVR, center SAVR volume was inversely associated with payments. These data will be increasingly important to address value-based reimbursement in valve replacement surgery.
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Affiliation(s)
| | - John D Syrjamaki
- Michigan Value Collaborative, Ann Arbor, Michigan; Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Scott E Regenbogen
- Michigan Value Collaborative, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gaetano Paone
- Henry Ford Hospital Division of Cardiac Surgery, Detroit, Michigan
| | - Andrew L Pruitt
- Michigan Heart and Vascular Institute, St. Joseph Mercy Hospital, Ann Arbor, Michigan
| | - Francis L Shannon
- Division of Cardiovascular Surgery, Beaumont Health, Royal Oak, Michigan
| | - Theodore J Boeve
- Section of Cardiac Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Michael P Thompson
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Value Collaborative, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - James M Dupree
- Michigan Value Collaborative, Ann Arbor, Michigan; Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan.
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Kaye DR, Ye Z, Li J, Herrel LA, Dupree JM, Ellimoottil C, Miller DC. The Stability of Physician-Specific Episode Costs for Urologic Cancer Surgery: Implications for Urologists Under the Merit-Based Incentive Program. Urology 2018; 123:114-119. [PMID: 30125647 DOI: 10.1016/j.urology.2018.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/05/2018] [Accepted: 04/27/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the stability of physician-specific episode payments for prostatectomy, nephrectomy, and cystectomy in the context of value-based purchasing programs, such as the merit-based incentive payment system. METHODS We utilized Surveillance, Epidemiology and End Results-Medicare data to identify patients aged 66-99 who underwent a prostatectomy, nephrectomy, or cystectomy from 2008 to 2012. We calculated each surgeon's average 90-day episode payment by procedure. Next, we examined payment differences between the most and least expensive quartile providers. For the most expensive quartile of physicians in 2010, we examined their spending quartile in 2011. Finally, we evaluated the correlation in spending over time and across procedures. RESULTS We identified 14,585 patients who underwent surgery by one of 1895 unique clinicians. Differences in payments between the highest and lowest quartiles were $5881, $17,714, and $40,288 for prostatectomy, nephrectomy, and cystectomy, respectively. Only 39%, 16%, and 13% of physicians that were in the highest spending quartile for prostatectomy, nephrectomy, and cystectomy in 2010 were also in the most expensive quartile in 2011. Although we observed weak correlation in year-to-year spending for prostatectomy (0.108, P = .033 to .270, P < .001), annual payments for nephrectomy and cystectomy were not significantly correlated. Finally, there was minimal correlation in surgeon spending across procedures. CONCLUSION There is wide variation in physician-specific episode payments for prostatectomy, nephrectomy, and cystectomy. However, physician spending patterns are not stable over time or across procedures, raising concerns about the ability of the cost-based measures in merit-based incentive payment system to change physician behavior and reliably distinguish those providing less efficient or lower quality care.
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Affiliation(s)
- Deborah R Kaye
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Zaojun Ye
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Jonathan Li
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - David C Miller
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
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Kahn EN, Ellimoottil C, Dupree JM, Park P, Ryan AM. Variation in payments for spine surgery episodes of care: implications for episode-based bundled payment. J Neurosurg Spine 2018; 29:214-219. [DOI: 10.3171/2017.12.spine17674] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESpine surgery is expensive and marked by high variation across regions and providers. Bundled payments have potential to reduce unwarranted spending associated with spine surgery. This study is a cross-sectional analysis of commercial and Medicare claims data from January 2012 through March 2015 in the state of Michigan. The objective was to quantify variation in payments for spine surgery in adult patients, document sources of variation, and determine influence of patient-level, surgeon-level, and hospital-level factors.METHODSHierarchical regression models were used to analyze contributions of patient-level covariates and influence of individual surgeons and hospitals. The primary outcome was price-standardized 90-day episode payments. Intraclass correlation coefficients—measures of variability accounted for by each level of a hierarchical model—were used to quantify sources of spending variation.RESULTSThe authors analyzed 17,436 spine surgery episodes performed by 195 surgeons at 50 hospitals. Mean price-standardized 90-day episode payments in the highest spending quintile exceeded mean payments for episodes in the lowest cost quintile by $42,953 (p < 0.001). Facility payments for index admission and post-discharge payments were the greatest contributors to overall variation: 39.4% and 32.5%, respectively. After accounting for patient-level covariates, the remaining hospital-level and surgeon-level effects accounted for 2.0% (95% CI 1.1%–3.8%) and 4.0% (95% CI 2.9%–5.6%) of total variation, respectively.CONCLUSIONSSignificant variation exists in total episode payments for spine surgery, driven mostly by variation in post-discharge and facility payments. Hospital and surgeon effects account for relatively little of the observed variation.
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Affiliation(s)
- Elyne N. Kahn
- 1Institute for Healthcare Policy and Innovation,
- 2Department of Neurosurgery,
| | - Chandy Ellimoottil
- 1Institute for Healthcare Policy and Innovation,
- 3Department of Urology, and
| | - James M. Dupree
- 1Institute for Healthcare Policy and Innovation,
- 3Department of Urology, and
| | - Paul Park
- 1Institute for Healthcare Policy and Innovation,
- 2Department of Neurosurgery,
| | - Andrew M. Ryan
- 1Institute for Healthcare Policy and Innovation,
- 4Department of Health Management and Policy/School of Public Health, University of Michigan, Ann Arbor, Michigan
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Modi PK, Kaufman SR, Qi J, Lane BR, Cher ML, Miller DC, Hollenbeck BK, Shahinian VB, Dupree JM. National Trends in Active Surveillance for Prostate Cancer: Validation of Medicare Claims-based Algorithms. Urology 2018; 120:96-102. [PMID: 29990573 DOI: 10.1016/j.urology.2018.06.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To better describe the real-world use of active surveillance. Active surveillance is a preferred management option for low-risk prostate cancer, yet its use outside of high-volume institutions is poorly understood. We created multiple claims-based algorithms, validated them using a robust clinical registry, and applied them to Medicare claims to describe national utilization. MATERIALS AND METHODS We identified men with prostate cancer from 2012-2014 in a 100% sample of Michigan Medicare data and linked them with the Michigan Urologic Surgery Improvement Collaborative (MUSIC) registry. Using MUSIC treatment assignment as the standard, we determined the performance of 8 claims-based algorithms to identify men on active surveillance. We selected 3 algorithms (the most sensitive, the most specific, and a balanced algorithm incorporating age and comorbidity) and applied them to a 20% national Medicare sample to describe national trends. RESULTS We identified 1186 men with incident prostate cancer and completely linked data. Eight algorithms were tested with sensitivity ranging from 23.5% to 88.2% and specificity ranging from 93.5% to 99.1%. We found that the use of surveillance for men with incident prostate cancer increased from 2007 to 2014, nationally. However, among all men in the population, there was a large decrease in the rate of prostate cancer diagnosis and an increased or stable rate in the use of active surveillance, depending on the algorithm used. Less than 25% of men on active surveillance underwent a confirmatory prostate biopsy. CONCLUSION We describe the performance of claims-based algorithms to identify active surveillance.
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Affiliation(s)
- Parth K Modi
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Ji Qi
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Brian R Lane
- Urologic Oncology, Spectrum Health, Grand Rapids, MI.
| | - Michael L Cher
- Department of Urology, Wayne State University, Detroit, MI.
| | - David C Miller
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI.
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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Dupree JM. How might centralization of male factor infertility care impact patients and residents? Fertil Steril 2018; 110:56. [PMID: 29980262 DOI: 10.1016/j.fertnstert.2018.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
- James M Dupree
- Department of Urology, Division of Andrology, Division of Health Services Research, University of Michigan, Ann Arbor, Michigan
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Abstract
Infertility is a disease, and the male partner plays a role in approximately 50% of infertility cases. For most patients, infertility care does not receive insurance coverage like other diseases, leaving them to pay out of pocket for their treatments. Because of the lack of insurance coverage, evaluations and treatments are expensive for patients, with costs often approaching the median annual US income. These increased costs reduce access to care and limit the ability to diagnose the cause of infertility, treat the underlying causes, and downgrade the intensity of the intervention needed to achieve the pregnancy. This leaves much of the burden for infertility care on the female partner. In an ideal health care system, evaluations and interventions for male infertility would receive the same insurance coverage as evaluations and interventions for other diseases.
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Affiliation(s)
- James M. Dupree
- Division of Andrology, Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI 48109-5330, USA
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Modi PK, Wang Y, Kirk PS, Dupree JM, Singer EA, Chang SL. The Receipt of Industry Payments is Associated With Prescribing Promoted Alpha-blockers and Overactive Bladder Medications. Urology 2018; 117:50-56. [PMID: 29680480 PMCID: PMC6005747 DOI: 10.1016/j.urology.2018.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/20/2018] [Accepted: 04/05/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the impact of physicians' financial relationships with the pharmaceutical industry on prescribing marketed alpha-blockers and overactive bladder (OAB) medications. We also aim to examine if the number or total value of transactions is influential. MATERIALS AND METHODS We linked the Open Payments Program database of industry payments to prescribers with Medicare Part D prescription data. We used binomial logistic regression to identify the association between receipt of industry payment and prescribing of marketed alpha-blockers (silodosin) and OAB medications (fesoterodine, solifenacin, and mirabegron). We also evaluated the impact of increasing total value and number of payments on prescribing of marketed drugs. RESULTS The receipt of industry payment was associated with increased odds of prescribing the marketed drug for all included drugs: silodosin (odds ratio [OR] 34.1), fesoterodine (OR 5.9), solifenacin (OR 2.7), and mirabegron (OR 6.8) (all P <.001). We also found that increasing value of total payment and increasing frequency of payments were both independently associated with increased odds of prescribing with a dose-response effect. CONCLUSION There is a consistent association between receipt of industry payment and prescribing marketed alpha-blockers and OAB medications. Both the total value and number of transactions were associated with prescribing.
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Affiliation(s)
- Parth K Modi
- Department of Urology, Dow Division of Health Services Research, Michigan Medicine, Ann Arbor, MI.
| | - Ye Wang
- Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Peter S Kirk
- Department of Urology, Dow Division of Health Services Research, Michigan Medicine, Ann Arbor, MI
| | - James M Dupree
- Department of Urology, Dow Division of Health Services Research, Michigan Medicine, Ann Arbor, MI
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Steven L Chang
- Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
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Andino JJ, Shah PK, Roberts WW, Weizer AZ, Dupree JM, Morgan TM, Mukundi SG, Ellimoottil C. MP51-05 THE IMPACT OF VIDEO VISITS ON MEASURES OF CLINICAL EFFICIENCY AND REIMBURSEMENT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Herrel L, Kaye D, Min A, Ellimoottil C, Dupree JM, Miller D. MP76-04 ACCOUNTABLE CARE ORGANIZATIONS AND THE COST AND QUALITY OF UROLOGICAL CANCER CARE AT THE END OF LIFE. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Using SEER‐Medicare data, this article demonstrates that considerable differences exist in expenditures across phases of care and varying patient characteristics. These findings can help to provide a better understanding of the drivers of payment variation across patient and tumor characteristics to inform efforts to decrease costs and increase quality of cancer care. Purpose. The aim of this study was to estimate Medicare payments for cancer care during the initial, continuing, and end‐of‐life phases of care for 10 malignancies and to examine variation in expenditures according to patient characteristics and cancer severity. Materials and Methods. We used linked Surveillance, Epidemiology and End Results‐Medicare data to identify patients aged 66–99 years who were diagnosed with one of the following 10 cancers: prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian, from 2007 through 2012. We attributed payments for each patient to a phase of care (i.e., initial, continuing, or end of life), based on time from diagnosis until death or end of study interval. We summed payments for all claims attributable to the primary cancer diagnosis and analyzed the overall and phase‐based costs and then by differing demographics, cancer stage, geographic region, and year of diagnosis. Results. We identified 428,300 patients diagnosed with one of the 10 malignancies. Annual payments were generally highest during the initial phase. Mean expenditures across cancers were $14,381 during the initial phase, $2,471 for continuing, and $13,458 at end of life. Payments decreased with increasing age. Black patients had higher payments for four of five cancers with statistically significant differences. Stage III cancers posed the greatest annual cost burden for four cancer types. Overall payments were stable across geographic region and year. Conclusion. Considerable differences exist in expenditures across phases of cancer care. By understanding the drivers of such payment variations across patient and tumor characteristics, we can inform efforts to decrease payments and increase quality, thereby reducing the burden of cancer care. Implications for Practice. Considerable differences exist in expenditures across phases of cancer care. There are further differences by varying patient characteristics. Understanding the drivers of such payment variations across patient and tumor characteristics can inform efforts to decrease costs and increase quality, thereby reducing the burden of cancer care.
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Affiliation(s)
- Deborah R Kaye
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hye Sung Min
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - David C Miller
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Kaye DR, Min HS, Norton EC, Ye Z, Li J, Dupree JM, Ellimoottil C, Miller DC, Herrel LA. System-Level Health-Care Integration and the Costs of Cancer Care Across the Disease Continuum. J Oncol Pract 2018; 14:e149-e157. [PMID: 29443647 DOI: 10.1200/jop.2017.027730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Policy reforms in the Affordable Care Act encourage health care integration to improve quality and lower costs. We examined the association between system-level integration and longitudinal costs of cancer care. METHODS We used linked SEER-Medicare data to identify patients age 66 to 99 years diagnosed with prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian cancer from 2007 to 2012. We attributed each patient to one or more phases of care (ie, initial, continuing, and end of life) according to time from diagnosis until death or end of study interval. For each phase, we aggregated all claims with the primary cancer diagnosis and identified patients treated in an integrated delivery network (IDN), as defined by the Becker Hospital Review list of the top 100 most integrated health delivery systems. We then determined if care provided in an IDN was associated with decreased payments across cancers and for each individual cancer by phase and across phases. RESULTS We identified 428,300 patients diagnosed with one of 10 common cancers. Overall, there were no differences in phase-based payments between IDNs and non-IDNs. Average adjusted annual payments by phase for IDN versus non-IDNs were as follows: initial, $14,194 versus $14,421, respectively ( P = .672); continuing, $2,051 versus $2,099 ( P = .566); and end of life, $16,257 versus $16,232 ( P = .948). However, in select cancers, we observed lower payments in IDNs. For bladder cancer, payments at the end of life were lower for IDNs ($11,041 v $12,331; P = .008). Of the four cancers with the lowest 5-year survival rates (ie, pancreatic, lung, esophageal, and liver), average expenditures during the initial and continuing-care phases were lower for patients with liver cancer treated in IDNs. CONCLUSION For patients with one of 10 common malignancies, treatment in an IDN generally is not associated with lower costs during any phase of cancer care.
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Affiliation(s)
| | - Hye Sung Min
- All authors: University of Michigan, Ann Arbor, MI
| | | | - Zaojun Ye
- All authors: University of Michigan, Ann Arbor, MI
| | - Jonathan Li
- All authors: University of Michigan, Ann Arbor, MI
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Guduguntla V, Syrjamaki JD, Ellimoottil C, Miller DC, Prager RL, Norton EC, Theurer P, Likosky DS, Dupree JM. Drivers of Payment Variation in 90-Day Coronary Artery Bypass Grafting Episodes. JAMA Surg 2018; 153:14-19. [PMID: 28832865 PMCID: PMC5833620 DOI: 10.1001/jamasurg.2017.2881] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/02/2017] [Indexed: 11/14/2022]
Abstract
Importance Coronary artery bypass grafting (CABG) is scheduled to become a mandatory Medicare bundled payment program in January 2018. A contemporary understanding of 90-day CABG episode payments and their drivers is necessary to inform health policy, hospital strategy, and clinical quality improvement activities. Furthermore, insight into current CABG payments and their variation is important for understanding the potential effects of bundled payment models in cardiac care. Objective To examine CABG payment variation and its drivers. Design, Setting, and Participants This retrospective cohort study used Medicare and private payer claims to identify patients who underwent nonemergent CABG surgery from January 1, 2012, through October 31, 2015. Ninety-day price-standardized, risk-adjusted, total episode payments were calculated for each patient, and hospitals were divided into quartiles based on the mean total episode payments of their patients. Payments were then subdivided into 4 components (index hospitalization, professional, postacute care, and readmission payments) and compared across hospital quartiles. Seventy-six hospitals in Michigan representing a diverse set of geographies and practice environments were included. Main Outcomes and Measures Ninety-day CABG episode payments. Results A total of 5910 patients undergoing nonemergent CABG surgery were identified at 33 of the 76 hospitals; of these, 4344 (73.5%) were men and mean (SD) age was 68.0 (9.3) years. At the patient level, risk-adjusted, 90-day total episode payments for CABG varied from $11 723 to $356 850. At the hospital level, the highest payment quartile of hospitals had a mean total episode payment of $54 399 compared with $45 487 for the lowest payment quartile (16.4% difference, P < .001). The highest payment quartile hospitals compared with the lowest payment quartile hospitals had 14.6% higher index hospitalization payments ($34 992 vs $30 531, P < .001), 33.9% higher professional payments ($8060 vs $6021, P < .001), 29.6% higher postacute care payments ($7663 vs $5912, P < .001), and 35.1% higher readmission payments ($3576 vs $2646, P = .06). The drivers of this variation are diagnosis related group distribution, increased inpatient evaluation and management services, higher utilization of inpatient rehabilitation, and patients with multiple readmissions. Conclusions and Relevance Wide variation exists in 90-day CABG episode payments for Medicare and private payer patients in Michigan. Hospitals and clinicians entering bundled payment programs for CABG should work to understand local sources of variation, with a focus on patients with multiple readmissions, inpatient evaluation and management services, and postdischarge outpatient rehabilitation care.
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Affiliation(s)
- Vinay Guduguntla
- Medical Student, School of Medicine, University of Michigan, Ann Arbor
- Michigan Value Collaborative, University of Michigan, Ann Arbor
| | | | - Chad Ellimoottil
- Michigan Value Collaborative, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - David C. Miller
- Michigan Value Collaborative, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Richard L. Prager
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, University of Michigan, Ann Arbor
- Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan, Ann Arbor
- Section of Adult Cardiac Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor
| | - Edward C. Norton
- Michigan Value Collaborative, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Health Management and Policy, University of Michigan, Ann Arbor
- Department of Economics, University of Michigan, Ann Arbor
| | - Patricia Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, University of Michigan, Ann Arbor
| | - Donald S. Likosky
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan, Ann Arbor
| | - James M. Dupree
- Michigan Value Collaborative, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
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Li J, Ye Z, Dupree JM, Hollenbeck BK, Min HS, Kaye D, Herrel LA, Miller DC, Ellimoottil C. Association of Delivery System Integration and Outcomes for Major Cancer Surgery. Ann Surg Oncol 2017; 25:856-863. [PMID: 29285642 DOI: 10.1245/s10434-017-6312-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Integrated delivery systems (IDSs) are postulated to reduce spending and improve outcomes through successful coordination of care across multiple providers. Nonetheless, the actual impact of IDSs on outcomes for complex multidisciplinary care such as major cancer surgery is largely unknown. METHODS Using 2011-2013 Medicare data, this study identified patients who underwent surgical resection for prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, or ovarian cancer. Rates of readmission, 30-day mortality, surgical complications, failure to rescue, and prolonged hospital stay for cancer surgery were compared between patients receiving care at IDS hospitals and those receiving care at non-IDS hospitals. Generalized estimating equations were used to adjust results by cancer type and patient- and hospital-level characteristics while accounting for clustering of patients within hospitals. RESULTS The study identified 380,053 patients who underwent major resection of cancer, with 38% receiving care at an IDS. Outcomes did not differ between IDS and non-IDS hospitals regarding readmission and surgical complication rates, whereas only minor differences were observed for 30-day mortality (3.5% vs 3.2% for IDS; p < 0.001) and prolonged hospital stay (9.9% vs 9.2% for IDS; p < 0.001). However, after adjustment for patient and hospital characteristics, the frequencies of adverse perioperative outcomes were not significantly associated with IDS status. CONCLUSIONS The collective findings suggest that local delivery system integration alone does not necessarily have an impact on perioperative outcomes in surgical oncology. Moving forward, stakeholders may need to focus on surgical and oncology-specific methods of care coordination and quality improvement initiatives to improve outcomes for patients undergoing cancer surgery.
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Affiliation(s)
- Jonathan Li
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Zaojun Ye
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - James M Dupree
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Brent K Hollenbeck
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Hye Sung Min
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Deborah Kaye
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Lindsey A Herrel
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - David C Miller
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Chad Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. .,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Ohl DA, Dupree JM, Jensen CFS. Editorial Comment. J Urol 2017; 199:821. [PMID: 29272709 DOI: 10.1016/j.juro.2017.11.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dana A Ohl
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - James M Dupree
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Christian F S Jensen
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Jensen CFS, Khan O, Sønksen J, Fode M, Dupree JM, Shah T, Ohl DA. Comparison of semen quality between university-based and private assisted reproductive technology laboratories. Scand J Urol 2017; 52:65-69. [PMID: 29191079 DOI: 10.1080/21681805.2017.1409264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Obtaining a semen analysis (SA) is an essential step in evaluating infertile men. Despite using standardized procedures for analysis semen quality in the same individual often varies on repeated tests. The objective of this study was to investigate inter-laboratory variation in semen quality between private- and university-based assisted reproductive technology (ART) laboratories. MATERIALS AND METHODS IRB approval was obtained to retrospectively evaluate men with a SA at both the private- and university-based ART laboratories. When more than one SA was available from either laboratory, the first at each laboratory was selected for analysis. Comparison of major semen parameters was performed using descriptive statistics and Bland-Altman plots, with differences tested using Wilcoxon-signed rank test. RESULTS Twenty-eight men aged 33 ± 5 (mean ± SD) years were included in the study. Motility was higher at the private laboratories compared to the university-based laboratory (Median difference -12.5%, 95% confidence interval -20.3%; -5.5%). Percent normal morphology was higher at the university-based laboratory compared to private laboratories (5.0%, 3.6%; 6.9%). No significant differences were found in volume, concentration and total motile sperm count although the Bland-Altman plot bias for concentration was clinically significant (15.9 × 106/ml). CONCLUSIONS In this small series, motility was significantly higher at private laboratories compared to a university-based laboratory but was above WHO reference limits at both places. Normal sperm morphology was significantly lower in semen analyses performed at private laboratories compared to a university-based laboratory and was below WHO reference limits.
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Affiliation(s)
- Christian Fuglesang S Jensen
- a Department of Urology , University of Michigan , Ann Arbor , MI , USA.,b Department of Urology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Omar Khan
- a Department of Urology , University of Michigan , Ann Arbor , MI , USA
| | - Jens Sønksen
- b Department of Urology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Mikkel Fode
- b Department of Urology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - James M Dupree
- a Department of Urology , University of Michigan , Ann Arbor , MI , USA.,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA
| | - Tariq Shah
- c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA
| | - Dana A Ohl
- a Department of Urology , University of Michigan , Ann Arbor , MI , USA
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Song C, Sukul D, Seth M, Dupree JM, Khandelwal A, Dixon SR, Wohns D, LaLonde T, Gurm HS. Ninety-Day Readmission and Long-Term Mortality in Medicare Patients (≥65 Years) Treated With Ticagrelor Versus Prasugrel After Percutaneous Coronary Intervention (from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium). Am J Cardiol 2017; 120:1926-1932. [PMID: 29025684 DOI: 10.1016/j.amjcard.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 11/27/2022]
Abstract
Ticagrelor and prasugrel were found to be superior to clopidogrel for the treatment of acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI); however, the comparative effectiveness of these 2 drugs remains unknown. We compared postdischarge outcomes among older patients treated with ticagrelor versus prasugrel after PCI for ACS. We linked clinical data from PCIs performed in older patients (age ≥65) for ACS at 47 Michigan hospitals to Medicare fee-for-service claims from January 1, 2013, to December 31, 2014, to ascertain rates of 90-day readmission and long-term mortality. We used propensity score matching to adjust for the nonrandom use of ticagrelor and prasugrel at discharge. Logistic regression and Cox proportional hazards models were used to compare rates of 90-day readmission and long-term mortality, respectively. Patients discharged on ticagrelor (n = 1,243) were more frequently older, female, had a history of cerebrovascular disease, and presented with ST- or non-ST-elevation myocardial infarction compared with prasugrel (n = 1,014). After matching (n = 756 per group), there were no significant differences in the rates of 90-day readmission (16.7% ticagrelor vs 14.6% prasugrel; adjusted odds ratio 1.15, 95% confidence interval 0.86 to 1.55, p = 0.35) or 1-year mortality (5.4% ticagrelor vs 3.7% prasugrel; hazard ratio 1.3, 95% confidence interval 0.8 to 2.2, p = 0.31). In conclusion, we found no significant differences in the rates of 90-day readmission or long-term mortality between older patients treated with ticagrelor and patients treated with prasugrel after PCI for ACS. In the absence of randomized data to the contrary, these 2 treatments appear similarly effective.
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Khouri RK, Hou H, Dhir A, Andino JJ, Dupree JM, Miller DC, Ellimoottil C. What is the impact of a clinically related readmission measure on the assessment of hospital performance? BMC Health Serv Res 2017; 17:781. [PMID: 29179718 PMCID: PMC5704581 DOI: 10.1186/s12913-017-2742-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 11/17/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Hospital Readmission Reduction Program (HRRP) penalizes hospitals for high all-cause unplanned readmission rates. Many have expressed concern that hospitals serving patient populations with more comorbidities, lower incomes, and worse self-reported health status may be disproportionately penalized by readmissions that are not clinically related to the index admission. The impact of including clinically unrelated readmissions on hospital performance is largely unknown. We sought to determine if a clinically related readmission measure would significantly alter the assessment of hospital performance. METHODS We analyzed Medicare claims for beneficiaries in Michigan admitted for pneumonia and joint replacement from 2011 to 2013. We compared each hospital's 30-day readmission rate using specifications from the HRRP's all-cause unplanned readmission measure to values calculated using a clinically related readmission measure. RESULTS We found that the mean 30-day readmission rates were lower when calculated using the clinically related readmission measure (joint replacement: all-cause 5.8%, clinically related 4.9%, p < 0.001; pneumonia: all cause 12.5%, clinically related 11.3%, p < 0.001)). The correlation of hospital ranks using both methods was strong (joint replacement: 0.95 (p < 0.001), pneumonia: 0.90 (p < 0.001)). CONCLUSIONS Our findings suggest that, while greater specificity may be achieved with a clinically related measure, clinically unrelated readmissions may not impact hospital performance in the HRRP.
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Affiliation(s)
- Roger K Khouri
- Dow Division of Health Services Research, Department of Urology, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.,Michigan Value Collaborative, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA
| | - Hechuan Hou
- Dow Division of Health Services Research, Department of Urology, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.,Michigan Value Collaborative, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA
| | - Apoorv Dhir
- Dow Division of Health Services Research, Department of Urology, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.,Michigan Value Collaborative, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA
| | - Juan J Andino
- Dow Division of Health Services Research, Department of Urology, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.,Michigan Value Collaborative, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.,University of Michigan's Ross School of Business, 701 Tappan Ave, Ann Arbor, MI, 48109, USA
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.,Michigan Value Collaborative, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.,U-M Institute for Healthcare Policy & Innovation, North Campus Research Complex (NCRC), 2800 Plymouth Rd, Bldg 16, 1st Floor, Room 100S, Ann Arbor, MI, 48109-2800, USA
| | - David C Miller
- Dow Division of Health Services Research, Department of Urology, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.,Michigan Value Collaborative, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.,U-M Institute for Healthcare Policy & Innovation, North Campus Research Complex (NCRC), 2800 Plymouth Rd, Bldg 16, 1st Floor, Room 100S, Ann Arbor, MI, 48109-2800, USA
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA. .,Michigan Value Collaborative, North Campus Research Complex (NCRC), 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA. .,U-M Institute for Healthcare Policy & Innovation, North Campus Research Complex (NCRC), 2800 Plymouth Rd, Bldg 16, 1st Floor, Room 100S, Ann Arbor, MI, 48109-2800, USA.
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San Juan J, Hou H, Ghani KR, Dupree JM, Hollingsworth JM. Variation in Spending around Surgical Episodes of Urinary Stone Disease: Findings from Michigan. J Urol 2017; 199:1277-1282. [PMID: 29180300 DOI: 10.1016/j.juro.2017.11.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To help rein in surgical spending there is growing interest in the application of payment bundles to common outpatient procedures like ureteroscopy and shock wave lithotripsy. However, before urologists can move to such a payment system they need to know where episode costs are concentrated. MATERIALS AND METHODS Using claims data from Michigan Value Collaborative we identified patients who underwent ureteroscopy or shock wave lithotripsy at hospitals in Michigan from 2012 to 2015. We then totaled expenditures for all relevant services during the 30-day surgical episodes of these patients and categorized component payments (ie those for the index procedure, subsequent hospitalizations, professional services and postacute care). Finally we quantified the variation in total episode expenditures for ureteroscopy and shock wave lithotripsy across hospitals, examining drivers of this variation. RESULTS A total of 9,449 ureteroscopy and 6,446 shock wave lithotripsy procedures were performed at 62 hospitals. Among these hospitals there was threefold variation in ureteroscopy and shock wave lithotripsy spending. The index procedure accounted for the largest payment difference between high vs low cost hospitals (ureteroscopy $7,936 vs $4,995 and shock wave lithotripsy $4,832 vs $3,207, each p <0.01), followed by payments for postacute care (ureteroscopy $2,207 vs $1,711 and shock wave lithotripsy $2,138 vs $1,104, each p <0.01). Across hospitals the index procedure explained 68% and 44% of the variation in episode spending for ureteroscopy and shock wave lithotripsy, and postacute care payments explained 15% and 28%, respectively. CONCLUSIONS There exists substantial variation in ambulatory surgical spending across Michigan hospitals for urinary stone episodes. Most of this variation can be explained by payment differences for the index procedure and for postacute care services.
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Affiliation(s)
- Juan San Juan
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Hechuan Hou
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Khurshid R Ghani
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - James M Dupree
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - John M Hollingsworth
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan.
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