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Golan R, North A, Kraft KH, Modi PK, Meeks W, Helsel A, Galen E, Harris AM. Exploring the Demands of Urology: On-Call Compensation, Frequency, and Variability. Urol Pract 2024; 11:569-574. [PMID: 38526389 DOI: 10.1097/upj.0000000000000542] [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: 09/14/2023] [Accepted: 01/25/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION We investigate and analyze the available information regarding on-call patterns among urologists in the US. METHODS The AUA Workforce Workgroup collaborated with the AUA Data Team to analyze information from the 2022 AUA Census. Extracted data were analyzed to identify variability across gender, subspecialty, hours worked per week, AUA section, salary, and practice setting. We used χ2 tests to compare the groups with respect to each factor and defined statistical significance as a P value less than .05. RESULTS There were significant differences by gender and several other on-call factors including being required to take call to maintain hospital privileges (reported by 76% of female urologists vs 67% of male urologists; P = .026), getting paid for weekend call (28% of females vs 38% of males; P = .030), and making over $500 per day when taking weekend call (18% of females vs 32% of males; P < .001). Other differences existed between AUA sections in percentage of physicians receiving over $500 for weekday or weekend calls (P < .001). Lastly, practice setting differed in likelihood of being paid over $500 for weekday call (44% reported by private practice urologists, 7% reported by academic urologists, 14% reported by institutional urologists; P < .001). CONCLUSIONS These results underscore the substantial variability in on-call responsibilities and structure within the AUA workforce. Further research and regular participation in future censuses are recommended to continue to characterize these trends.
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Affiliation(s)
- Roei Golan
- Florida State University College of Medicine, Tallahassee, Florida
| | - Amanda North
- Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Parth K Modi
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois
| | - William Meeks
- American Urological Association, Linthicum, Maryland
| | - Alexis Helsel
- American Urological Association, Linthicum, Maryland
| | - Emily Galen
- American Urological Association, Linthicum, Maryland
| | - Andrew M Harris
- Department of Urology, University of Kentucky Medical Center, Lexington, Kentucky
- Lexington VA Medical Center, Lexington, Kentucky
- Veterans Health Administration, Lexington, Kentucky
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Hyman MJ, Skolarus TA, Cabral J, Shewmon K, Bedziner M, Agarwal PK, Modi PK. Utilization and Timing of Cystoscopy for Hematuria Evaluation by Advanced Practice Providers and Urologists. Urology 2024:S0090-4295(24)00291-7. [PMID: 38663584 DOI: 10.1016/j.urology.2024.04.021] [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: 02/28/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To characterize differences between urologists and advanced practice providers (APPs) in the utilization of cystoscopy for hematuria. METHODS We identified patients initially evaluated for hematuria by a urologist or urology APP between 2015 and 2020 in the MarketScan Research Databases. We determined whether they received a cystoscopy within 6 months of their urology visit and the number of days until cystoscopy. We used multivariable regression to analyze the association between these outcomes and whether the urology clinician was an advanced practice registered nurse (APRN), physician assistant (PA), or urologist. RESULTS We identified 34,470 patients with microscopic hematuria and 17,328 patients with gross hematuria. Patients evaluated by urologists more often received a same-day cystoscopy than those evaluated by APPs (13% vs 5.8%). The odds that patients evaluated for microscopic and gross hematuria received a cystoscopy were 46.2% and 26.2% lower, respectively, if they were evaluated by an APRN vs a urologist. Patients seeing an APRN for microscopic and gross hematuria also waited approximately 7 and 14 days longer for their cystoscopy, respectively. No differences were observed for patients evaluated by PAs vs urologists. CONCLUSION Patients evaluated for hematuria by an APRN were less likely to receive a cystoscopy and had a longer wait until the procedure compared to those evaluated by a urologist; however, no differences were observed between PAs and urologists. Better understanding APP integration into urology clinics is warranted.
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Affiliation(s)
- Max J Hyman
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, IL
| | - Ted A Skolarus
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
| | - Joshua Cabral
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
| | - Kate Shewmon
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
| | - Moshe Bedziner
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
| | - Piyush K Agarwal
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
| | - Parth K Modi
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL.
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Johnson EK, Hyman MJ, Hardy C, Maizels M, Seager CM, Matoka DJ, Liu DB, Gong EM, Holl JL, Modi PK. Growth in Newborn Circumcisions Performed by Pediatric Urologists and Advanced Practice Providers Between 2010 and 2021 in the United States. Urology 2024; 184:206-211. [PMID: 37979701 DOI: 10.1016/j.urology.2023.10.033] [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: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade. METHODS The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year. Simple linear regression assessed growth in proportion of newborn circumcisions performed by pediatric urologists and APPs (nurse practitioner/physician assistant/midwife), over time. RESULTS In total, 1,006,748 newborn circumcisions (59% inpatient) were identified; while most were performed by obstetricians (45%) or pediatricians (33%); APPs performed 0.9%, and pediatric urologists performed 0.7%. From 2010-2021, the proportion of newborn circumcisions performed by pediatric urologists increased from 0.3% to 2.0% and by APPs in from 0.5% to 2.9% (P < .001 for both). Growth for both pediatric urologists and APPs occurred APPs predominantly from 2016 to 2021. Trends in proportion of newborn circumcision performed by pediatricians was stable [31.5% (2010) and 32.5% (2021)], but decreased for obstetricians [48.8% (2014) and 38.1% (2021)]. CONCLUSION The proportion of newborn circumcisions performed by pediatric urologists and APPs increased more than 6-fold between 2010 and 2021, though both specialties still perform a minority of newborn circumcisions. These data provide important baseline information for newborn circumcision workforce planning, including evaluating collaborative care models where pediatric urologists train APPs to perform circumcision.
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Affiliation(s)
- Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Max J Hyman
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, IL
| | - Camille Hardy
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Max Maizels
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Catherine M Seager
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Derek J Matoka
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dennis B Liu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edward M Gong
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane L Holl
- Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL
| | - Parth K Modi
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
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Nusbaum DJ, Sidana A, Modi PK. Editorial Comment. J Urol 2024; 211:213. [PMID: 38033174 DOI: 10.1097/ju.0000000000003788.01] [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] [Received: 08/15/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Affiliation(s)
- David J Nusbaum
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Abhinav Sidana
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Parth K Modi
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois
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Polcari K, Hyman MJ, Skolarus TA, Sales AE, Meltzer DO, Modi PK. Industry Payments for Vibegron and Prescribing Patterns Among Urologic Clinicians. JAMA Health Forum 2023; 4:e234020. [PMID: 38127590 PMCID: PMC10739068 DOI: 10.1001/jamahealthforum.2023.4020] [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: 06/23/2023] [Accepted: 09/18/2023] [Indexed: 12/23/2023] Open
Abstract
This cross-sectional study compares the prescribing practices among urologists and advanced practice clinicians who received vs did not receive payment from drug manufacturers.
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Affiliation(s)
- Kayla Polcari
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Max J. Hyman
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | - Ted A. Skolarus
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Anne E. Sales
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Family and Community Medicine, University of Missouri, Columbia
- Sinclair School of Nursing, University of Missouri School of Medicine, Columbia
| | - David O. Meltzer
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
- Department of Medicine and Economics, Harris School of Public Policy Studies, University of Chicago, Chicago, Illinois
| | - Parth K. Modi
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois
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Reed S, Singh A, Hyman MJ, Meltzer DO, Sales AE, Skolarus TA, Modi PK. Industry Payments to Urologists and Urologic Advanced Practice Providers in 2021. Urology 2023; 180:121-129. [PMID: 37517679 DOI: 10.1016/j.urology.2023.06.032] [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: 05/04/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To compare industry payments from drug and medical device companies to urologists and urologic advanced practice providers (APPs) in 2021. METHODS We used the 2020 Medicare Data on Provider Practice and Specialty file to identify single-specialty urology practices, defined as those where the majority of physicians were urologists. We then used the Open Payments Program Year 2021 data to summarize the value and number of industry payments to urologists and APPs, including nurse practitioners and physician assistants, in these practices. We calculated the total value and number of payments and median total value and number of payments per provider for urologists and urologic APPs. RESULTS We identified 4418 urologists and 1099 APPs working in single-specialty urology practices in 2021 (Table 1). Of these, 3646 (87%) urologists received at least one industry payment, totaling $14,755,003 from 116,039 payments, and 954 urologic APPs (87%) received at least one industry payment, including 463 nurse practitioners (85%), totaling $401,283 from 13,035 payments, and 491 physician assistants (89%), totaling $543,429 from 14,626 payments. We observed significantly greater median total value and number of payments per provider for urologists ($620 and 24 payments) compared to urologic APPs ($473 and 21 payments; P < .001 and P = .017, respectively). CONCLUSION A similar percentage of urologists and urologic APPs received industry payments in 2021. While urologists received a higher total number and total value of payments in 2021, urologic APPs were a common target of industry marketing payments.
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Affiliation(s)
| | - Armaan Singh
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Max J Hyman
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL
| | - David O Meltzer
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL
| | - Anne E Sales
- Sinclair School of Nursing, University of Missouri, Columbia, MO
| | - Ted A Skolarus
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Parth K Modi
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
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Stensland KD, Modi PK, Skolarus TA. Using Implementation Science to Improve Patient Care. J Urol 2023; 210:577-579. [PMID: 37578467 DOI: 10.1097/ju.0000000000003649] [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: 06/22/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Kristian D Stensland
- University of Michigan, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | - Ted A Skolarus
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Chicago, Chicago, Illinois
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Hyman MJ, Skolarus TA, Litwack K, Meltzer DO, Modi PK. Outcomes of Hematuria Evaluation by Advanced Practice Providers and Urologists. Urology 2023; 178:67-75. [PMID: 37196831 DOI: 10.1016/j.urology.2023.03.049] [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: 12/16/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To examine the quality and costs of care for patients evaluated for hematuria by urologic advanced practice providers (APPs) and urologists. The roles of APPs in urology are growing, but their clinical and financial outcomes compared to urologists are not well understood. METHODS We conducted a retrospective cohort study of commercially insured patients using data from 2014 to 2020. We included adult beneficiaries with a diagnosis code for hematuria and an initial outpatient evaluation and management visit with a urologic APP or urologist. We assessed receipt of cystoscopy procedure, imaging study, bladder biopsy procedure, and bladder cancer diagnosis within 6 months of the initial visit. Secondary outcomes included the time until each of these outcomes occurred and the out-of-pocket spending and total payments. RESULTS We identified 59,923 patients who were initially evaluated for hematuria. Visits with urologic nurse practitioners rather than urologists were associated with significantly lower odds of receiving cystoscopy procedures (odds ratio [OR] 0.93, 95% confidence interval [95% CI] 0.54-0.72, P < .001), imaging studies (OR 0.79, 95% CI 0.69-0.91, P < .001), and bladder biopsy procedures (OR 0.61, 95% CI 0.41-0.92, P = .02). Visits with urologic physician assistants were associated with 11% greater out-of-pocket payments (incident risk ratio 1.11, CI 1.01-1.22, P = .02) and 14% greater total payments (incident risk ratio 1.14, CI 1.04-1.25, P = .004). CONCLUSION There are clinical and financial differences in hematuria care delivered by urologic APPs and urologists. The incorporation of APPs into urologic care warrants further study, and specialty-specific training for APPs should be considered.
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Affiliation(s)
- Max J Hyman
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL
| | - Ted A Skolarus
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Kim Litwack
- College of Nursing, University of Wisconsin Milwaukee, Milwaukee, WI
| | - David O Meltzer
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL; Departments of Medicine and Economics, Harris School of Public Policy Studies, University of Chicago, Chicago, IL
| | - Parth K Modi
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL; Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
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Modi PK, Ward KC, Filson CP. Characteristics of prostate cancer patients captured by facility-based versus geography-based cancer registries. Urol Oncol 2023; 41:324.e1-324.e7. [PMID: 37150737 DOI: 10.1016/j.urolonc.2023.04.011] [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: 01/23/2023] [Revised: 03/15/2023] [Accepted: 04/09/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE We determined differences in demographics, tumor factors, and treatment patterns of prostate cancer patients in a geographic-based cancer registry based on eligibility for a facility-based cancer registry system. METHODS We identified prostate cancer patients captured by the Surveillance, Epidemiology, and End Results (SEER) database from 2018 to 2019. Our exposure was receipt of cancer care at a facility accredited by the American College of Surgeons' Commission on Cancer (CoC) providing eligibility for inclusion in the National Cancer Database (NCDB). Outcomes included patient demographics, tumor factors (e.g., biopsy grade), and treatment with radical prostatectomy. RESULTS We identified 113,733 prostate cancer patients of whom 65,708 (57%) were NCDB-eligible with an analytic abstract, and 11,010 (10%) were NCDB-eligible without an analytic abstract. NCDB-eligible men were younger (67.0 vs. 68.1 years, P < 0.001), less likely to be Hispanic/Latino (8.7% vs. 13.2%, P < 0.001), and more likely in a county with median income over $75,000 (40.9% vs. 30.0%, P < 0.001). NCDB eligibility varied widely by registry, from 95.9% in Connecticut to 42.6% in Utah. NCDB-ineligible patients were more likely to have unknown stage (17.2% vs. 2.9% NCDB-eligible) and missing PSA (22.9% vs 9.3% NCDB-eligible). NCDB-eligible men were less likely to have Grade Group 1 cancer on biopsy (28.2% vs. 39.2%, P < 0.001). Treatment with prostatectomy was more common among NCDB-eligible patients for low-risk (19.6% vs. 8.8%, adjusted OR 2.30, 95% CI 1.72-6.66) and high-risk tumors (43.5% vs. 26.0%, adjusted OR 1.95, 95% CI 1.33-2.86). CONCLUSION Compared NCDB-ineligible patients, those eligible for inclusion in the NCDB have important differences in demographics, eligibility for active surveillance, and treatment patterns. Generalizations related to epidemiologic trends, practice patterns, and outcomes for this select population should be interpreted with caution.
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Affiliation(s)
- Parth K Modi
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Christopher P Filson
- Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Department of Urology, Emory University School of Medicine, Atlanta, GA.
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Raheem OA, Xing MH, Cooper CA, Hyman MJ, Khera M, Modi PK. Reply by Authors. Urol Pract 2023; 10:326. [PMID: 37341370 DOI: 10.1097/upj.0000000000000402.02] [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] [Received: 12/27/2022] [Accepted: 03/07/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Monica H Xing
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Caleb A Cooper
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Max J Hyman
- The Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Parth K Modi
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
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Raheem OA, Xing MH, Cooper CA, Hyman MJ, Khera M, Modi PK. Increasing Role of the Advanced Practice Provider in Men's Health Clinics: An Analysis of Medicare and Commercial Claims in the United States. Urol Pract 2023:101097UPJ0000000000000402. [PMID: 37167418 DOI: 10.1097/upj.0000000000000402] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION As urologic care delivery in the U.S. continues to evolve to meet patient needs, we aim to clarify the role of Advanced Practice Providers (APPs) for publicly and privately insured patients in the treatment of male urologic conditions commonly encountered in men's health clinics. METHODS Medicare and commercial insurance claims from the Physician/Supplier Procedure Summary and Merative MarketScan Commercial Database, were queried for procedures submitted by APPs between 2010 and 2021. Common urologic conditions were identified using Current Procedural Terminology codes and grouped into 4 categories: testicular hypofunction, erectile dysfunction (ED) and Peyronie's disease (PD), benign prostatic hyperplasia (BPH), and scrotal pain. The proportion of procedures submitted by APPs was calculated for each year and category. RESULTS From 2010 to 2021, the proportion of APP submitted service counts for each condition within the MarketScan group increased up to 5-fold, with BPH representing the greatest growth. The proportion of APP submitted service counts within the Medicare group increased up to 8-fold, with ED/PD representing the greatest fold change. The proportion of claims submitted by APPs treating all 4 conditions were higher in 2021 than 2010 in both publicly and privately insured groups. CONCLUSIONS The role of APPs in men's urologic health is increasing for both privately and publicly insured patient populations. APPs play a critical role in urologic care and can help to improve access to men's health.
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Affiliation(s)
- Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Monica H Xing
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Caleb A Cooper
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Max J Hyman
- The Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Parth K Modi
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
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12
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Ho MD, Modi PK. Novel cryotherapy in non-muscle-invasive bladder cancer. Cancer 2023; 129:333-334. [PMID: 36477685 DOI: 10.1002/cncr.34560] [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] [Indexed: 12/12/2022]
Affiliation(s)
- Matthew D Ho
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Parth K Modi
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois, USA
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Abstract
OBJECTIVE To assess the effects of adding advanced practice providers to surgical practices on surgical complications, readmissions, mortality, episode spending, length of stay, and access to care. SUMMARY BACKGROUND DATA There has been substantial growth in the number of nurse practitioners and physician assistants (ie, advanced practice providers) in the United States. The extent to which advanced practice providers have been integrated into surgical practice, and their impact on surgical outcomes and access is unclear. METHODS Using a 20% sample of national Medicare claims, we performed a retrospective cohort study of fee-for-service beneficiaries undergoing one of 4 major procedures (coronary artery bypass graft, colectomy, major joint replacement, and cystectomy) between 2010 and 2016. We limited our study population for each procedure to patients treated by single-specialty surgical groups to ensure that the advanced practice providers have direct interactions with its surgeons and patients. All outcomes were measured at the practice level for the year before and the year after the addition of the first advanced practice provider. Outcomes included: complications, readmission, mortality, episode payments, length of stay. Models were adjusted for age, race, sex, comorbidity, socioeconomic class and procedure type. Secondary outcome: practice-level office visits by surgical group type. RESULTS The number of advanced practice providers increased by 13%, from 6713 to 7596 between 2010 and 2016. The largest relative increases occurred in general (46.9%) and urologic (27.6%) surgical practices. The year after an advanced practice provider was added to a surgical practice, the odds of complications were 17% and 16% lower at 30- and 90-days postprocedure, respectively. Additionally, 90-day readmissions were 18% less likely and length of stay was 0.33 days shorter (a 7.1% reduction). Average 30-day and90-day episode spending was $1294.73 and $1427.76 lower, respectively ( P < 0.001). General surgical, orthopedic, and urology practices realized increases of 49.0 (95% CI 13.5-84.5), 112.0 (95% CI 83.0-140.5), and 205.0 (95% CI 117.5-292.0) in-office visits per surgeon, respectively. CONCLUSIONS The addition of advanced practice providers to single-specialty surgical groups is associated with improvements in surgical outcomes and access. Future work should clarify the mechanisms by which advanced practice providers within surgical practices contribute to health outcomes to identify best practices for deployment.
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Affiliation(s)
| | | | - Mary Oerline
- Departments of Urology, University of Michigan, Ann Arbor
| | - Parth K. Modi
- Departments of Urology, University of Michigan, Ann Arbor
| | | | - Vahakn B. Shahinian
- Departments of Urology, University of Michigan, Ann Arbor
- Departments of Medicine, University of Michigan, Ann Arbor
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Abstract
IMPORTANCE Advanced practice clinicians (APCs) are a growing part of the US health care system, and their financial relationships with pharmaceutical and medical device companies have not been well studied. OBJECTIVES To examine the value, frequency, and types of payments made to APCs and the association of state scope-of-practice laws with these payments. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 2021 Open Payments Program data to analyze payments from pharmaceutical or medical device companies to physicians or APCs between January 1 and December 31, 2021. Doctors of medicine and osteopathy were categorized as physicians, and nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, and anesthesiologist assistants as APCs. MAIN OUTCOMES AND MEASURES The total value and total number of payments were calculated in aggregate and per clinician for each type of APC, all APCs, and physicians. These calculations were repeated by submitting manufacturer, form of payment, nature of payment, and state scope-of-practice law for nurse practitioners, physician assistants, and physicians. RESULTS A total of 412 000 physicians and 232 000 APCs collectively received $1.99 billion in payments from industry in 2021, of which APCs received $121 million (6.1%). The median total value of payments per clinician for physicians was $167 (IQR, $45-$712) and for APCs was $117 (IQR, $33-$357). The median total number of payments per clinician was equal for physicians and APCs (n = 4). The most common payments to APCs included food and beverage ($69 million [57.6%]), compensation for services other than consulting ($32 million [26.4%]), and consulting fees ($8 million [6.6%]). Advanced practice clinicians in states with the most restrictive scope-of-practice laws received 15.9% lower total value of payments than those in the least restrictive states (P = .002). Physician assistants received 7.6% (P = .005) higher value and 18.1% (P < .001) greater number of payments than nurse practitioners. CONCLUSIONS AND RELEVANCE In this cross-sectional study, 232 000 APCs collectively received $121 million in industry payments in 2021. The frequency of industry interactions with APCs was similar to that for physicians, but the average value was lower. The greater value of payments to APCs who practice in states with the least restrictive scope-of-practice laws suggests that industry payments may be related to clinician autonomy.
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Affiliation(s)
- Armaan Singh
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Max J. Hyman
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, Illinois
| | - Parth K. Modi
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, Illinois
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Singh A, Lassner JW, Sleiman MG, Diaz A, Quallich S, Modi PK. Advanced Practice Providers and Wait Times in Urology Offices: A Secret Shopper Study. Urol Pract 2022; 9:389-395. [PMID: 37145719 DOI: 10.1097/upj.0000000000000333] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Advanced practice providers (APPs), such as nurse practitioners and physician assistants, are a growing part of urology practices. However, the impact of APPs on improving new patient access in urology is unknown. We examined the impact of APPs on new patient wait times in a real-world sample of urology offices. METHODS Research assistants posing as caretakers called urology offices in the Chicago metropolitan area and attempted to schedule a new patient appointment for an elderly grandparent with gross hematuria. Appointments were requested with any available provider: physician or APP. Descriptive measurements of clinic characteristics were reported and differences in appointment wait times were determined using negative binomial regressions. RESULTS Of the 86 offices with which we scheduled appointments, 55 (64%) employed at least 1 APP but only 18 (21%) allowed for new patient appointments with APPs. When requested for the earliest appointment regardless of provider type, offices with APPs could offer shorter wait times compared to physician-only offices (10 vs 18 days; p=0.09). Initial appointments with an APP were available with a significantly shorter wait than those with a physician (5 days vs 15 days; p=0.04). CONCLUSIONS Urology offices are commonly employing APPs but giving them a limited role in new patient visits. This suggests that offices with APPs may have an unrealized opportunity to improve new patient access. Further work is needed to better elucidate the role of APPs in these offices and how they might best be deployed.
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Affiliation(s)
- Armaan Singh
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Jared W Lassner
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Marc G Sleiman
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Parth K Modi
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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16
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Reed S, Shewmon K, Modi PK. Editorial Commentary. Urol Pract 2022; 9:496-497. [PMID: 37145753 DOI: 10.1097/upj.0000000000000334.01] [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] [Received: 04/08/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Sawyer Reed
- Morehouse School of Medicine, Atlanta, Georgia
| | - Kate Shewmon
- Section of Urology, University of Chicago, Chicago, Illinois
| | - Parth K Modi
- Section of Urology, University of Chicago, Chicago, Illinois
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17
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Hyman MJ, Modi PK. The Growth of Advanced Practice Providers in Urology Procedural Care: Evidence from Public and Private Health Insurers. Urology 2022; 168:110-115. [DOI: 10.1016/j.urology.2022.06.027] [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] [Received: 03/23/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
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Goldenthal SB, Reimers MA, Singhal U, Farha M, Mehra R, Piert M, Tosoian JJ, Modi PK, Curci N, Peabody J, Kleer E, Smith DC, Morgan TM. Prostate Cancer with Peritoneal Carcinomatosis: A robotic-assisted radical prostatectomy-based Case Series. Urology 2022; 167:171-178. [PMID: 35472327 DOI: 10.1016/j.urology.2022.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/23/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To aid in the diagnosis and treatment of patients with metastatic tumor seeding, an exceedingly phenomenon following minimally invasive urological surgery, additional case reports are needed. MATERIALS AND METHODS We report our experience with patients determined to have peritoneal carcinomatosis following robotic-assisted radical prostatectomy (RARP) and provide a descriptive summary of these unique cases. RESULTS Five cases of peritoneal carcinomatosis were identified, all of which occurred relatively late - between 8-13 years - following RARP. Four of the five cases had T3 disease at the time of prostatectomy. 68Ga-PSMA PET identified peritoneal carcinomatosis in three of five cases. CONCLUSIONS Certain clinical factors, such as advanced pathologic stage at the time of prostatectomy, may predict risk for carcinomatosis following RARP. Additionally, next generation imaging modalities, such as PSMA PET, may aid in identifying these metastases and are likely to identify increasing numbers of these patients as next generation imaging becomes more widely available. Continued documentation and classification of this atypical presentation are needed to improve our understanding and management of this phenomenon.
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Affiliation(s)
- Steven B Goldenthal
- Department of Urology, University of Michigan, Ann Arbor, MI; Department of Urology, Ohio State Wexner Medical Center, Columbus, OH.
| | - Melissa A Reimers
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Udit Singhal
- Department of Urology, University of Michigan, Ann Arbor, MI; Mayo Clinic, Department of Urology, Rochester, MN
| | - Mark Farha
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Morand Piert
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | | | - Parth K Modi
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Nicole Curci
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | - James Peabody
- Department of Urology, Henry Ford Health System, Detroit, MI
| | - Eduardo Kleer
- IHA Urology, St. Joseph Mercy Hospital, Ypsilanti, MI
| | - David C Smith
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
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19
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Modi PK, Eggener SE. Radical Prostatectomy Without Biopsy: Audacious, Imprudent, or Innovative? Eur Urol 2022; 82:161-162. [DOI: 10.1016/j.eururo.2022.03.008] [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] [Received: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
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20
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Filson CP, Modi PK, Ward KC. Characteristics of prostate cancer patients captured by facility-based versus geography-based cancer registries. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.237] [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] [Indexed: 11/20/2022] Open
Abstract
237 Background: Cancer registries provide valuable information related to cancer epidemiology, treatment, and outcomes. However, the sampling for inclusion can impact generalizability of findings to other settings. We use a population-based cancer registry to evaluate demographics, cancer factors, and treatment patterns based on eligibility for a facility-based cancer registry. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify men diagnosed with prostate cancer (site = C61.9) in 2018. Exposure was whether data were reported from a facility accredited by American College of Surgeons’ Commission on Cancer (CoC), providing eligibility for the National Cancer Database (NCDB) (i.e., NCDB-eligible). Outcomes of interest included demographics, tumor factors (e.g., biopsy grade), and treatment. Bivariate testing and multivariable regression analyses tested for significant associations between exposure and outcomes of interest. Results: We identified 57,713 men diagnosed with prostate cancer in 2018, of which 32,384 (61.9%) were eligible for inclusion in NCDB. NCDB-eligible men were younger (66.6 vs 67.8 years, p < 0.001), less likely to be Hispanic/Latino (8.0% vs 14.4%, p < 0.001), and more likely to reside in a county with median income over $75,000 (39.7% vs 33.3%, p < 0.001). NCDB eligibility varied widely by registry, from 96.1% in Connecticut to 44.7% in Utah. The proportion of localized cancer patients with Grade Group 1 cancer on biopsy was higher among men ineligible for NCDB (41.4% vs 26.9%, p < 0.001). The proportion of patients with more advanced disease at presentation was higher among NCDB-eligible patients (metastatic: 9.4% vs 6.8%; regional: 18.7% vs 8.7%; p < 0.001). For patients with localized or regional cancer, treatment was identified more frequently among NCDB-eligible patients for both low-risk (38.5% vs 22.7%, p < 0.001) and high-risk tumors (84.9% vs 64.2%). Among treated patients, use of radical prostatectomy was more common among NCDB-eligible patients (low risk: 58.9% vs 43.1%; high risk: 53.7% vs 43.4%, p < 0.001). Conclusions: Prostate cancer patients eligible for inclusion in the facility based NCDB have important differences in demographics, severity of cancer risk, and treatment patterns compared to those who are not eligible. Generalizations related to epidemiologic trends, practice patterns, and outcomes for prostate cancer patients in the NCDB should be interpreted with caution.
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Affiliation(s)
| | - Parth K. Modi
- University of Chicago Department of Urology, Chicago, IL
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21
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Lai LY, Kaufman SR, Modi PK, Ellimoottil C, Oerline M, Caram ME, Hollenbeck BK, Shahinian VB. Impact of Advanced Practice Provider Integration into Multispecialty Group Practices on Outcomes Following Major Surgery. Surg Innov 2022; 29:111-117. [PMID: 33896274 PMCID: PMC8542060 DOI: 10.1177/15533506211013150] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background. While advanced practice providers (APPs) are increasingly integrated into care delivery models, little is known about their impact in surgical settings. Given that many patients undergo surgery in multispecialty group practice settings, we examined the impact of APP integration into such practices on outcomes after major surgery. Methods. We used a 20% sample of national Medicare claims to identify 190 101 patients who underwent 1 of 4 major surgeries (coronary artery bypass graft [CABG], colectomy, major joint replacement, and cystectomy) at multispecialty group practices from 2010 through 2016. The level of APP integration was measured as the ratio of APPs to physicians within each practice. Rates of mortality, major complications, and readmission within 30 days of discharge after the index surgery were compared between patients treated in practices with low, medium, and high levels of APP integration using multivariable regression analysis. Results. Relative to patients treated in practices with low APP integration, those treated in practices with medium or high APP integration had significantly lower rates of mortality (2.4% [low integration] vs 1.9% [medium integration] vs 2.0% [high integration]; P < .01), major complications (34.1% [low] vs 31.2% [medium] vs 30.2% [high]; P < .01), and readmission (11.7% [low] vs 10.6% [medium] vs 10.1% [high]; P < .01). This relationship was consistent for virtually all outcomes when considering each surgery type individually. Conclusions. Integration of APPs into multispecialty group practices was associated with improved postoperative outcomes after major surgery. Future research should identify the mechanisms by which APPs improve outcomes to inform optimal utilization.
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Affiliation(s)
- Lillian Y. Lai
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Parth K. Modi
- Department of Urology, University of Chicago, Chicago, IL
| | | | - Mary Oerline
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | | | - Vahakn B. Shahinian
- Department of Urology, University of Michigan, Ann Arbor, MI,Departments of Medicine, University of Michigan, Ann Arbor, MI
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22
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Singh A, Faris S, Agarwal P, Reynolds LF, Modi PK. Association between Industry Payments and Published Position on Use of Devices for the Treatment of Lower Urinary Tract Symptoms. Urology 2021; 159:87-92. [PMID: 34752849 DOI: 10.1016/j.urology.2021.10.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/07/2021] [Accepted: 10/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the impact of industry payments to authors of opinion articles on the Urolift and Rezum devices. We also examined the extent to which authors omitted acknowledgements of financial conflicts-of-interest. METHODS We searched Google Scholar for all articles that cite either of the respective pivotal trials for these devices. 2 blinded urologists coded the articles as favorable or neutral. A separate blinded researcher recorded industry payments from the manufacturers using the Open Payments Program database. RESULTS We identified 29 articles written by 27 unique authors from an initial screening list of 235 articles. Of these articles, 15 (52%) were coded as positive and 14 (48%) were coded as neutral. 20 (74%) authors have accepted payments from the manufacturer of the device. Since 2014, these authors have collectively received $270,000 from NeoTract and $314,000 from Boston Scientific. Of the 20 authors with payments, 9 (45%) received more than $10,000 from either manufacturer. Of authors with payments, 65% (13/20) contributed to only positive articles. Authors who received payments had more than 4 times the number of article contributions than did authors without payments (42 vs 10). Authors of at least one favorable article were more likely to have received payments from the device manufacturers than authors of neutral articles (P = .014, Chi-squared test). Most (80%, 16/20) authors with payments did not report a relevant conflict-of-interest within any of their articles. CONCLUSION These data suggest a relationship between payments from a manufacturer and positive published position on that company's device. There may be a critical lack of published editorial pieces by authors without financial conflicts of interest.
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Affiliation(s)
- Armaan Singh
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Sarah Faris
- Section of Urology, Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL
| | - Piyush Agarwal
- Section of Urology, Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL
| | - Luke F Reynolds
- Section of Urology, Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL
| | - Parth K Modi
- Section of Urology, Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL.
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23
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Hollenbeck BK, Dunn RL, Sukul D, Modi PK, Nallamothu BK, Sen A, Bynum JP. Aortic valve replacement among patients with Alzheimer's disease and related dementias. J Am Geriatr Soc 2021; 69:3468-3475. [PMID: 34498253 DOI: 10.1111/jgs.17432] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has made palliation from aortic stenosis more broadly available to populations previously thought to be too high risk for surgery, such as those with Alzheimer's disease and related dementias (ADRD); however, its safety and effectiveness in this context are uncertain. METHODS We performed a retrospective cohort study of national Medicare beneficiaries, aged 66 and older with Parts A and B, between 2010 and 2016. Patients undergoing AVR were identified, and follow-up was available through 2017. Multivariable regression was used to measure the independent association between having a diagnosis of ADRD at the time of AVR, stratified by TAVR and surgery, and outcomes (mortality and Medicare institutional days at 1 year after AVR). RESULTS The average rate of increase in AVR per year was 17.5 cases per 100,000 ADRD and 8.4 per 100,000 non-ADRD beneficiaries, largely driven by more rapid adoption of TAVR. Adjusted mortality following AVR declined significantly between those treated in 2010 and 2016, from 13.5% (95% CI 10.2%-17.7%) to 6.3% (95% CI 5.2%-7.6%) and from 13.7% (95% CI 12.7%-14.7%) to 6.3% (95% CI 5.8%-6.9%) in those with and without ADRD, respectively. The sharpest decline was noted for patients undergoing TAVR between 2011 and 2016, with adjusted mortality declining from 19.9% (95% CI 11.2%-32.8%) to 5.2% (95% CI 4.1%-6.5%) and from 12.2% (95% CI 9.3%-15.8%) to 5.0% (95% CI 4.4%-5.6%) in patients with and without ADRD, respectively. Similar declines were evident for Medicare institutional days in the year after AVR in both patient groups. CONCLUSIONS Rates of AVR in those with ADRD increased during the past decade largely driven by the diffusion of TAVR. The use of TAVR in this vulnerable population did not come at the expense of increasing Medicare institutional days or mortality at 1-year.
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Affiliation(s)
- Brent K Hollenbeck
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Rodney L Dunn
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Devraj Sukul
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Parth K Modi
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Brahmajee K Nallamothu
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ananda Sen
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie P Bynum
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
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24
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Affiliation(s)
- Kathryn A Marchetti
- Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI
| | - Parth K Modi
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
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25
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Marchetti KA, Oerline M, Hollenbeck BK, Kaufman SR, Skolarus TA, Shahinian VB, Caram MEV, Modi PK. Urology Workforce Changes and Implications for Prostate Cancer Care Among Medicare Enrollees. Urology 2021; 155:77-82. [PMID: 33610652 PMCID: PMC8374001 DOI: 10.1016/j.urology.2020.12.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/03/2020] [Revised: 11/28/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer. METHODS Using Medicare claims data from 2010 to 2016, we identified all urologists billing Medicare and the practice with which they were affiliated. We characterized groups as solo, small single specialty, large single specialty, multispecialty, specialist, or hospital-owned practices. Using a 20% sample of national Medicare claims, we identified all patients with incident prostate cancer and identified their primary treatment. RESULTS The number of urologists increased from 9,305 in 2010 to 9,570 in 2016 (P = .03), while the number of practices decreased from 3,588 to 2,861 (P < .001). The proportion of urologists in multispecialty groups increased from 17.1% in 2010 to 28.2% in 2016, while those within solo practices declined from 26.2% to only 15.8% over the same time period. A higher proportion of patients at hospital-owned practices were treated with observation (P < .001) and surgery (P < .001), while a higher proportion of patients at large single specialty practices were treated with radiation therapy (P < .001). CONCLUSION We characterized shifts in urologist membership from smaller, independent groups to larger, multispecialty or hospital-owned practices. This trend coincides with higher utilization of observation and surgical treatment for prostate cancer.
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Affiliation(s)
- Kathryn A Marchetti
- Division of Health Services Research, Department of Urology, University of Michigan.
| | - Mary Oerline
- Division of Health Services Research, Department of Urology, University of Michigan
| | - Brent K Hollenbeck
- Division of Health Services Research, Department of Urology, University of Michigan
| | - Samuel R Kaufman
- Division of Health Services Research, Department of Urology, University of Michigan
| | - Ted A Skolarus
- Division of Health Services Research, Department of Urology, University of Michigan; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Vahakn B Shahinian
- Division of Health Services Research, Department of Urology, University of Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Megan E V Caram
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Parth K Modi
- Division of Health Services Research, Department of Urology, University of Michigan
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26
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Modi PK, Meltzer DO. Assessing Value-based Health Care Initiatives in Urology. Eur Urol 2021; 79:586-587. [PMID: 33454164 DOI: 10.1016/j.eururo.2021.01.002] [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] [Received: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Parth K Modi
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA.
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
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27
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Affiliation(s)
- Parth K Modi
- Section of Urology, Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL
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28
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Sterling J, Rivera-Núñez Z, Patel HV, Farber NJ, Kim S, Radadia KD, Modi PK, Goyal S, Parikh R, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Factors Associated With Receipt of Partial Nephrectomy or Minimally Invasive Surgery for Patients With Clinical T1a and T1b Renal Masses: Implications for Regionalization of Care. Clin Genitourin Cancer 2020; 18:e643-e650. [PMID: 32389458 PMCID: PMC7502425 DOI: 10.1016/j.clgc.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/13/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify factors associated with receipt of partial nephrectomy (PN) and minimally invasive surgery (MIS) in patients with clinical T1 renal cell carcinoma (RCC) using the National Cancer Data Base (NCDB). METHODS We queried the NCDB from 2010 to 2014 identifying patients treated surgically for cT1a-bN0M0 RCC. Logistic regression was used to examine associations between socioeconomic, clinical, and treatment factors, and receipt of MIS or PN within the T1 patient population. RESULTS Our cohort included 69,694 patients (cT1a, n = 44,043; cT1b, n = 25,651). For cT1a tumors, 70% of patients received PN and 65% underwent MIS. For cT1b tumors, 32% of patients received PN and 62% underwent MIS. cT1a and cT1b patients with household income < $62,000, without private insurance, and treated outside academic centers were less likely to receive MIS or PN. cT1a patients traveling > 31 miles were more likely to undergo MIS. For both cT1a/b, the farther a patient traveled for treatment, the more likely a PN was performed. CONCLUSION Data showed an increase in utilization of MIS and PN from 2010 to 2014. However, patients in the lowest socioeconomic groups were less likely to travel and were more likely to receive more invasive treatments. On the basis of these findings, additional research is needed into how regionalization of RCC surgery affects treatment disparities.
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Affiliation(s)
- Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Zorimar Rivera-Núñez
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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Caram MEV, Oerline MK, Dusetzina S, Herrel LA, Modi PK, Kaufman SR, Skolarus TA, Hollenbeck BK, Shahinian V. Adherence and out-of-pocket costs among Medicare beneficiaries who are prescribed oral targeted therapies for advanced prostate cancer. Cancer 2020; 126:5050-5059. [PMID: 32926427 DOI: 10.1002/cncr.33176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/06/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Abiraterone and enzalutamide are high-cost oral therapies that increasingly are used to treat patients with advanced prostate cancer; these agents carry the potential for significant financial consequences to patients. In the current study, the authors investigated coping and material measures of the financial hardship of these therapies among patients with Medicare Part D coverage. METHODS The authors performed a retrospective cohort study on a 20% sample of Medicare Part D enrollees who underwent treatment with abiraterone or enzalutamide between July 2013 and June 2015. The authors described the variability in adherence rates and out-of-pocket payments among hospital referral regions in the first 6 months of therapy and determined whether adherence and out-of-pocket payments were associated with patient factors and the socioeconomic characteristics of where a patient was treated. RESULTS There were 4153 patients who filled abiraterone or enzalutamide prescriptions through Medicare Part D in 228 hospital referral regions. The mean adherence rate was 75%. The median monthly out-of-pocket payment for abiraterone and enzalutamide was $706 (range, $0-$3505). After multilevel, multivariable adjustment for patient and regional factors, adherence was found to be lower in patients who were older (69% for patients aged ≥85 years vs 76% for patients aged <70 years; P < .01) and in those with low-income subsidies (69% in those with a subsidy vs 76% in those without a subsidy; P < .01). Both Hispanic ethnicity and living in a hospital referral region with a higher percentage of Hispanic beneficiaries were found to be independently associated with higher out-of-pocket payments for abiraterone and enzalutamide. CONCLUSIONS There were substantial variations in the adherence rate and out-of-pocket payments among Medicare Part D beneficiaries who were prescribed abiraterone and enzalutamide. Sociodemographic patient and regional factors were found to be associated with both adherence and out-of-pocket payments.
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Affiliation(s)
- Megan E V Caram
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Ann Arbor VA Center for Clinical Management Research, VA Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Mary K Oerline
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Stacie Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lindsey A Herrel
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Parth K Modi
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Samuel R Kaufman
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ted A Skolarus
- Ann Arbor VA Center for Clinical Management Research, VA Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brent K Hollenbeck
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Vahakn Shahinian
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
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Modi PK, Kaufman SR, Caram ME, Ryan AM, Shahinian VB, Hollenbeck BK. Medicare Accountable Care Organizations and the Adoption of New Surgical Technology. J Am Coll Surg 2020; 232:138-145.e2. [PMID: 33122038 DOI: 10.1016/j.jamcollsurg.2020.10.016] [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: 08/18/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dissemination of new surgical technology is a major contributor to healthcare spending growth. Accountable care organization (ACO) policy aims to control spending while maintaining quality. As a result, ACOs provide incentive for hospitals to selectively adopt newer procedures with high value. STUDY DESIGN We conducted a retrospective cohort study using a 20% sample of national Medicare claims from 2010 to 2015. We identified hospitals that performed 1 of 6 sets of procedures: abdominal aortic aneurysm repair, aortic valve replacement, carotid endarterectomy or stent, lung lobectomy, colectomy, and prostatectomy. We identified hospitals participating in a Medicare Shared Savings Program ACO and a set of matched non-ACO control hospitals. We used a difference-in-differences approach to compare rate of surgical treatment and use of newer surgical technology for each set of procedures in ACO and non-ACO hospitals. RESULTS We included 707 ACO-hospitals and 1,770 control hospitals. ACO hospitals performed surgery for carotid stenosis at a lower rate than non-ACO hospitals. There was no difference in the rate of surgical treatment for all other procedure sets. ACO hospitals were less likely to use an endovascular approach for abdominal aortic aneurysm repair (85.2% vs 88.2%, p < 0.001) and more likely to use a minimally invasive approach for lung lobectomy (42.2% vs 34.7%, p = 0.004) than non-ACO hospitals. In difference-in-differences analysis, ACO participation was not associated with any significant difference in use of surgical care for any of the 6 procedure sets, nor with any significant difference in use of newer surgical technology. CONCLUSIONS Despite ACO policy incentives to selectively adopt newer surgical technology, ACO participation was not associated with differences in rate of surgery or use of newer surgical technology for 6 major surgical procedures.
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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
| | - Megan Ev Caram
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Andrew M Ryan
- Department of Medicine, University of Michigan Medical School and the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Vahakn B Shahinian
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Nephrology, University of Michigan, Ann Arbor, MI
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
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31
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Kim IE, Jang TL, Kim S, Modi PK, Singer EA, Elsamra SE, Kim IY. Abrogation of survival disparity between Black and White individuals after the USPSTF's 2012 prostate-specific antigen-based prostate cancer screening recommendation. Cancer 2020; 126:5114-5123. [PMID: 32888321 DOI: 10.1002/cncr.33179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/16/2020] [Revised: 06/05/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In May 2012, the US Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA)-based screening for prostate cancer (PCa), assigning it a grade D. This decision then was modified in 2018 to a grade C for men aged 55 to 69 years. The authors hypothesized that changes in screening practices would reduce survival outcomes for both Black and White men but maintain racial discrepancies in outcomes. METHODS Using the Surveillance, Epidemiology, and End Results database, the authors examined PCa-specific survival based on race and year of diagnosis. The period between January 2010 and December 2012 was categorized as the pre-USPSTF era, whereas the period between January 2014 and December 2016 was classified as the post-USPSTF era. The year 2013 was considered the transition year and was excluded from the analysis. RESULTS A total of 49,388 men were identified in the pre-USPSTF era who were diagnosed with PCa, approximately 83.7% of whom were White and 16.3% of whom were Black. In the post-USPSTF era, a total of 41,829 men were diagnosed with PCa, approximately 82.7% of whom were White and 17.3% of whom were Black. When compared with the pre-USPSTF era, men diagnosed in the post-USPSTF era were found to have more adverse clinical features. In the pre-USPSTF era, White men were less likely to die of PCa than Black men. This survival disparity between White and Black men was no longer observed in the post-USPSTF era. CONCLUSIONS In men diagnosed with PCa between 2014 and 2016, a survival disparity between White and Black men was not observed due to a decrease in survival among White men while the survival of Black men remained steady.
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Affiliation(s)
- Isaac E Kim
- Department of Urology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Sinae Kim
- Department of Biostatistics, Rutgers School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Parth K Modi
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Sammy E Elsamra
- Department of Urology, Warren Alpert Medical School, Brown University, Providence, Rhode Island.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
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Modi PK, Moloci N, Herrel LA, Hollenbeck BK, Hollingsworth JM. Medicare Accountable Care Organizations Reduce Spending on Surgery. Am J Accountable Care 2020; 8:12-19. [PMID: 33073160 PMCID: PMC7561039] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Surgical care among older adults is costly. While Medicare accountable care organizations (ACOs) are designed around primary care, there are reasons to believe that participation may also affect spending on surgery. This study examines the impact that Medicare ACO alignment has on spending for inpatient and outpatient surgical care. STUDY DESIGN We conducted a retrospective cohort study using national Medicare claims (2008 through 2015). Among a 20% random sample of beneficiaries, we identified adults 65 years of age and older enrolled in fee-for-service Medicare, distinguishing between those aligned and unaligned with a Medicare ACO. We then measured payments for surgical services made on their behalf. Finally, we fit multivariable regression models to evaluate the association between ACO alignment and spending for inpatient and outpatient surgical care. RESULTS We identified 37,249,845 beneficiary-year observations, of which 2,950,188 (7.9%) were aligned with a Medicare ACO. After adjustment for patient factors, ACO alignment was associated with $181 [95% confidence interval (CI), -$243 to -$118; P <0.001] lower spending per beneficiary-year. ACO alignment was associated with 2.9% fewer inpatient surgical episodes per year [incidence rate ratio (IRR), 0.97; 95% CI, 0.96 to 0.98; P <0.001] but 2.3% more outpatient episodes per year (IRR, 1.02; 95% CI, 1.02 to 1.03; P <0.001). Among inpatient surgical episodes, average payments were $956 lower for ACO aligned beneficiaries (95%CI -$1218 to -$694, P <0.001). CONCLUSIONS AND RELEVANCE ACO alignment was associated with savings on surgical care. These savings resulted from increased outpatient surgery and reduced use of inpatient surgery as well as reduced spending per inpatient surgical episode. Greater focus on surgical care may improve the ability of ACOs to control healthcare spending.
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Affiliation(s)
- Parth K Modi
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Nicholas Moloci
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - John M Hollingsworth
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
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Srivastava A, Rivera-Núñez Z, Kim S, Sterling J, Farber NJ, Radadia KD, Patel HV, Modi PK, Goyal S, Parikh R, Mayer TM, Saraiya B, Sadimin ET, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Impact of pathologic lymph node-positive renal cell carcinoma on survival in patients without metastasis: Evidence in support of expanding the definition of stage IV kidney cancer. Cancer 2020; 126:2991-3001. [PMID: 32329899 DOI: 10.1002/cncr.32912] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/19/2019] [Revised: 01/01/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stage III renal cell carcinoma (RCC) encompasses both lymph node-positive (pT1-3N1M0) and lymph node-negative (pT3N0M0) disease. However, prior institutional studies have indicated that among patients with stage III disease, those with lymph node disease have worse oncologic outcomes and experience survival that is similar to that of patients with American Joint Committee on Cancer (AJCC) stage IV disease. The objective of the current study was to validate these findings using a large, nationally representative sample of patients with kidney cancer. METHODS Patients with AJCC stage III or stage IV RCC were identified using the National Cancer Data Base (NCDB). Patients were categorized as having lymph node-positive stage III (pT1-3N1M0), lymph node-negative stage III (pT3N0M0), or stage IV metastatic (pT1-3 N0M1) disease. Cox proportional hazards models compared outcomes while adjusting for comorbidities. Kaplan-Meier estimates illustrated relative survival when comparing staging groups. RESULTS A total of 8988 patients met the inclusion criteria, with 6587 patients classified as having lymph node-negative stage III disease, 2218 as having lymph node-positive stage III disease, and 183 as having stage IV disease. Superior survival was noted among patients with lymph node-negative stage III disease, but similar survival was noted between patients with lymph node-positive stage III and stage IV RCC, with 5-year survival rates of 61.9% (95% confidence interval [95% CI], 60.3%-63.4%), 22.7% (95% CI, 20.6%-24.9%), and 15.6% (95% CI, 11.1%-23.8%), respectively. CONCLUSIONS Current RCC staging systems group pT1-3N1M0 and pT3N0M0 disease as stage III disease. However, the results of the current validation study suggest the need for further stratification and even placement of patients with pT1-3N1M0 disease into the stage IV category. Staging that accurately reflects oncologic prognosis may help clinicians better counsel and select patients who might derive the most benefit from lymphadenectomy, adjuvant systemic therapy, more rigorous imaging surveillance, and clinical trial participation.
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Affiliation(s)
- Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Tina M Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Evita T Sadimin
- Division of Genitourinary Pathology and Informatics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Modi PK, Eggener SE. Prostate-specific Antigen to Predict Early Success of Focal Therapy: Focusing on Appropriate Endpoints. Eur Urol 2020; 78:161-162. [PMID: 32593531 DOI: 10.1016/j.eururo.2020.05.031] [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] [Received: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Parth K Modi
- Division of Urologic Oncology, Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | - Scott E Eggener
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
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Sessine MS, Weizer A, Kirk PS, Borza T, Jacobs BL, Qin Y, Oerline M, Li B, Modi PK, Lavieri MS, Gilbert SM, Montgomery JS, Hollenbeck BK, Urish K, Helm JE, Skolarus TA. Reframing Financial Incentives Around Reducing Readmission After Radical Cystectomy. Urology 2020; 142:99-105. [PMID: 32413517 DOI: 10.1016/j.urology.2020.03.059] [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: 11/24/2019] [Revised: 02/29/2020] [Accepted: 03/29/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To better understand the financial implications of readmission after radical cystectomy, an expensive surgery coupled with a high readmission rate. Currently, whether hospitals benefit financially from readmissions after radical cystectomy remains unclear, and potentially obscures incentives to invest in readmission reduction efforts. MATERIALS AND METHODS Using a 20% sample of national Medicare beneficiaries, we identified 3544 patients undergoing radical cystectomy from January 2010 to November 2014. We compared price-standardized Medicare payments for index admissions and readmissions after surgery. We also examined the variable financial impact of length of stay and the proportion of Medicare payments coming from readmissions based on overall readmission rate. RESULTS Medicare patients readmitted after cystectomy had higher index hospitalization payments ($19,164 readmitted vs $18,146 non-readmitted, P = .03) and an average readmission payment of $7356. Adjusted average Medicare readmission payments and length of stay varied significantly across hospitals, ranging from $2854 to $15,605, and 2.0 to 17.1 days, respectively (both P <.01), with longer length of stay associated with increased payments. After hospitals were divided into quartiles based on overall readmission rates, the percent of payments coming from readmissions ranged from 5% to 13%. CONCLUSION Readmissions following radical cystectomy were associated with increased Medicare payments for the index hospitalization, and the readmission payment, potentially limiting incentives for readmission reduction programs. Our findings highlight opportunities to reframe efforts to support patients, caregivers, and providers through improving the discharge and readmission processes to create a patient-centered experience, rather than for fear of financial penalties.
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Affiliation(s)
- Michael S Sessine
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Alon Weizer
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Peter S Kirk
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Tudor Borza
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Urology, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Yongmei Qin
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Mary Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Benjamin Li
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Parth K Modi
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Mariel S Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI
| | - Scott M Gilbert
- Department of Urology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jeffrey S Montgomery
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Ken Urish
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jonathan E Helm
- Department of Operations and Decision Technologies, Kelley School of Business, Indiana University, Bloomington, IN
| | - Ted A Skolarus
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI; VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
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Tabakin AL, Shinder BM, Kim S, Rivera-Nunez Z, Polotti CF, Modi PK, Sterling JA, Farber NJ, Radadia KD, Parikh RR, Kim IY, Saraiya B, Mayer TM, Singer EA, Jang TL. Retroperitoneal Lymph Node Dissection as Primary Treatment for Men With Testicular Seminoma: Utilization and Survival Analysis Using the National Cancer Data Base, 2004-2014. Clin Genitourin Cancer 2020; 18:e194-e201. [PMID: 31818649 DOI: 10.1016/j.clgc.2019.10.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/07/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The role of retroperitoneal lymph node dissection (RPLND) as first-line treatment for testicular seminoma is less well defined than for testicular nonseminomatous germ-cell tumors. We describe utilization of primary RPLND in the United States and report on overall survival (OS) after surgery for these men. PATIENTS AND METHODS Using 2004-2014 data from the National Cancer Data Base, we identified 62,727 men with primary testicular cancer, 31,068 of whom were diagnosed as having seminoma. After excluding men with benign, non-germ cell, and nonseminomatous germ-cell tumor histologies, those who did not undergo RPLND, those where clinical stage and survival data were unavailable, and those with testicular seminoma who underwent RPLND in the postchemotherapy setting (n = 47), 365 men comprised our final cohort. Descriptive statistics were used to summarize clinical and demographic factors. The Kaplan-Meier method was used to determine OS. RESULTS A total of 365 men with testicular seminoma underwent primary RPLND. At a median follow-up of 4.1 years, there were 16 deaths in the entire cohort. Five-year OS was 94.2%. Subset analysis of men with stage I and IIA/B disease who underwent primary RPLND revealed 5-year OS rates of 97.3% and 92.0%, respectively (P = .035). OS did not significantly differ in patients with stage IIA versus IIB disease (91.8% vs. 92.3%, respectively, P = .907). CONCLUSION Although RPLND is rarely used as primary therapy in testicular seminoma, OS rates appear to be comparable to rates reported in the literature for primary chemotherapy or radiotherapy. Ongoing prospective trials will clarify the role of RPLND in the management of testicular seminoma.
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Affiliation(s)
- Alexandra L Tabakin
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Brian M Shinder
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Sinae Kim
- Department of Biostatistics and Epidemiology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Zorimar Rivera-Nunez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Charles F Polotti
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Parth K Modi
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Joshua A Sterling
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Nicholas J Farber
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Kushan D Radadia
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Isaac Y Kim
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Biren Saraiya
- Division of Medical Oncology, Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Tina M Mayer
- Division of Medical Oncology, Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Eric A Singer
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Thomas L Jang
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ.
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Caram MV, Oerline M, Dusetzina S, Modi PK, Herrel LA, Skolarus TA, Hollenbeck BK, Shahinian VB. Financial hardship among Medicare beneficiaries prescribed oral targeted therapies for advanced prostate cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.68] [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] [Indexed: 11/20/2022] Open
Abstract
68 Background: Abiraterone and enzalutamide are increasingly being used to treat advanced prostate cancer. Understanding barriers to adhering to treatment is of paramount importance in ensuring continued access to these important therapies. Patients with limited resources or insufficient access to mechanisms that lower their out-of-pocket cost are likely to suffer from significant financial toxicity and may engage in coping mechanisms such as rationing or abandoning their medication. Methods: To address the variability in measures of financial hardship, we performed a retrospective cohort study on a 20% sample of patients eligible for Medicare Part D who received their first fill of abiraterone or enzalutamide between July 2013 and June 2015. Patients were assigned to a provider based on their first prescription, and a hospital referral region (HRR) based on their ZIP code. The primary outcomes were to determine the proportion of days covered (PDC), overall prescription adherence, and average monthly out-of-pocket cost to patients prescribed abiraterone or enzalutamide, all within the first six months of treatment. Results: From mid-2013 to mid-2015, 4529 patients filled abiraterone or enzalutamide through Medicare Part D, within 305 HRRs. There was substantial variability in PDC, adherence, and out-of-pocket cost to patients among HRRs. The mean PDC was 84% with mean adherence of 73%, which included the 393 (8.7%) of patients who abandoned oral therapy after 1-2 fills. The median standard monthly out-of-pocket cost was $707, ranging between $0 and $3505. Among patients with low-income subsidies, median out-of-pocket cost by HRR ranged from $0 to $2815. We observed that PDC tracked closely with socioeconomic status – HRRs that included a higher proportion of patients eligible for Medicaid had lower PDCs and adherence, but lower standard out-of-pocket cost. Conclusions: This investigation demonstrated significant variation in PDC, adherence, and out-of-pocket cost among different HRRs for patients prescribed abiraterone and enzalutamide and that much of the variability in financial hardship measures among HRRs may be due to socioeconomic variables and regional variability.
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Modi PK, Sukul DA, Oerline M, Thompson MP, Nallamothu BK, Ellimoottil C, Shahinian VB, Hollenbeck BK. Episode Payments for Transcatheter and Surgical Aortic Valve Replacement. Circ Cardiovasc Qual Outcomes 2019; 12:e005781. [PMID: 31830824 DOI: 10.1161/circoutcomes.119.005781] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic stenosis is the most common valvular heart disease in the United States. Transcatheter aortic valve replacement (TAVR) is increasingly being adopted as an alternative to surgical aortic valve replacement (SAVR). In an era of value-based payment reform, our objective was to better understand the economic impact of the use of TAVR and SAVR in the United States. METHODS AND RESULTS We performed a retrospective cohort study of Medicare beneficiaries who underwent TAVR or SAVR between 2012 and 2015. Using claims from a 20% sample of national fee-for-service Medicare beneficiaries, we calculated episode payments for patients who underwent aortic valve replacement from 90 days before aortic valve replacement through 90 days after hospital discharge. Among 18 804 eligible patients, 6455 underwent TAVR (34.3%), and 12 349 underwent SAVR (65.7%). After adjustment for patient characteristics, episode payments for TAVR were ≈7% lower than for SAVR (TAVR, $55 545 [95% CI, $54 643-56 446] versus $59 467 [95% CI, $58 723-60 211]; P<0.001). Patients with TAVR had higher preprocedural payments, but lower payments during and after the index hospitalization for the procedure. Episode payments increased with increasing comorbidity score for patients undergoing TAVR or SAVR (rate ratio, 1.16 [95% CI, 1.15-1.17]; P<0.001); however, this association was stronger for SAVR (rate ratio, 1.18 [95% CI, 1.17-1.19]) than for TAVR (rate ratio, 1.11 [95% CI, 1.11-1.12]; P<0.001 for interaction). Thus, differences in episode payments between TAVR and SAVR were greatest for the sickest patients but much less in healthier patients. CONCLUSIONS TAVR is associated with lower episode payments than SAVR. However, episode payments for TAVR are less influenced by patient comorbidity. Therefore, as TAVR is increasingly used in patients with better baseline health status, the economic advantages of TAVR relative to SAVR may diminish.
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Affiliation(s)
- Parth K Modi
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, Ann Arbor
| | - Devraj A Sukul
- Division of Cardiovascular Diseases, Department of Internal Medicine (D.A.S., B.K.N.), University of Michigan, Ann Arbor
| | - Mary Oerline
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, Ann Arbor
| | - Michael P Thompson
- Department of Cardiac Surgery (M.P.T.), University of Michigan, Ann Arbor
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine (D.A.S., B.K.N.), University of Michigan, Ann Arbor
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, Ann Arbor
| | - Vahakn B Shahinian
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, Ann Arbor.,Division of Nephrology, Department of Internal Medicine (V.B.S.), University of Michigan, Ann Arbor
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, 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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Caram MEV, Kaufman SR, Modi PK, Herrel L, Oerline M, Ross R, Skolarus TA, Hollenbeck BK, Shahinian V. Adoption of Abiraterone and Enzalutamide by Urologists. Urology 2019; 131:176-183. [PMID: 31136769 PMCID: PMC6711811 DOI: 10.1016/j.urology.2019.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/07/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the adoption of abiraterone and enzalutamide by urologists. Abiraterone and enzalutamide are oral therapies approved for the treatment of metastatic castration-resistant prostate cancer, a disease most commonly treated by medical oncologists. METHODS Using the Medicare Part D Public Use Files from 2013 to 2016, we identified total abiraterone and enzalutamide prescriptions 2013-2016 and urologists who prescribed moderate to high volumes of these drugs. We then characterized the urologist practices of those urologists according to practice context (eg, single-specialty group) using data from the Centers for Medicare and Medicaid Services, and the geographic distribution of those providers. RESULTS We found abiraterone prescriptions increased from 71,423 in 2013 to a peak of 100,371 in 2015 and enzalutamide prescriptions continued to increase from 29,572 in 2013 to 100,980 in 2016. Prescriptions by urologists increased between 2013 and 2016 while prescriptions by other specialties plateaued. The number of moderate-high prescribing urologists increased from 98 (abiraterone) and 22 (enzalutamide) in 2013, to 301 (abiraterone) and 671 (enzalutamide) by 2016 with 1063 unique urologists prescribing moderate-high volumes of either drug between 2013 and 2016. Among urologists who prescribe androgen deprivation therapy, 5% were moderate-high prescribers of abiraterone and 12% of enzalutamide in 2016. The majority of moderate-high prescribing urologists were in single-specialty groups (70%). CONCLUSION Urologists are increasingly prescribing oral therapies for metastatic castration-resistant prostate cancer. Understanding the distribution of urologists specializing in castration-resistant prostate cancer therapeutics will help guide future interventions to optimize the care for this important patient population.
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Affiliation(s)
- Megan E V Caram
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; VA Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
| | - Samuel R Kaufman
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Parth K Modi
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Lindsey Herrel
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Mary Oerline
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Ryan Ross
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Ted A Skolarus
- VA Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Brent K Hollenbeck
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Vahakn Shahinian
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Urology, University of Michigan Medical School, Ann Arbor, MI
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Palmer S, Sukul D, Moloci NM, Nallamothu BK, Modi PK, Hollenbeck BK, Hollingsworth JM. Substitution of Transcatheter for Surgical Aortic Valve Replacement: An Observational Study. Surg Innov 2019; 26:766-767. [PMID: 31434539 DOI: 10.1177/1553350619870072] [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: 11/15/2022]
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Radadia KD, Rivera-Núñez Z, Kim S, Farber NJ, Sterling J, Falkiewicz M, Modi PK, Goyal S, Parikh R, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Accuracy of clinical nodal staging and factors associated with receipt of lymph node dissection at the time of surgery for nonmetastatic renal cell carcinoma. Urol Oncol 2019; 37:577.e17-577.e25. [PMID: 31280982 DOI: 10.1016/j.urolonc.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/19/2018] [Revised: 05/27/2019] [Accepted: 06/05/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The benefit of lymph node dissection (LND) in renal cell carcinoma (RCC) remains poorly defined. Despite this uncertainty, the American Urological Association (AUA) guideline on localized renal cancer recommends that LND be performed for staging purposes when there is suspicion of regional lymphadenopathy on imaging. Using the National Cancer Database (NCDB), we sought to determine how much of a departure the new AUA guideline is from current practice. We hypothesized that practice patterns would reflect the "Expert Opinion" recommendation and that patients who are clinical lymph node (cLN) positive would receive a LND more often than those who are cLN negative. Additionally, we sought to determine factors that would trigger a LND as well the accuracy of clinical staging by examining the relationship between cLN and pathologic lymph node (pLN) status of patients who received a LND. MATERIALS AND METHODS The NCDB was queried for patients with nonmetastatic RCC who underwent partial nephrectomy or nephrectomy from 2010 to 2014. Patient sociodemographic and clinical characteristics were extracted. Frequency distributions were calculated for patients with both cLN and pLN status available. Of patients who received a LND, sensitivity, specificity, and positive/negative predictive values (PPV/NPV) of cLN status for pLN positivity were calculated. Logistic regression models were used to examine association between clinical and socioeconomic factors and receipt of LND. Propensity score matching was used in sensitivity analyses to examine potential for reporting bias in NCDB data. RESULTS We identified 110,963 patients who underwent surgery for RCC, of whom 11,867 (11%) had LND performed at the time of surgery. cLN and pLN information were available in 11,300 patients, of which 1,725 were preoperatively staged as having positive cLN. More LNDs were performed per year for patients who were cLN negative than cLN positive. Of patients who received a LND, the majority of patients were cLN negative across all clinical T (cT) stages. Multivariable analysis showed that all patients who had care at an academic/research institution (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.43-1.74) and had to travel >12.5 to 31.0 miles and >31.0 miles to a treatment center (OR: 1.08, 95%CI: 1.01-1.15 and OR: 1.28, 95%CI: 1.20-1.36, respectively) were more likely to get a LND. As cT stage increased from cT2-4, the risk of LND increased (OR range: 4.7-7.90, respectively). Patients who were cLN positive were more likely to receive a LND at the time of surgery (OR: 18.68, 95%CI: 16.62-21.00). Of the patients who received a LND, clinical staging was more specific than sensitive. CONCLUSION More patients received a LND who were cLN negative compared to patients who were cLN positive. Patients who were cLN positive were more likely to receive a LND. Treatment center type, distance to treatment center, cT stage, and cLN positivity were factors associated with LND receipt.
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Affiliation(s)
- Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health, New Brunswick, NJ
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Marissa Falkiewicz
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
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Modi PK, Herrel LA, Kaufman SR, Yan P, Borza T, Skolarus TA, Schroeck FR, Hollenbeck BK, Shahinian VB. Urologist Practice Structure and Spending for Prostate Cancer Care. Urology 2019; 130:65-71. [PMID: 31029672 DOI: 10.1016/j.urology.2019.03.029] [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] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/19/2019] [Accepted: 03/08/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the impact of urologist practice structure on health care spending for men with prostate cancer. We hypothesize that 3 elements of urologist practice structure may influence spending for prostate cancer care: urologist participation within a multispecialty group (MSG), practice size among single specialty urology groups, and intensity-modulated radiation therapy (IMRT) ownership. MATERIALS AND METHODS We used a 20% sample of fee-for-service Medicare beneficiaries to identify men newly diagnosed with prostate cancer between 2011 and 2014. We identified each man's urologist and used data from the Healthcare Relational Spheres provider files to identify practice type, size, and IMRT ownership for each urologist. We then fit generalized linear mixed models to estimate the association between these practice features and Medicare payments in the year after diagnosis. All models were adjusted for patient and healthcare market characteristics. RESULTS We identified 35,929 men with newly diagnosed prostate cancer who were treated by 6381 urologists. Medicare payments for men with newly diagnosed prostate cancer were significantly lower in MSGs ($19,181 v. $22,366 large single specialty group, P < 0.001) and significantly higher among practices with IMRT ownership ($23,801 v. $20,162 for non-owners, P < 0.001). These differences persisted in sensitivity analyses including only men treated with radiotherapy and examining only prostate cancer-related claims. CONCLUSION Urologist practice structure is associated with payments for prostate cancer care. MSGs had the lowest Medicare payments per episode of prostate cancer care while groups with IMRT ownership had the highest.
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Affiliation(s)
- Parth K Modi
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Lindsey A Herrel
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Samuel R Kaufman
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Phyllis Yan
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Tudor Borza
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Ted A Skolarus
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Florian R Schroeck
- Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Brent K Hollenbeck
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
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Modi PK, Kaufman SR, Portney DS, Ryan AM, Hollenbeck BK, Ellimoottil C. Telemedicine utilization by providers in accountable care organizations. Mhealth 2019; 5:10. [PMID: 31143768 PMCID: PMC6509430 DOI: 10.21037/mhealth.2019.03.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/28/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Parth K. Modi
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Samuel R. Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - David S. Portney
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Andrew M. Ryan
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA
| | - Brent K. Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Radadia KD, Rivera-Nunez Z, Kim S, Farber N, Sterling J, Modi PK, Sharad G, Rahul P, Weiss RE, Kim I, Elsamra S, Jang T, Singer E. Factors linked with receiving a lymph node dissection during surgery for nonmetastatic renal cell carcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.672] [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] [Indexed: 11/20/2022] Open
Abstract
672 Background: The benefit of a lymph node dissection (LND) in renal cell carcinoma (RCC) remains poorly defined. Despite this uncertainty, the American Urological Association (AUA) guideline on localized renal cancer recommends that LND be performed for staging purposes when there is suspicion of regional lymphadenopathy on imaging. Using the National Cancer Database (NCDB), we examined factors associated with the receipt of LND at the time of renal surgery. Methods: The NCDB was queried for non-metastatic patients who underwent partial nephrectomy or nephrectomy for RCC from 2010 to 2014. Patient socio-demographics, clinical characteristics, and treatment factors were extracted. Logistic regression models were used to examine factors associated with the receipt of LND. Results: We identified 110,963 patients who underwent surgery for RCC, of whom 11,867 (11%) had LND performed at the time of surgery. Clinical lymph node (cLN) and pathologic lymph node (pLN) information were available in 11,300 patients, of which 1,725 were preoperatively staged as having positive cLN. In the entire study population, patients who were cLN positive were approximately 19 times more likely to receive a LND at the time of surgery (OR: 18.68, 95%CI: 16.62-21.00). Factors associated with a LND in patients who are cLN negative (n = 106,370) were assessed. Clinical T (cT) stage was the strongest indicator of LND (cT2-4, OR range: 4.87-11.1). Among both cohorts, patients who received surgery at an academic/research institution or traveled farther ( > 31 miles) to a treatment center were more likely to undergo a LND. Patients from both cohorts who underwent robotic or laparoscopic surgery were less likely to receive a LND compared to open surgery. Conclusions: The greatest predictor of LND receipt is being cLN positive. Among patients who are cLN negative, the greatest predictor of LND is cT stage. Predictors of undergoing LND in all patients and those who are cLN negative include treatment center type and distance to the treatment center. Additional studies to determine the accuracy of clinical staging and assess novel preoperative imaging modalities that evaluate nodal involvement are indicated.
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Affiliation(s)
- Kushan Dilip Radadia
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Zorimar Rivera-Nunez
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Sinae Kim
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Nicholas Farber
- Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Joshua Sterling
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Parth K. Modi
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Goyal Sharad
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Parikh Rahul
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Robert E. Weiss
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Kim
- Rutgers Cancer Institute of New Jersey, Piscataway, NJ
| | - Sammy Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Sterling J, Rivera-Nunez Z, Farber N, Modi PK, Radadia KD, Kim S, Sharad G, Rahul P, Weiss RE, Kim I, Elsamra S, Jang T, Singer E. Treatment disparities among patients in the National Cancer Database (NCDB) with clinical TIa and TIb renal masses. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.648] [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] [Indexed: 11/20/2022] Open
Abstract
648 Background: AUA guidelines on the management of renal cell carcinoma (RCC) recommend prioritizing partial nephrectomy (PN) for the treatment of clinical T1a (cT1a) tumors, using PN for clinical T1b (cT1b) tumors when feasible, and performing minimally invasive surgery (MIS) when possible. Since cT1 RCC is a heterogeneous disease, we evaluated patterns of care in this population to examine factors associated with receipt of PN and MIS. Methods: We queried the NCDB from 2010-2014 to identify patients treated surgically for cT1N0M0 RCC. Patient socio-demographics, clinical characteristics, and treatment parameters were compared between cT1a and cT1b patients. Logistic regression models examined factors associated with receiving MIS. Results: Our population included 69,694 patients (44,043 cT1a and 25,651 cT1b). For cT1a tumors, 70% of patients received PN, while 30% received RN; 35% of patients underwent an open procedure and 65% underwent MIS. For cT1b tumors, 32% of patients received PN and 68% received RN; 38% of patients underwent an open operation and 62% underwent MIS. In both cohorts, African Americans and those earning <$62,000 were less likely to have MIS. Distance to treatment was not significant in cT1b patients, but cT1a patients who traveled >31 miles were more likely to undergo MIS. Patients treated at a community hospital were less likely to receive MIS compared to those treated at academic centers (cT1a OR: 0.48, 95% CI: 0.44-0.53 and cT1b OR: 0.63, 95% CI: 0.56-0.7). cT1a patients without private insurance were less likely to receive MIS (OR range: 0.58-0.93). However, only uninsured cT1b patients were less likely to undergo MIS (OR: 0.74, 95% CI: 0.64-0.86). Conclusions: PN occurred more frequently for cT1a (70%) vs. cT1b (32%) tumors. Most cT1 tumors received MIS; 35% of cT1a patients and 38% of cT1b patients underwent an open procedure, presenting an opportunity for improvement. cT1a and cT1b patients with lower household income, without private insurance, and those treated outside academic centers were less likely to receive MIS. Based on these findings additional research on the impact of regionalization of RCC surgery on utilization of PN vs. RN, receipt of MIS, and outcomes is warranted.
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Affiliation(s)
- Joshua Sterling
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Zorimar Rivera-Nunez
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Nicholas Farber
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Parth K. Modi
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kushan Dilip Radadia
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Sinae Kim
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Goyal Sharad
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Parikh Rahul
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Robert E. Weiss
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Kim
- Rutgers Cancer Institute of New Jersey, Piscataway, NJ
| | - Sammy Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Modi PK. EDITORIAL COMMENT. Urology 2019; 124:105-106. [PMID: 30784706 DOI: 10.1016/j.urology.2018.07.042] [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] [Received: 05/30/2018] [Revised: 06/24/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Parth K Modi
- Department of Urology, Dow Division of Health Services Research, Michigan Medicine, Ann Arbor, MI
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Farber NJ, Chuchvara N, Modi PK, Sterling J, Elsamra SE. Urologists' estimations of the cost of commonly used disposable devices. Can J Urol 2019; 26:9660-9663. [PMID: 30797249] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION To assess whether urologists are able to accurately estimate the cost of commonly used endourologic disposable devices. MATERIALS AND METHODS An anonymous questionnaire was presented to resident and attending urologists in one academic healthcare system. Respondents estimated the cost of 15 disposable devices commonly used in ureteroscopy. Twenty-five surgeons (9 resident and 16 attending urologists) participated for a response rate of 96.2%. Respondents' cost estimates were compared to actual institutional costs and considered accurate if the absolute percentage error was within 20%. Additional information obtained included: years in practice, participation in purchasing activities, practice setting, number of ureteroscopy procedures performed monthly, degree of confidence in ability to estimate cost, and the importance of cost in device selection for each respondent. RESULTS Of 375 total responses, 62 (16.5%) were accurate, 308 (82.1%) were inaccurate, and 5 (1.3%) were unanswered. The mean percentage error (MPE) for all responses was 178.8% (IQR 35.1%-211.4%). Overall, 73% of responses were overestimations and 27% were underestimations. Residents had an MPE of 128.4%, while attending urologists had an MPE of 207.8%. The most inaccurately estimated cost was for an endoscopic y-adapter, while the most accurate estimations were for a 1.5Fr nitinol ureteroscopic stone basket. CONCLUSIONS Neither attending nor resident urologists are able to accurately estimate the cost of commonly used disposable devices. Improving urologists' understanding of device costs is necessary for improved cost control and a reduction in healthcare expenditures.
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Affiliation(s)
- Nicholas J Farber
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Modi PK, Kaufman SR, Caram MV, Ellimoottil C, Shahinian VB, Hollenbeck BK. Impact of Medicare Office Visit Payment Reform on Urologic Practices. Urology 2019; 126:83-88. [PMID: 30682462 DOI: 10.1016/j.urology.2019.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/13/2018] [Accepted: 01/16/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the 2019 Medicare Physician Fee Schedule, which modifies reimbursement for office evaluation and management (E&M) visits. This policy moves payment to a single rate for levels 2 through 4 office E&M visits, regardless of complexity. METHODS Using a 20% sample of 2015 National Medicare claims, we identified urologic practices and their practice organization, academic affiliation, and degree of office focus (ie, proportion of revenues from office visits). Using billing data for each practice, we calculated the revenues expected under the current system and the new policy (both E&M payments and a new add-on code). For each practice, we determined the impact of new payment rates on total Medicare payments. RESULTS We identified 2822 practices: 1372 (48.6%) solo practices, 1033 (36.6%) multispecialty groups, 322 (11.4%) small urology groups, and 95 (3.4%) large urology groups. Under the new reimbursement rates, the median practice would have a 0.9% increase in Medicare Part B payments (range -20.4% to +50.3%) and, with the add-on code, an increase of 6.8% (range -7.5% to +74.9%). Solo practices had the most heterogeneity, with a quarter losing at least 2.3%. The median multispecialty group would increase payments by 0.4% (range -13.7% to 50.3%). However, the 107 (10.4%) academic multispecialty groups had a median gain of only 0.1% (range -2.8% to +8.1%). CONCLUSION Urology groups would, on average, benefit from the anticipated change in Medicare office E&M visit payments. However, solo practices with a high office focus and academic multispecialty practices may see reduced Medicare payments.
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Affiliation(s)
- Parth K Modi
- Division of Urologic Oncology, Department of Urology, University of Michigan, MI; Division of Health Services Research, Department of Urology, University of Michigan, MI.
| | - Samuel R Kaufman
- Division of Health Services Research, Department of Urology, University of Michigan, MI
| | - Megan V Caram
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, MI
| | - Chad Ellimoottil
- Division of Health Services Research, Department of Urology, University of Michigan, MI
| | - Vahakn B Shahinian
- Division of Health Services Research, Department of Urology, University of Michigan, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan, MI
| | - Brent K Hollenbeck
- Division of Urologic Oncology, Department of Urology, University of Michigan, MI; Division of Health Services Research, Department of Urology, University of Michigan, MI
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Modi PK, Kaufman SR, Borza T, Oliphant BW, Ryan AM, Miller DC, Shahinian VB, Ellimoottil C, Hollenbeck BK. Medicare Accountable Care Organizations and Use of Potentially Low-Value Procedures. Surg Innov 2018; 26:227-233. [PMID: 30497340 DOI: 10.1177/1553350618816594] [Citation(s) in RCA: 6] [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] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the effect of Accountable Care Organizations (ACOs) on the use of vertebroplasty and arthroscopic partial meniscectomy, 2 procedures for which randomized controlled trials suggest similar outcomes to sham surgery and therefore may provide low value. Medicare Shared Savings Program ACOs aim to improve quality and decrease health care spending. Reducing the use of potentially low-value procedures can accomplish both of these goals. METHODS We performed a retrospective cohort study of patients who underwent potentially low-value orthopedic procedures (vertebroplasty and partial meniscectomy) and a control (hip fracture) from 2010 to 2015 using a 20% sample of national Medicare claims. We performed an interrupted time-series analysis using linear spline models to evaluate the count of each procedure per 1000 patients, stratified by ACO participation. RESULTS We identified 76 256 patients who underwent arthroscopic partial meniscectomy, 44 539 patients who underwent vertebroplasty, and 50 760 patients who underwent hip fracture admission. Arthroscopic partial meniscectomy rates decreased, vertebroplasty rates remained stable, and hip fracture rates increased for both groups during the study period, with similar trends among ACO and non-ACO patients. After January 1, 2013, ACO and non-ACO populations had similar trends for vertebroplasty (ACO incidence rate ratio [IRR] = 1.15 [1.08-1.23] vs non-ACO IRR = 1.11 [1.05-1.16]), meniscectomy (ACO IRR = 1.06 [1.01-1.12] vs non-ACO IRR = 1.03 [0.99-1.07]), and hip fracture (ACO IRR = 1.08 [1.01-1.14] vs non-ACO IRR = 1.08 [1.03-1.13]). CONCLUSIONS ACOs were not associated with a reduction in the frequency of vertebroplasty and arthroscopic partial meniscectomy.
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Affiliation(s)
| | | | - Tudor Borza
- 1 University of Michigan, Ann Arbor, MI, USA
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