Medium-Term Outcomes of Conservative and Surgical Treatments for Stress Urinary Incontinence: A Medicare Claims Analysis: Developed by the AUGS Payment Reform Committee.

OBJECTIVE: This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older. METHODS: This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment. RESULTS: Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons). CONCLUSIONS: In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings.

Effect of COVID-19 on Female Pelvic Medicine and Reconstructive Surgery Fellowship Education and Training.

IMPORTANCE: The COVID-19 pandemic has caused a noticeable disruption in national medical and surgical care, including medical training. OBJECTIVES: We designed a survey to examine the educational effect of the pandemic on female pelvic medicine and reconstructive surgery (FPMRS) training and secondarily to identify areas for innovation and opportunity in FPMRS fellowship training. STUDY DESIGN: We used an online survey, approved by the American Urogynecologic Society Scientific Committee and distributed it to FPMRS fellows with responses obtained and stored in REDCap. Demographic data, educational and surgical experiences, the implications of the changes, and data regarding working from home were collected. RESULTS: The survey was completed by 88 fellows, with 92% of respondents being obstetrics and gynecology- based. All 10 geographic regions had at least one response. Six regions had a 50% or greater redeployment rate. Only 16% of respondents were not redeployed or on-call to be redeployed. Eighty-five percent of the ob/gyn fellow redeployments were within their home department. There was no relationship between training region and redeployment. Only 31.7% of the respondents continued to perform any FPMRS surgery. Approximately 35% of the fellows desired the opportunity for surgical simulation training because surgical cases were reduced.No relationship was seen between either redeployment status and needs (P = 0.087-0.893) or difficulties (P = 0.092-0.864) nor training location and needs (P = 0.376-0.935) or difficulties (P = 0.110-0.921). CONCLUSIONS: There was a high rate of redeployment among fellows; however, this was not associated with their reported needs and difficulties. The FPMRS-related surgical experience was affected during this time, and the fellows desired increased surgical simulation training.

Developing an Advanced Alternative Payment Model for Stress Urinary Incontinence.

ABSTRACT: Historically, our health care system has been based on a fee-for-service model, which has resulted in high-cost and fragmented care. The Center for Medicare & Medicaid Services is moving toward a paradigm in which health care providers are incentivized to provide cost-effective, coordinated, value-based care in an effort to control costs and ensure high-quality care for all patients. In 2015, the Medicare Access and Children's Health Insurance Program Reauthorization Act repealed the Sustainable Growth Rate and the fee-for-service model, replacing them with a 2-track system: Merit-based Incentive Payment System and the advanced Alternative Payment Model (aAPM) system. In 2016, the American Urogynecologic Society Payment Reform Committee was created and tasked with developing aAPMs for pelvic floor disorders. The purpose of this article is to describe the stress urinary incontinence aAPM framework, the data selected and associated data plan, and some of the challenges considered and encountered during the aAPM development.