The Role of Advanced Practice Providers in Urology.

The nation's undersupply of urology services disproportionately affects Medicare beneficiaries compared to the general population. Advanced Practice Providers (APPs), most commonly nurse practitioners and physician assistants may be a vehicle to meet this need. The increased use of APPs in urology is hampered by physician discomfort with delegating responsibility to APPs. This discomfort may be compounded by complexities with billing issues and interstate variation in scope of practice regulations. To expand access to urological services while simultaneously ensuring service quality, it is imperative that urologists engage with APPs individually and as a specialty.

Private Equity and Urology: An Emerging Model for Independent Practice.

Independent urology practices are under increasing competitive pressure in a changing marketplace. By providing access to capital and business management expertise, private equity can help practices consolidate and scale to unlock new growth opportunities, navigate an increasingly complex regulatory environment, and institute best practice across a network, while retaining physician ownership and an opportunity for equity appreciation. This article examines the role of private equity in urology and the potential benefits of private equity investment. It also looks at what firms look for in investment partners, how to prepare for private equity investment, and how private equity investments are structured.

Health Policy and Advocacy.

Awareness of the activities of federal and state legislative and regulatory activities is vital for physicians to avoid having their services misvalued and to protect patients' access to care. Professional organizations are encouraging physicians to develop political leadership and advocacy skills to protect patient care, research, and access to technology. The political polarization of the country and the public health emergency have had an impact on the ability and willingness of some to engage in policy discussions. This article reviews mechanisms by which urologists can engage in health policy and political activity and avenues to expand the number of urologists involved.

Current and Future Status of Merit-Based Incentive Payment Systems.

The Quality Payment Program was established by the Medicare Access and CHIP Reauthorization Act (MACRA) legislation in response to repeated efforts to create a permanent so-called doc fix in response to the failures of the sustainable growth formula. This article examines the history leading up to MACRA, the current pathways associated with the Quality Payment Program, and future expectation both from the Centers for Medicare and Medicaid Services, stakeholders, and patients.

The Cost of Prostate Biopsies and their Complications: A Summary of Data on All Medicare Fee-for-Service Patients over 2 Years.

INTRODUCTION: We define the cost of a contemporary prostate biopsy and the rate and incremental impact of complications on costs. METHODS: A retrospective analysis of all Medicare fee-for-service claims for prostate biopsies in the United States from January 31, 2014 to December 1, 2015 was performed. Costs of each biopsy episode (including 30 days after each biopsy) were calculated. The effects of complications, biopsy setting and subsequent inpatient hospitalization were explored. RESULTS: The average cost of the 234,819 biopsies reviewed was $2,020 and 46% of biopsy costs occurred in the 30 days following each biopsy. Biopsies performed in the office setting comprised 66% of the total and were least costly ($1,750) compared to biopsies performed in ambulatory surgical centers ($2,260) and outpatient hospital settings ($2,730, both p <0.001). Biopsies performed in the office setting were associated with fewer complications (10%) compared to the outpatient hospital (19%) or ambulatory surgical center settings (12%, both p <0.001). An uncomplicated biopsy episode cost an average of $1,740, which increased to $4,060 when at least 1 complication occurred (difference +$2,320, p <0.001). The largest charges incurred were related to inpatient admissions, which added $13,840 to the cost of a prostate biopsy (p <0.001) but were rare, constituting only 2.8% of biopsies. CONCLUSIONS: Nearly half of costs during prostate biopsy episodes occur due to complications that occur in the days following a biopsy. These data should be used as benchmarks to incentivize interventions to reduce complications and subsequent admissions following biopsies.

Utilization trends in prostate cancer therapy.

PURPOSE: We determined therapeutic trends in the management of adenocarcinoma of the prostate, and in the case of intensity modulated radiation therapy we investigated whether site of service influenced those trends. MATERIALS AND METHODS: A variety of CPT codes to treat adenocarcinoma of the prostate were extracted from the Medicare Part B 5% sample for the years 2006 to 2008 inclusive. Data were stratified by year, type of service and, in the case of radiation therapy, site of service. Treatment trends were calculated by indexing the total number of Medicare beneficiaries receiving a service against needle biopsies of the prostate. RESULTS: The percentage of Medicare beneficiaries receiving therapy indexed to needle biopsies of the prostate increased from 43.8% in 2006 to 49.0% in 2008. Trends in radiation and surgery were similar with 11.5% and 13% increases in each modality, respectively. Total Medicare beneficiaries receiving intensity modulated radiation therapy and laparoscopic radical prostatectomy increased by 25.4% and 22.1%, respectively, while Medicare beneficiaries treated with open radical prostatectomy and 3-dimensional conformal radiation therapy decreased by 27.9% and 37.6%, respectively. The pattern of use for intensity modulated radiation therapy was similar in physician office and hospital facility settings, increasing from 7.3% to 11.1% and 8.3% to 11.3% of Medicare beneficiaries indexed to needle biopsies of the prostate receiving intensity modulated radiation therapy at these sites in 2008, respectively. CONCLUSIONS: Treatment trends in surgery and radiation strongly favor newer technologies, and in the case of intensity modulated radiation therapy, utilization trends for treatment of adenocarcinoma of the prostate are similar across all sites of service.