The Variation of Chargemaster Price Listings for Urogynecologic Procedures.

IMPORTANCE: A 2018 Executive Order calling for price transparency required hospitals to publicly provide chargemasters, which are detailed lists of standard price listings for billable medical procedures. OBJECTIVES: The objective of this study was to evaluate price listing variations in common urogynecology procedures. STUDY DESIGN: This was a cross-sectional study of chargemasters obtained between February and April 2020 from hospitals across 5 states chosen to reflect the diversity of health systems in the United States. Hospital characteristic and quality metric data were obtained from the Homeland Infrastructure Foundation, U.S. Department of Agriculture, and U.S. Centers for Medicare & Medicaid Services websites. Current Procedural Terminology codes and procedure names for 9 urogynecologic procedures were used to search each chargemaster and extract price listings. Price listings were compared with data on quality, population demographics, and hospital characteristics to determine if any significant relationships existed. RESULTS: Eight hundred thirty-four chargemasters were identified. Price listings for most procedures differed significantly across the 5 states, including colpocleisis, cystoscopy with chemodenervation, diagnostic cystoscopy, diverticulectomy, sacral neuromodulation, midurethral sling, and sacrospinous ligament fixation. Price listings were significantly higher in urban hospitals than rural hospitals for 6 procedures. No significant association was seen with price listing and quality measures for most procedures. CONCLUSIONS: Listed prices varied for several urogynecologic procedures. Some of this variation is associated with hospital characteristics such as urban setting. However, notably, price listing was not associated with quality. Further investigation of chargemaster price listings with hospital characteristics and quality metrics and with what is actually paid by patients is imperative for patients to navigate charges.

Surgical Complications and Hospital Costs in Robot-Assisted Versus Conventional Laparoscopic Hysterectomy With Concurrent Sacrocolpopexy: Analysis of the Nationwide Readmissions Database.

OBJECTIVES: Despite increasing use of robotic technology for minimally invasive hysterectomy with sacrocolpopexy, evidence supporting the benefits of these costly procedures remains inconclusive. This study aimed to compare differences in perioperative complications, 30-day readmissions, and costs between robot-assisted and conventional laparoscopic hysterectomy with concurrent sacrocolpopexy using a large national database. METHODS: Using the 2009-2015 Nationwide Readmissions Database and procedure codes, we identified patients who underwent a robot-assisted or conventional laparoscopic hysterectomy with sacrocolpopexy. We measured in-hospital perioperative complications using diagnosis and procedure codes and measured 30-day readmissions based on patient linkages across hospitalizations. Hospital costs were estimated using charges and cost-to-charge ratios. These outcomes were compared between robot-assisted and conventional laparoscopic procedures using bivariate and multivariable regression analysis. RESULTS: Our weighted sample included a total of 7,675 patients. Major perioperative complications occurred in 6.7% of robot-assisted and 11.2% of conventional laparoscopic procedures (unadjusted P < 0.001; adjusted odds ratio, 0.69; 95% confidence interval, 0.51-0.93; P = 0.02). Hospital costs were higher in robot-assisted than in conventional laparoscopic procedures (respective median costs, $16,367 vs $13,898; P < 0.001), with an adjusted cost ratio of 1.24 (95% confidence interval, 1.17-1.31; P < 0.001). The risk of 30-day readmission was similar between robot-assisted and conventional laparoscopic procedures. CONCLUSIONS: Nationally representative data suggest that, in laparoscopic hysterectomy with sacrocolpopexy, the robot-assisted approach is associated with a lower risk of perioperative complications, despite higher costs, compared with the conventional one. The risk of 30-day readmission was similar between the robot-assisted and conventional laparoscopic approaches.

Virtual Interviews During COVID-19: Perspectives of Female Pelvic Medicine and Reconstructive Surgery Program Directors.

OBJECTIVE: The aim of the study was to evaluate female pelvic medicine and reconstructive surgery (FPMRS) fellowship program directors' opinions regarding the effectiveness of virtual interviews for selecting fellows and their future interview mode preferences. METHODS: This was a cross-sectional online survey of all FPMRS program directors in the United States conducted from April 29, 2020, to May 30, 2020. At the time of this study, there were 73 program directors and 69 obstetrics and gynecology and urology-accredited FPMRS programs nationwide. The primary outcome was to subjectively assess the effectiveness of virtual interviews as compared with in-person interviews for evaluating applicants. RESULTS: Fifty seven (82.6%) of the program directors completed the survey. A total of 80.7% (46/57) of the respondents had participated in interviews for the active match cycle. Of the programs that participated in the interview process, almost all conducted interviews using virtual platforms (97.8%, 45/46). Program directors who conducted interviews virtually found them effective in evaluating applicants (88.9%, 40/45) and were satisfied with the virtual interview process (86.7%, 39/45). A total of 31.1% of respondents (14/45) preferred a virtual platform to an in-person setting for future interviews, and 60% (27/45) reported that they will likely perform future interviews virtually. CONCLUSIONS: Although the pandemic resulted in a sudden reformatting of FPMRS fellowship interviews, most program directors nationally were satisfied with the process and found virtual interviews effective for assessing applicants. More than 50% of FPMRS program directors are likely to consider the virtual format for future interviews.

Trends in Surgical Exposure and Experience in Female Pelvic Medicine and Reconstructive Surgery Fellowship Programs.

OBJECTIVES: This study aimed to characterize variations in female pelvic medicine and reconstructive surgery (FPMRS) fellows' surgical experiences, concurrence with Accreditation Council for Graduate Medical Education (ACGME) proposed procedural volume guidelines, and to explore how these factors affect self-assessed preparedness to practice independently upon graduation. METHODS: An electronic survey was sent to 166 fellows enrolled in ACGME-approved FPMRS fellowship programs during the 2017-2018 academic year. The survey included questions on demographics, program specifics, desires for future practice, case volume, and self-assessed ability to independently perform selected procedures. RESULTS: A total of 99 fellows responded, yielding a 59.6% (99/166) response rate. Procedures assessed as "core" urogynecologic surgeries were midurethral sling, sacral nerve stimulator placement, abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, extraperitoneal colpopexy, intraperitoneal colpopexy, anterior colporrhaphy, posterior colporrhaphy, colpocleisis, rectovaginal fistula repair, vesicovaginal fistula repair, and urethral diverticulectomy. The percentage of third-year respondents meeting proposed ACGME guidelines varied from 56.3% (18/32; sling procedures) to 96.9% (31/32; intraperitoneal colpopexy and rectovaginal fistula repair). Although 67.7% (67/99) of all respondents reported that they did not expect to feel qualified to perform at least one of these procedures independently upon graduation from fellowship, 99.0% (98/99) predicted that they would be adequately trained overall to practice independently upon graduation. CONCLUSIONS: Surgical experience varied among FMPRS surgical fellows. Case volume was somewhat but not completely associated with self-perceived ability to practice a procedure independently.

Obstetric Fistula Repair in Sub-Saharan Africa: Partnering to Create Sustainable Impact for Patients and Trainees.

Obstetric fistula, an abnormal connection between a woman's genital tract and urinary tract or rectum, can be physically and psychosocially debilitating. We describe a sustainable obstetric fistula surgical trip model that includes providers from Women and Infants Hospital at Brown University. These surgical trips provide pre-operative, surgical, and post-operative care to patients with fistulae at Kibagabaga Hospital in Kigali, Rwanda. To ensure patients are prepared for the recovery process after fistula surgery, the team created a post-operative education curriculum that includes illustrative visual aids and teaching guides translated into Kinyarwanda, focusing on topics including urinary catheter care, wound care, and pain management. Through this program, the team is committed to restoring women's dignity through fistula repair as well as providing a model for delivery of sustainable surgical care in low-resource settings. Involvement of trainees into a global health team like this can benefit both the trainee and the patients served.