Sandeep Voleti, BS, Mayo Clinic Alix School of Medicine, Scottsdale, AZ, discusses a study evaluating monetary trends in Medicare reimbursement for radical hysterectomy and prostatectomy procedures between 2010 and 2019 and comparing reimbursement rates for these open procedures to minimally invasive approaches.

This study was presented at the virtual 2021 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.

Transcript

Hi, everyone. My name is Sandeep Voleti, and I'm a second-year medical student at the Mayo Clinic Alix School of Medicine at the Arizona campus. I'm the primary author of this study that we're discussing.

A quick background about the study. We were motivated to look into reimbursement practices for oncologic procedures in gynecology and urology. We think it's really important to look at these procedures because our health care system is a very big business, and a lot of decisions are influenced by the finances of the matter. 

We thought looking at gender-specific surgeries such as hysterectomy and prostatectomy, which are very common procedures in their respective fields, might give us more insight into the finances behind both of these fields. Our main method was to look at Medicare reimbursement because that's publicly available information that we can fine-tune and analyze.

What we did with our study was we decided to look at both open and minimally-invasive approaches to radical hysterectomies with lymphadenectomy and radical prostatectomies with lymphadenectomy being the respective oncologic procedures in each of these fields.

We got the public information using CPT codes for each of these specific procedures and got their reimbursements from the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services.

We extracted the average reimbursement rate for each respective year, from 2010 to 2019, for each of these procedures. We then used the Consumer Price Index to adjust all of these values for inflation to 2020 values. 

We did a comparison across the board of all of these different procedures, with our goal being, one, to look at how reimbursement rates have generally changed over time for these procedures, two, looking at how reimbursement rates might differ between female-specific oncology procedures and male-specific oncology procedures. 

Three, we also wanted to look at differences in reimbursement between the open approach and the laparoscopic or more minimally invasive/robotic-assisted approach for these procedures to see if there were any financial incentives for the safer approach in each respective procedure.

Once we got our data pulled together and looked into a little bit more, the first thing we saw, as expected, was a decline in reimbursement rates over the past decade for all of these procedures. 

What was notable was that the biggest decrease in reimbursement rate was with the urology procedures, which was a little bit more unexpected. The literature shows that urology is often much more highly reimbursed for their procedures with the prostatectomy mainly due to increased procedure time, complexity, and the physician effort and resources put into it.

However, we did see that there was approximately a 13% decrease in hysterectomy reimbursements over the past 10 years, while it was almost in the higher 20s for urology, which is one thing that was interesting to note. Something that was more interesting to note was that there still is a pretty stark difference in the reimbursement rates between these gender-specific procedures. 

While we did see, especially 10 years ago, that there was really big difference, considering there are differences in the complexity and the resources for each of these procedures, we did see a narrowing gap, which is something that is encouraging.

Something that we thought was a little bit more interesting to dive into was the differences in reimbursement rate between the two specialties, between the open approach and the minimally invasive approach.

When we were looking at our gynecologic procedures and our hysterectomy with lymphadenectomy, our open approach had a higher reimbursement rate, even in 2019, than the laparoscopic approach did, slightly higher, but they were almost the same, almost offering no financial incentive between the two. 

Whereas in urology, there was a significantly higher reimbursement rate for the laparoscopic or minimally invasive approach to the prostatectomy vs the open approach.

Why this is important is our minimally invasive approaches tend to be more safe for the patient, have better clinical outcomes, and they tend to cost more for the hospital system, meaning we should be reimbursing them greater for this procedure. 

Furthermore, I think it does give them a little bit more of a financial incentive to take the safe approach. Our current payment structures in the US might be counterintuitively incentivizing open surgery by offering financial benefits for physicians who don't utilize the more minimally invasive approaches. 

Between 2010 and 2019, the changes in reimbursement practices have led to increasing differences in reimbursement between the open and the minimally invasive prostatectomy with lymphadenectomy, suggesting that there is a strong financial incentive to take the safer approach to prostatectomy. 

We didn't see this difference in the gynecologic reimbursement trends, suggesting that there may be a little bit more work to do there in terms of advocacy. 

We think this is really important for physicians, for health care systems, and for policymakers nationally to take into account moving forward as we try to, one, start narrowing the gender reimbursement gaps in surgery, which are definitely exacerbated, especially with these sex-specific procedures. 

Two, looking at what's best for our patient outcomes and our patient safety, offering those financial incentives to make sure that our physicians and our patients are benefitting at the same time. At the end of the day, the needs of our patient do come first, and their safety should always be the top priority.

Voleti SS, Newman HR, Ghaith S, et al. Comparison of radical hysterectomy with pelvic lymphadenectomy and radical prostatectomy with lymphadenectomy: Medicare reimbursement 2010-2019. Presented at: the virtual 2021 SGO Annual Meeting on Women’s Cancer; March 19-25, 2021.

Mr Voleti reports no relevant financial relationships.