(241) Optimizing Care - Economic Impact of Reduced Teaching Visits After IPP Implantation
Authors: Gill B , Shin YE , Durand K , Rojanasarot S 
Published: February 2024

Abstract

Introduction
The increasing shortage of urologists has resulted in longer wait times for appointments and surgeries, causing delays in receiving care that may negatively impact quality-of-life, especially for erectile dysfunction (ED) treatment. Urologists specializing in inflatable penile prosthesis (IPP) implantation are familiar with such challenges and utilize various approaches to improve practice efficiency, including optimizing IPP teaching visits and post-operative care.

Objective
This study assessed whether reducing the number of IPP teaching visits within the immediate 90-day post-operative period may improve efficiency and enhance patient care amongst urology practices.

Methods
Using American Medical Association (AMA) resource-based relative value scale (RBRVS) data for IPP implantation [Current Procedural Terminology (CPT) 54405], a scenario analysis was constructed that assessed the effects on patient care and physician reimbursement of eliminating one 30-minute post-operative teaching visit (CPT 99213) from the average of 2.5 visits accounted for within the immediate 90-day postoperative period for CPT 54405 in RBRVS data. The efficiency impact on practices which perform 25, 50, or 100 IPP implants, annually, was modeled. The effects on patient access to care, by reapplying the time recaptured from the reduction in teaching visits, were evaluated under three scenarios: 1) the most frequent in-office CPT codes used by IPP implanters [from Definitive Healthcare 2021 commercial and Medicare claims], 2) evaluation and management of new ED patients who pursue/receive an IPP [CPT 99204 + 3x CPT 99214], and, as a control measure, 3) vasectomy procedures [CPT 55250]. Physician work time and reimbursement were conservatively estimated using 2023 Medicare Physician Fee Schedule. Changes to reimbursement if Advanced Practice Providers (APPs) in the urology practice provided post-operative IPP teaching were also modeled (data not shown).

Results
The reduction of one 30-minute post-operative IPP teaching visit for practices performing 25/50 / 100 IPP implants resulted in recapturing 750 /1,500/3,000 minutes annually, respectively. Applying this recaptured time to 1) commonly performed in-office visit types or procedures (Table 1), 2) evaluation and management of new ED patients, or 3) vasectomy translated to significant additional Medicare reimbursement, as high as $18,325 annually. At 25 IPP implants yearly, a urologist could care for an additional 13-25 patients through office visits, reaching $2,049-$2,270 in additional annual Medicare reimbursement. At 50 IPP implants yearly, clinical workups for 7 ED patients who go on to IPP implantation can result in an additional $4,125 of reimbursement, excluding any reimbursement from additional diagnostic procedures and/or downstream surgical cases. At 100 IPP implants yearly, recaptured schedule capacity can enable 37 patients for vasectomy care, resulting in a $12,563 reimbursement.

Conclusions
Regardless of IPP implant volume, practices optimizing care and achieving fewer post-operative IPP teaching visits gain additional schedule capacity that may serve more patients in the office and, potentially, the ability to treat more men with ED, including IPP implantation. These time savings and gains in practice efficiency enable implanters to manage patient demand and workload more effectively amidst the scarcity of urologists and growing wait times for care, while also helping ensure practice viability in the era of decreasing reimbursement.

Disclosure
Yes, this is sponsored by industry/sponsor: Boston Scientific - Data Acquisition, Statistical Support.
Clarification: Industry funding only - investigator initiated and executed study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.