Economic Trends of Endourologic Surgery Reimbursement Demonstrates Increased Profitability for Healthcare Systems
Ohad Kott, MD, Christopher Tucci, RN, Gyan Pareek, MD
Minimally Invasive Urology Institute, The Miriam Hospital; Department of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
BACKGROUND: Nephrolithiasis afflicts 11% of the United States population. The utilization of endourological procedures for nephrolithiasis has increased in the past decade. Concurrently, the number of practicing urologists per capita is declining and practice trends are shifting towards large grouppractices and integration into large hospital systems. In these shifting settings, urologists need to know their value to a healthcare system. As such, we sought to evaluate the economic impact of endourological procedures on a healthcare system. By understanding these financial trends, urologists may better understand their downstream value and empower themselves during contractual negotiations.
METHODS: We reviewed hospital records for ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) cases performed between January 1, 2013 - August 1, 2018. Medicare reimbursement data for the years 2013 - 2016 was reviewed for URS CPT codes 52353, 52356 and DRG code 669 as well as PCNL CPT codes 50080, 50081 and DRG code 660. We combined Medicare reimbursement data with a model developed to evaluate non-Medicare reimbursement.
RESULTS: Medicare reimbursement for outpatient URS increased 16% from $3457 in 2015 to $4027 in 2018, while inpatient reimbursement increased 15% from $9430 in 2015 to $10867 in 2018. Annual URS case volume at our institution increased 100% from 222 in 2013 to 443 in 2016. Annual gross reimbursement for ureteroscopy procedures is expected to reach $3.12 million in 2018. Medicare reimbursement for outpatient PCNL increased 139% from $3457 in 2015 to $8254 in 2018. However, for inpatient cases it decreased 1% from $14067 to $13996 during the same time period. Annual PCNL case volume at our institution increased 78% from 77 in 2013 to 137 in 2016. Annual gross reimbursement for PCNL is expected to reach $2.24 million in 2018.
CONCLUSIONS: Our data demonstrates that approximately $6 million in reimbursement per year is being generated from endourological care alone at our institution. This figure does not include revenues generated downstream from endourological care like visits, diagnostic tests, consultations etc.
It is critical for urologists to empower themselves with financial knowledge of their downstream value to the healthcare systems, especially during compensation discussions.
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