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New England Section of the American Urological Association

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A Novel Evaluation of Medicare Reimbursement for Commonly Treated Sexual Medicine Conditions
Lael Reinstatler, MD, MPH, Martin Gross, MD.
Dartmouth Hitchcock Medical Center, Lebanon, NH.

Introduction: Sexual medicine conditions commonly occur in Medicare patients. Medicare reimbursements are variable over time, and changes in Medicare compensation for sexual medicine disorders have not been previously described.Methods: A review of provider utilization and Medicare reimbursement for common procedures in sexual medicine was performed via review of publicly available CMS (Centers for Medicare & Medicaid Services) data. Results: From 2012-2016, utilization and reimbursement trends for medical and surgical management of Peyronie's disease, Erectile Dysfunction (ED), and Incontinence were examined. Over the time period, there was a 56% increase in providers for medical treatment of Peyronie's disease and a remarkable 86% increase in beneficiaries while the average submitted Medicare charge decreased by 10% and the average reimbursement remained stable. For the surgical treatment of Peyronie's, the number of providers remained the same and the number of beneficiaries increased slightly by 12%. Charges increased by 25% and reimbursement increased by 15% (Table 1). The medical treatment of ED saw an 8% increase in providers, a 10% increase in beneficiaries, a 5% decrease in submitted charges, and a 24% decrease in reimbursement. Surgical treatment of ED saw an 8% decrease in providers, a 5% decrease in beneficiaries, an 8% increase in submitted charges and a 33% increase in reimbursement. In the surgical treatment of male incontinence, a 17% decrease in providers was seen compared to a similar 20% decrease in beneficiaries with a 50% increase in submitted charges, and a 25% increase in reimbursement.Conclusion: An assessment of CMS data indicates that there has been a robust increase in the treatment of Peyronie's disease with only a slight change in the reimbursement. This is in contrast to the management of ED which has seen an increase in medical management with a decrease in reimbursements compared to a decrease in surgical management with an increasing reimbursement. In the final category, male incontinence, there was a 20% decrease in both providers and beneficiaries with an increase in charges and reimbursement. These data are informative in that demand (as defined by providers and beneficiaries) does not seem to correlate with Medicare patterns of reimbursement. Acknowledgements: NoneTable 1. CMS Patterns for Treatment of Peyronie's Disease

YearNumber ProvidersNumber BeneficiariesAverage ChargeAverage Payment
Medical Treatment of Peyronie's Disease
2012430806713.54143.14
2013381676602.82138.90
2014485948678.38145.40
20156261452659.09144.56
20166751504642.62142.69
Surgical Treatment of Peyronie's Disease
201245111407444.301447.81
201346812057274.931374.65
201439010557085.551305.84
201540810918062.181406.87
201645012839347.801691.78


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