Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Moderated Poster Session 1: Prostate Cancer Analyzing Recent Medicare Reimbursement Trends in Urology D. Nemirovsky 1 , J. Gong 2 , S. Wang 3 , A. Eltorai 2 , M. Siddiqui 3 1 The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; 2 Warren Alpert Medical School of Brown University, Providence, RI, USA; 3 University of Maryland School of Medicine, Baltimore, MD, USA Introduction and Objective: Understanding changes in insurance reimbursement rates is key to analyzing the sustainability of urologic practice. Unfortunately, there is a marked paucity of investigation into physician insurance remuneration trends over the last decade. Only one study has looked at recent urology insurance reimbursement rates, but the investigation was significantly limited as it only analyzed twenty current procedural terminology (CPT) codes. This study aimed to evaluate the changes in insurance reimbursement and consider possible sequelae in urology clinical practice. Methods: A multi-institution review of The Physician/Supplier Procedure Summary database for all procedures billed by urologists to Medicare Part B from 2010 to 2019 was conducted. CPT codes and reimbursement for more than 66 million approved procedures consisting of 606 unique codes were collected. CPT codes were categorized based on code ranges as defined by the American Medical Association. All monetary values were adjusted for inflation using 2019 US dollars. Results: From 2010 to 2019, average reimbursement declined by 17.9%. Among the largest decreases were in urodynamic procedures (-49.9%), endoscopycystoscopy/urethroscopy/cystourethroscopy (-27.0%), female genital procedures (-25.8%) and urethral procedures (-20.0%). Among the least affected were prostate (+0.7%) and kidney procedures (-7.5%). Conclusions: In this constantly changing healthcare environment, Medicare reimbursement for urologic procedures has shown an overall downward trend. As Medicare policies can affect both private and public insurance policies, decreasing reimbursement in urologymay have widespread impacts. Physicians should be aware of the changing landscape and the various ways it may affect their clinical practice. Racial and Stage Disparities in Increased Survival Among Patients with Metastatic Prostate Cancer in the Second-Line Antiandrogen Therapy Era I. Kim, Jr. 1 , T. Jang 2 , S. Kim 2 , D. Lee 2 , D. Kim 1 , E. Singer 2 , S. Ghodoussipour 2 , M. Aron 3 , M. Dall’Era 4 , I. Kim 2 1 Brown University, Providence, RI, USA; 2 Rutgers, The State University of New Jersey, New Brunswick, NJ, USA; 3 University of Southern California, Los Angeles, CA, USA; 4 University of California Davis, Davis, CA, USA Introduction and Objective: Since 2004, several drugs have been approved for metastatic prostate cancer including the chemotherapeutic agent docetaxel, immunotherapies, and second-line antiandrogen therapies (SATs). Given the recent advent of several SATs for metastatic prostate cancer since 2010, we hypothesized that there would be significant improvements in survival among patients with metastatic prostate cancer from the pre-docetaxel to SAT era (years 2000 to 2016). Methods: Using the SEER database, we assessed the survival outcome of metastatic prostate cancer patients based on three time periods: 2000-2003 (era 1), 2004-2009 (era 2), and 2010- 2016 (era 3). Prostate cancer-specific survival (PCSS) was estimated using the Kaplan-Meier product limit method stratified by three time periods. Age, treatment, and race/ethnicity were reported in a multivariable Cox proportional hazards model. Results: Among 41,149 patients at least 18-years-old diagnosed with distant prostate cancer between 2000 and 2016, there was a statistically significant improvement in prostate cancer-specific survival of 4 months among patients diagnosed from 2010-2016 when compared to those in the pre-2010 period. Interestingly, this survival benefit was limited to patients with bone and visceral metastases (M1b and M1c stage). Additional factors associated with improved PCSS were Hispanic ethnicity, Asian race, and receipt of local treatment. Conclusions: Collectively, our observation suggests that despite the new treatment agents such as second-line antiandrogen therapies introduced in the modern era, the improvement in survival of metastatic prostate cancer patients has been surprisingly small and observedmore in patients withM1b and M1c stages as well as Hispanic and Asian patients. MP1-12 MP1-11 10