Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts Concurrent Poster Session I Longitudinal Patient-Reported Outcomes Demonstrate Continued Improvements inUrinary and Erectile FunctionAfter Radical Prostatectomy Through 30 Months DanielM. Frendl,MD, PhD 1 , WesleyH. Chou, B.A. 1 ,MatthewF.Wszolek,MD 1 , Francis J. McGovern, MD 1 , Adam S. Feldman, MD, MPH 1 , Michael L. Blute, MD 1 , Jeffrey K. Twum-Ampofo, MD 1 , Marcela G. del Carmen, MD, MPH 2 , Marilyn Heng, MD, MPH 2 , Rachel C. Sisodia, MD 2 , Douglas M. Dahl, MD 1 1 Department of Urology, Massachusetts General Hospital, Boston, MA, USA; 2 Massachusetts General Hospital Physicians Organization, Massachusetts General Hospital, Boston, MA, USA Introduction: Patient-reported outcomes measures (PROMs) are a critical component for tracking quality of life and functional outcomes in patients. Urinary incontinence and sexual dysfunction are common adverse effectsmany patients experience transiently or permanently after radical prostatectomy (RP). Thus, PROMs may play a role in informing patients about expected recovery trajectories after RP. We assess long-term patient-reported return of urinary and sexual function after radical prostatectomy in routine clinical practice. Materials &Methods: The Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire was administered electronically to all patients who underwent RP at our institution in 2016 and 2017. These questionnaires were administered preoperatively and up to 30 months postoperatively. Our primary outcomes of interest were postoperative return of urinary and sexual function. We respectively defined these outcomes as either no urinary pads or use of one pad per day without overall urinary bother, as well as either erections sufficient for intercourse or erections sufficient for masturbation/foreplay without overall sexual bother. Kaplan- Meier estimators were used to evaluate time to return of these outcomes. Results: Of 634 patients who underwent RP, we included 392 (62%) who completed ≥1 questionnaire; 184/392 (47%) had both preoperative and postoperative responses. The mean age of included patients was 62.4 years (SD 6.5), with 93% of patients having undergone a nerve-sparing surgery and 38% having pathologic extracapsular (≥T3a) disease ( Table 1 ). At 12 months, unadjusted life table estimates for the likelihood of return to urinary continence was 55%, which improved to 88% and 98% by 24 and 30 months, respectively ( Fig. 1 ). For patients with good baseline sexual function who underwent nerve-sparing surgery, 24% reported return to sexual function by 12 months, improving to 57% at 24 months and 71% at 30 months ( Fig. 2 ). Conclusions: Routine electronic solicitation of PROMs in our clinical practice revealed continued improvements in continence and sexual function up to 30 months postoperatively. These findings may help inform patients regarding typical functional recovery trajectories following RP. P4 Trending Medicare Reimbursement in Urological Surgery: 2000-2020 Benjamin Pockros, BA , Daniel Finch, BA, Caroline Liang, BA Tufts University School of Medicine, Boston, MA, USA Introduction: A historical perspective of Urology reimbursement is important to inform and guide future payment policy in Urology. Physician reimbursement in the United States is largely determined by Medicare as the single largest andmost dominant healthcare payer. TheMedicare population is projected to increase by over 40% in the next decade.Analyzing reimbursement trends may help Urology practices prepare for upcoming financial changes. This study critically evaluates fiscal trends in Medicare reimbursement rates in Urological surgery over a 20-year period. Materials & Methods: The 20 most commonly billed Current Procedural Terminology (CPT) codes in Urology were queried using the American College of Surgeon’s National Surgical Quality Improvement Project (NSQIP) database. Reimbursement data from 2000 to 2020 was collected for each CPT code using the Center for Medicare Services Physician Fee Schedule Look-Up Tool. Relative Value Units (RVUs) were collected for each procedure. The change in annual reimbursement rates from 2000 to 2020 were compared with percent change in consumer price index (CPI) over the same period using a 2-tailed t test. CPI is a measure of inflation and was used to adjust all reimbursement data to 2020 US dollars. Asubgroup analysis was performed to compare the average adjusted reimbursement changes across different surgical categories, including oncologic vs. nononcologic procedures. Results: Data analysis for this study is still pending. Results will proceed as follows: Between 2000 and 2020, the mean unadjusted reimbursement rate for all included procedures * by *%. Over the same period, the CPI (a measure of inflation) increased by 52.8%, which is * compared to the change in rate of reimbursement. When all reimbursement data were corrected to 2020 US dollars to adjust for inflation, the mean reimbursement for all 20 procedures * by *%. Asubgroup analysis comparing oncologic vs nononcologic procedure reimbursement demonstrates that * experienced a larger * in adjusted reimbursement. The average total RVUs per procedure * by *% from * in 2000 to * in 2020. Conclusions: This study demonstrates that on average, Medicare physician reimbursement rates for the 20 most common Urological surgical procedures * by *% from 2000 to 2020 when adjusting for inflation. Contextualizing these changes in reimbursement is critical, given that inflation has increased by 53% over the same 20-year period and that practice expenses continue to increase. The findings of this study may be important for Urologists to consider during critical health policy decisions in the US. Urologists, policy leaders, and hospital committees shouldconsider these trendswhendevelopingnewpaymentmodels. P3 37