Abstracts from the New England Section of the AUA 2020: A Virtual Experience

NE AUA 2020 Abstracts Patient Desire for Disposition of Cryopreserved Sperm upon Death as a Surrogate Marker for Likelihood of Consent for Posthumous Sperm Retrieval DylanM. Buller, BA 1 , BrookeA. Harnisch, MD 1 , VikramLyall, BS 1 , Michael E. Goltzman, MD 1 , Stanton C. Honig, MD 2 1 University of Connecticut, Farmington, CT; 2 Yale University School of Medicine, NewHaven, CT Introduction: Decision-makingregardingposthumousspermretrievalcanbeethicallyand legally challenging. Most cases do not clearly delineate in writing whether the deceased would consent for sperm retrieval. Therefore, decision making is guided by hospital policy or on a case-by-case basis. Patients who cryopreserve sperm are required to decide on disposition of their cryopreserved sperm should death occur while their sperm is in storage. Patients must decide between whether sperm should be “discarded per ASRM ethicalguidelines”or“transferredtopartnerforhisorherownfamilybuildingefforts.”The objective of this study is to evaluate patient preference on consents for sperm disposition in case of death based on age, etiology of infertility, race/ethnicity, marital status, prior paternity, occupation, or insurance status. Materials & Methods: An IRB approved, retrospective chart review was conducted on patients who froze sperm from January, 2016 through October, 2019 at a single fertility center.Wereviewedthedispositionofcryopreservedspermshoulddeathoccurtoapatient. Collected data included age, race/ethnicity, occupation, insurance status, marital status and duration of marriage, prior biological children, and cause of fertility. Patients were excluded if they were not trying to get pregnant at present, prior to cancer therapy, prior to starting gender affirming treatments, or not in a committed relationship. Results: After review of 550 charts, 403 patients met criteria for inclusion. The mean age was 38.2 years +/- 6.7 (SD). Reasons for sperm cryopreservation were female factor (46.2%),malefactor(34.7%),orcombinedfactor(8.9%) infertility;adiagnosiswasunknown or unspecified in 9.4% of patients. Overall, 84.9% of patients consented to transfer their sperm to their partner in case of death. Male-factor infertility and having commercial insurance were predictors of electing to transfer sperm; there was no difference in “transfer to partner” rates with age, race/ethnicity, marital status, duration of marriage, having prior children, or occupation (Table 1). Conclusions: 84.9% of patients who cryopreserved sperm consented to transfer their sperm to their partners if death should occur. There does not appear to be a clear factor that would impact this decision, based on demographic information, prior children, or occupation. Since there is rarely written consent to perform posthumous sperm retrieval, this information is valuable in assessing whether most men who are married or in a committed relationship would consider proceeding in this fashion. This data may be useful to guide physician-institution-patient decisionmaking in these complex situations. 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 inMedicare patients. Medicare reimbursements are variable over time, and changes inMedicare compensation for sexual medicine disorders have not been previously described. Materials &Methods: Areview 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 remainedstable.ForthesurgicaltreatmentofPeyronie’s,thenumberofprovidersremained the same and the number of beneficiaries increased slightly by 12%. Charges increased by 25%andreimbursement increasedby15%(Table1).ThemedicaltreatmentofEDsawan8% 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. Conclusions: 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. 50 49 23 Scientific Session V: ED/Infertility