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MP32-01: Prostate Biopsy Payments to Ambulatory Surgery Centers Stable as Physician Reimbursement Falls: Summary of Medicare Reimbursement 2012 – 2014

Saturday, May 13
9:30 AM - 11:30 AM
Location: BCEC: Room 252

Presentation Authors: Mark Henry, David Howard, Dattatraya Patil, Atlanta, GA, Benjamin Davies, Pittsburgh, PA, Christopher Filson*, Atlanta, GA

Introduction: Since the United States Preventative Services Task Force recommended against routine prostate-specific antigen screening in 2012, the incidence of prostate biopsies has dropped substantially. In addition, Medicare decreased reimbursement for ultrasound-guidance for biopsies (Common Procedural Terminology (CPT) code 76942) in 2014. In that context, we examined how Medicare reimbursement for ultrasound-guided prostate biopsies allocated to physicians and ambulatory surgery centers (ASC) changed from 2012 through 2014.

Methods: Using publically available Medicare Provider Utilization and Payment Data (2012-2014), we assessed use of and Medicare payments for transrectal ultrasound-guided prostate biopsy (i.e., CPT codes 55700, 76842, 76972) for men with fee-for-service Medicare Part B coverage. We report average and total payments for (a) providers and (b) ASCs and trends from 2012 through 2014.

Results: From 2012-2014, we identified 359,698 biopsies performed for men with Part B fee-for-service Medicare coverage. Medicare expenditures were $134.5 million ($111.4 million to physicians, 82.8%; $23.1 million to ASCs, 17.2%). Between 2012 and 2014, Medicare payments for prostate biopsies declined by $20.3 million for physicians and only $0.4 million for ASCs. The decline in payments to physicians was due to a 20.4% decline in volume combined with a decline in the median reimbursement per procedure ($405 in 2012 to $273 in 2014, p<0.001). The slight decline in payments to ASCs reflected a 7.6% decline in volume that was offset by significant increases in median payments over time ($451 in 2012 to $463 in 2014, p=0.01). Overall, the share of biopsies performed at ASCs increased from 13.5% to 15.3%, and the overall proportion of payments to ASCs increased from 14.6% to 22.4% over that same time span (Figure).

Conclusions: Policy changes related to prostate cancer screening and procedure-based Medicare reimbursement resulted in drastic decreases in reimbursement for prostate biopsies performed by providers, but not ASCs. These policies may have unintended consequences of diverting typically office-based procedures to more-costly ASCs.

Source Of Funding: Emory Urology Research Scholars Grant; Winship Cancer Institute Prostate Cancer Pilot Grant

Christopher P. Filson, MD, MS

Emory University

Biography
Christopher Filson, MD, MS, is an Assistant Professor of Urology at Emory University School of Medicine. Dr. Filson's primary clinical interest is urologic oncology (cancers involving the prostate, bladder, kidney, testes, and penis). This includes management of complex urological malignancies such as robotic prostatectomy for prostate cancer, robotic partial nephrectomy for kidney cancer, and focal therapy techniques with state-of-the-art technology. Dr. Filson is a member of the Cancer Prevention and Control research program at Winship Cancer Institute. Dr. Filson received his Medical Degree from University of Michigan in Ann Arbor, Michigan. His postdoctoral training included a surgery internship and urology residency also at University of Michigan and a Fellowship in Urologic Oncology at University of California Los Angeles.
Dr. Filson has a particular interest in science and research, and in the pursuit individualized treatments for prostate and kidney cancer. His research has received funding support from the National Institutes of Health, Urology Care Foundation and American Cancer Society. His work currently focuses on understanding how to optimize the use of active surveillance and imaging tests for men with prostate cancer.

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