Advanced practice providers show increasing role in urology

In this interview, Omer Raheem, MD, MSc, MCh Urol, MCRSI, highlights a study on the increasing role of advanced practice providers (APPs) in urology, specifically related to men’s health conditions, for which he served as the lead author.^1,2 Raheem is an assistant professor of surgery and urology at University of Chicago Medicine in Chicago, Illinois.

Omer Raheem, MD, MSc, MCh Urol, MCRSI

Could you describe the background for this study?

Thank you very much for the opportunity to highlight some of the findings of this paper that just published last month in the journal of Urology Practice. It was a collaborative research effort between the section of urology at the University of Chicago Medicine, the Center for Health and Social Sciences at University of Chicago, and department of urology at Baylor College of Medicine.

[As] urological care and delivery in the United States continues to evolve to meet patients' increasing needs, we are currently facing some challenges including urologist shortages, access and care delivery, and others. For example, [the] aging workforce is increasing as approximately 18% of urologists [are] aged 65 and over. [Further,] according to American Urological Association (AUA) census data, urologist burnout is estimated to be over 41%, contributing to early retirement, among other factors. Generally, the United States’ aging population [will] increase the prevalence of urologic conditions – for example, every day, there [are] over 10,000 Americans [who] turn 65, leading to the expansion of the Medicare pool, [which] could be exerting more pressure on the urologic workforce. The AUA and American Board of Urology (ABU) have continuously aimed to increase the urology residency positions to train “more urologists”, but is this enough? I am certain there is more to be addressed to mitigate some of the issues pertaining to urologic care, access, and delivery.

Certainly, the integration of advanced practice providers could represent a promising solution.The AUA has “endorsed the use of APPs in the care of patients with genitourinary disease through a formally defined, supervised role with a board-certified urologist under the auspices of applicable state law”.³

In this paper we aimed to evaluate the role of APPs for publicly and privately insured patients in the treatment of male urologic conditions commonly encountered in men's health clinics. We investigated the Medicare and commercial insurance claims from the Physician/Supplier Procedure Summary and Merative MarketScan Commercial Database. [The databases] were queried for procedures submitted by between 2010 and 2021. Common urologic conditions were identified using Current Procedural Terminology codes and grouped into 4 categories: testicular hypofunction, erectile dysfunction (ED) and Peyronie's disease, benign prostatic hyperplasia (BPH), and scrotal pain. The proportion of procedures submitted by APPs was calculated for each year and category.

What were some of the notable findings from the study?

The claims submitted by APPs treating all 4 conditions - testicular hypofunction, ED and Peyronie's disease, BPH, and scrotal pain - were higher in 2021 compared to 2010 in both publicly and privately insured groups. Specifically, there was 5-fold rise with BPH and 8-fold rise with ED/Peyronie’s disease claims.

What are some of the implications that these findings might have for patients, urologists, and APPs?

We extremely delighted that this paper was published in Urology Practice, an official journal of the AUA. This paper indeed highlights the increasing role of APPs in urology, particularly in men's health related conditions. Moreover, the integration of APPs in urologic practice could play a critical role in addressing the current urologist shortages, [issues with] access, and delivery of urological care across United States. Ultimately, this 2-way APP-urologist integration needs to be continuously evaluated, monitored, and supervised within the boundaries of the urology clinics and practices, governed by state-specific law, with the ultimate goal to improve patient care.

Is any further research on this topic planned? If so, what will that focus on?

At the University of Chicago Medicine section of urology, we are partnering with the Booth Business School at the University of Chicago through the Booth health fellowship program to address questions pertaining to assessing APP-urologist training modules, evaluating APP-urologist working schedule and revenue modules, [and] optimizing APP-urologist interactions and supervision. I think this is a very exciting development of this research aimed to optimize APP-urologist integration and standardization.

Is there anything else that you’d like to add?

We are very grateful to Urology Times for this wonderful opportunity to highlight some of this collaborative research and we look forward to providing updated findings in the near future.

References

1. Raheem OA, Xing MH, Cooper CA, Hyman MJ, Khera M, Modi PK. Increasing role of the advanced practice provider in men’s health clinics: an analysis of Medicare and commercial claims in the United States. Urol Pract. Published online May 11, 2023. Accessed June 20, 2023. doi:10.1097/UPJ.0000000000000402

2. Raheem OA, Xing MH, Cooper CA, Hyman MJ, Khera M, Modi PK. Reply by authors. Urol Pract. 2023 Jul;10(4):326. doi: 10.1097/UPJ.0000000000000402.02

3. Current state of advanced practice providers in urologic practice. American Urological Association. https://www.auanet.org/guidelines-and-quality/quality-and-measurement/quality-improvement/clinical-consensus-statement-and-quality-improvement-issue-brief-(ccs-and-qiib)/current-state-of-advanced-practice-providers-in-urologic-practice