Kevin Zorn, MD, on the potential impact of inconsistent compensation for BPH surgery

In this video, Kevin C. Zorn, MD, FRCSC, FACS, discusses the implications of findings from the study, “An analysis of benign prostatic hyperplasia surgical treatment reimbursement trends across Canada: Examining provincial changes over the recent decade with comparison to cost of living changes,” for which he served as the senior author. Overall, the study showed variations in the reimbursement for BPH treatments across Canada, as well as rates that failed to keep up with inflation.

Zorn is the founder and director of BPH Canada in Montreal, Canada.

Video Transcript:

What are the implications of these findings?

Certainly, I think when you have these inherent challenges or biases in the reimbursement aspects, it has to beg the question, does this or how will this impact the future of acquisition or passing down of these newer technologies? Where will they fit? I believe in Manitoba, now in Quebec, they're going to be offering the Rezum MIST procedure using a code with the same reimbursement as a TURP. So, for the same urologist, or different urologist, one's going to go off and do 250 g HoLEP, a 3-hour endeavor, and then someone will go do a 5- or 6-minute Rezum, and they get paid the same reimbursement. It begs the question, will this influence the behaviors of those offering treatments? And will that impact some people to maybe abuse certain things outside of indications and against the global increase of its adoption in practice?

I think there needs to be a pause and reflection, looking at maybe designating—like in diving—degrees of difficulties. You're going to have one that's going to be more challenging than others, or another area of expertise that has to be considered. The implications, I think, that may limit or pose challenge as we introduce more of these MIST technologies—Optilume BPH, iTind, and these other techniques. They're in an orphan state, at least in Canada, not covered by most provincial coverage programs. The question is, how do you fit them in? Do you create a new slot and a new reimbursement appropriate to that and make sure that they're all balanced. What I'm seeing is a bit of an imbalance at present in where we fit this in. "Well, we'll use a TURP code." I guess that's great for the average urologist, but for those 5% of people who are brave and are leaders in advancing BPH in these more challenging, anti-coagulated, larger prostates, it's challenging. There has to be some sort of fight for them to say, "look, this doesn't make sense." The implications, I guess, are challenging as we bring on new technology and making sure that there's a fairness across the urological community in Canada.

What future work is planned based on this study?

With this data and having reached out to the individual 10 province KOLs, there's Dr Connor Forbes, who has done fellowship in HoLEP and a leader in BPH in British Columbia. He and his team have responded saying we should also do this for all therapies, including open, simple prostatectomy and other types of cost analysis and adoption across Canada. I know that they're spawning interests of doing something similar, looking at the data set of numbers of procedures performed, and seeing if some of these factors we talked about have influenced or changed adoption. Where are we at with laser? Where we at with HoLEP? To get some number of users. Is that growing? Is that remain stagnant? And how [are] all these technologies we want to bring to patients to have better outcomes, shorter recovery, longer durability, are they impeded? Because, number 1, access, and 2, interest of the surgeon for the inherent things we just talked about.

This transcript was AI generated and edited by human editors for clarity.