Kevin Zorn, MD, on variation in BPH procedure reimbursement across Canada

In this video, Kevin C. Zorn, MD, FRCSC, FACS, describes the background and notable 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. Zorn is the founder and director of BPH Canada in Montreal, Canada.

Video Transcript:

Could you describe the background/rationale for this study?

The rationale for conducting this study was to look at the Canadian experience with TURP and the other surgical therapies like TURP, mainly in 2023. [We] work[ed] with key opinion leaders in every province to get the code. Number 1 is to show people across the world, outside of Canada, that although there is a universal health care principle, each province has its own sovereignty on choosing the code and the reimbursement for every technique. In this case, TURP, the staple BPH procedure done by all urologists––that's our bread and butter. [It] used to be the biggest number in terms of surgical therapies back in the 80s, then medications changed that. But nonetheless, to see how that did in 2023 and then also, compared to [2010], so 13 years have passed. How much change in reimbursement has there been to meet with the cost-of-living index? We wanted to look at that.

Then also, to really team into some of the more advanced techniques, [like] Greenlight for more anti-coagulated patients, it requires more training and little bit longer OR time. And [in] HoLEP, an enucleation technique designated standard of care, especially in larger prostates. We know only about 5% of urologists are offering [this] or have gone to do the necessary extra training as a fellowship to initiate this into their program. Is it equitable compared to some of the other techniques that are there? And to see, is there a designation? That was the purpose of this, to look and show what the differences are in Canada. How do things change over [13] years? And is there a designation and a respect, not an honor, but is there an initial fee for the quality, the skillset, the extra anxiety, the ergonomics, these longer OR times for these more challenging, more difficult procedures. In the States, I think they have different modifiers for those more challenging [procedures]. In this case, HoLEP, anatomic enucleation—I think everyone who's listening will agree that is by far one of the most challenging procedures—is there something specific for that procedure amongst the 10 provinces?

What were the key findings?

The first would be that amongst the 10 provinces, there's 10 different fees for a TURP. That's remained the same from [2010] to 2023. [There are] some big variances of at least 20%-30% differences between provinces—that's just for TURP. From 2012 to 2023, there's 2 provinces that had the same fee structure for physicians that had not changed. The others were all single digit percentages. Compared to the cost-of-living index, it was far inferior. It did not keep up with the cost-of-living index for the staple urological procedure. I think those are our main findings just for TURP.

[When] we look at Greenlight and anatomic enucleation like HoLEP, there's only 3 of the 10 provinces that had a designated code or a small modifier. In Quebec, they have an additional $100 if you have at least 2 or 2.5 hours of anesthesia time. Otherwise, same code as TURP. I think [that is] the key finding, is that there's a disparity. There's not an increase of reimbursement across all provinces in Canada that met up or was at par with the cost-of-living index. In the States, they have different CPT codes for individual MISTs, TURP, enucleation that have, I think, appropriate RVUs or reimbursement for those levels of challenges that is not being seen in the global components of Canadian health care.

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