Victoria S. Edmonds, MD, on reimbursement disparities for urolithiasis treatments

In this video, Victoria S. Edmonds, MD, discusses the recent Urology paper, “Trends in Patient Complexity, Practice Setting, and Surgeon Reimbursement for Urolithiasis: Do Rural Urologists Pay the Price?” Edmonds is a urology resident at Mayo Clinic in Phoenix, Arizona.

Transcription:

How might the findings of this study influence the decision-making process for urologists when considering the treatment options of ureteroscopy vs PCNL, especially in rural areas or for patients with high medical complexity?

I think it's possible that the relatively lower reimbursement for treating these more complex patients might eventually start to disincentivize urologists from taking care of those kinds of patients, particularly in rural areas, where they have less support and less resources in general. We already know that rural urology practices across the country are struggling. Rural urologists are, on average, older than their urban counterparts. They're delaying retirement, and it's felt that this could either be because of financial hardship, so they're not prepared to retire, or perhaps there's not enough junior partners coming on to sustain those practices. There are large areas of the country where patients need to drive more than 60 minutes just to see a urologist, and so I think in general, we need to be doing more to support those rural practices.

Based on the observed disparities in reimbursement, what specific policy recommendations would you propose to address the identified gaps and ensure equitable compensation for urologists performing these procedures, regardless of patient complexity or practice location?

One idea that we had in thinking about this topic in general, writing the paper, is that we know that hospital and facility payments are both risk adjusted to account for patient complexity, so more complex episodes of care are reimbursed more to the hospital or facility. But this has not been done for physician reimbursement or surgeon reimbursement in the past. So I think we could explore risk adjustment for surgeon reimbursement as a way of incentivizing providers and compensating them fairly for taking care of these more complex patients. The other thing we could think about is that there's maybe room to update and potentially reform the geographic multiplier. As of now, there are 89 payment localities across the country with different GPCIs assigned to each of them, but many of those don't really align in true differences in how rural or urban each of those localities are. For example, Arizona, where I am, has 1 GPCI for the entire state. But if you live here, you know that Phoenix is a huge metropolitan area, but there are other areas of the state that are extremely rural and extremely under resourced.

What is the take-home message for the practicing urologist?

I think just being aware of these trends is very important for urologists moving forward. I think that if we can focus collective efforts on advocating for changes in policy that will allow us to provide high-quality care across the country in a sustainable way, we would be able to make a real difference in the lives of our patients.

This transcript was edited for clarity.