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    Urologists show low adherence to value-based care pathway

    Urologists’ adherence to value-based care pathways (VBCP) for BPH surgery is extremely low and only modestly improved when they are given individualized feedback on patient outcomes, costs, and practice patterns relative to peers, according to a study presented by University of California Los Angeles (UCLA) researchers at the AUA annual meeting.

    “Since passage of the Affordable Care Act, there has been a lot of talk about the need to transition from fee-for-service to value-based care. The results of our study show that we still have a long way to go before we reach that goal,” said first author Alan L. Kaplan, MD, of UCLA.

    “Furthermore, our research indicates that merely showing surgeons how they are performing compared to their colleagues, a strategy that might drive change through competition, is not enough to meaningfully move behavior toward a VBCP for BPH surgery. Clearly, more powerful incentives than data feedback are needed.”

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    A VBCP for BPH surgery was introduced at UCLA in April 2014. Designed to include the mix of preoperative testing and surgery that would provide the highest quality care at the lowest cost, it requires PSA testing when indicated, urinalysis, and post-void residual measurement preoperatively and use of bipolar transurethral resection or vaporization as the surgical option.

    “Cystoscopy and urodynamics are not included in the VBCP as UCLA data, which were presented at this year’s AUA meeting, show these invasive tests fail to improve outcomes but greatly increase cost,” Dr. Kaplan said.

    Since the BPH surgery VBCP was released, all urologists receive a confidential, quarterly report card by email that contains data on their outcomes, costs, and practice pattern (VBCP adherence) compared to de-identified colleagues.

    To study adherence to the BPH surgery VBCP and determine if it was affected by the surgeon-specific feedback, adherence rates for 18 urologists were analyzed at baseline, 6 months, and 12 months after implementation of the quarterly report program. A similar analysis was performed for adherence to the AUA-recommended pathway for BPH, which is less stringent than the UCLA VBCP because it is silent on both preoperative invasive testing and operation of choice.

    Next: Compliance with UCLA VBCP 5% at 6 months

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