Pd57-07 Impact of Quality Improvement Initiative Tied to Value-Based Reimbursement Metric on Salvage Therapy Utilization After Radical Prostatectomy

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (PD57)1 May 2024PD57-07 IMPACT OF QUALITY IMPROVEMENT INITIATIVE TIED TO VALUE-BASED REIMBURSEMENT METRIC ON SALVAGE THERAPY UTILIZATION AFTER RADICAL PROSTATECTOMY Arsyad Santosa, Apoorv Dhir, Kevin Ginsburg, Tudor Borza, Anna Johnson, Robert Dess, Patrick Lewicki, Arvin George, Mohammad Jafri, Brad Rosenberg, Daniel Spratt, Todd Morgan, and for the Michigan Urological Surgery Improvement Collaborative Arsyad SantosaArsyad Santosa , Apoorv DhirApoorv Dhir , Kevin GinsburgKevin Ginsburg , Tudor BorzaTudor Borza , Anna JohnsonAnna Johnson , Robert DessRobert Dess , Patrick LewickiPatrick Lewicki , Arvin GeorgeArvin George , Mohammad JafriMohammad Jafri , Brad RosenbergBrad Rosenberg , Daniel SprattDaniel Spratt , Todd MorganTodd Morgan , and for the Michigan Urological Surgery Improvement Collaborative for the Michigan Urological Surgery Improvement Collaborative View All Author Informationhttps://doi.org/10.1097/01.JU.0001008808.16085.aa.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite guideline recommendations in support of salvage radiotherapy (sRT) for patients with biochemical recurrence (BCR) following radical prostatectomy (RP), previous investigations have shown low utilization. In 2019, we initiated a quality improvement strategy to increase rates of sRT, coupling an educational initiative to a value-based reimbursement (VBR) metric in collaboration with Blue Cross Blue Shield of Michigan (BCBSM). We report the impact of this strategy on salvage therapy utilization. METHODS: The Michigan Urological Surgery Improvement Collaborative (MUSIC) and BCBSM developed a VBR metric to align reimbursement with quality of care. This was applied for sRT from July 2019-June 2021 and coupled with educational sessions. Here, we identified MUSIC patients who underwent RP from 2012-2023 and met the following criteria: PSA ≥0.1 after 30 days post RP and at least 1 follow-up PSA or initiation of treatment after the detectable PSA. Patients who received treatment before RP or prior to the detectable PSA were excluded. The primary outcome was the Kaplan-Meier probability estimate of sRT at 1 year. The probability of any salvage therapy was also assessed. Time periods were categorized as pre-VBR (2012-June 2019), VBR (July 2019-June 2021), and post-VBR (July 2021-2023). RESULTS: The cohort consisted of 5,811 patients with a median age of 64 yrs (IQR 59-69) and median time from RP to detectable PSA of 4.4 mo (1.6-17.4). A total of 2,533 underwent any salvage therapy, consisting of RT (n=469), RT+ADT (n=957), and ADT/systemic therapy (n=1,107). Median PSA at sRT initiation was 0.5 ng/mL (0.2-1.9) pre-VBR, 0.4 ng/mL (0.2-1.5) during the VBR, and 0.4 ng/mL (0.2-1.9) post-VBR. The 1-year probability estimate for sRT was 26% pre-VBR, 28% during the VBR, and 36% post-VBR (p<0.001; Figure 1). The 1-year probability estimate for any salvage therapy was 42% pre-VBR, 43% during the VBR, and 55% post-VBR (p<0.001). CONCLUSIONS: Rates of salvage therapy changed little initially but increased significantly over time. These data suggest that the salvage therapy initiative, employing both educational and reimbursement strategies, was ultimately successful at improving the delivery of guideline concordant care in this setting. Download PPT Source of Funding: Funding from Blue Cross Blue Shield of Michigan © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1211 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Arsyad Santosa More articles by this author Apoorv Dhir More articles by this author Kevin Ginsburg More articles by this author Tudor Borza More articles by this author Anna Johnson More articles by this author Robert Dess More articles by this author Patrick Lewicki More articles by this author Arvin George More articles by this author Mohammad Jafri More articles by this author Brad Rosenberg More articles by this author Daniel Spratt More articles by this author Todd Morgan More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...