
AUA '17 puts emphasis squarely on 'value'
In this article, members of the Urology Times editorial advisory board weigh in on the themes and specific sessions that annual meeting attendees should watch for across a variety of health policy and clinical topics.
Cost. Quality. Value. These terms are not new to urologists, but at this year’s AUA annual meeting in Boston, the degree that these buzzwords permeate the meeting program is unprecedented.
Of course, the emphasis on value-based care is no accident. It is what drives physician reimbursement under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which rewards providers for better value through the Quality Payment Program. (Also see,
“In contrast to years past, when there was an effort to divide cost and quality of care issues from the science of urology, this year’s meeting emphasizes many aspects of health policy impact across all elements of urologic care delivery and across all formats of the program: plenary sessions, moderated posters, instructional courses, and specific forums,” said Jeffrey E. Kaufman, MD, a urologist in private practice in Orange County, CA. “It’s a reflection of how important considerations of value, cost, and quality have become that they’re integrated into everything we do.”
Dr. Kaufman and other members of the Urology Times editorial advisory board weighed in on the themes and specific sessions that annual meeting attendees should watch for across a variety of health policy and clinical topics. Their insights follow.
Jump to a topic:
Health Policy
Dr. KaufmanReviewing the wealth of presentations on health policy issues at this year’s meeting “is like giving an overview of the entire meeting agenda,” Dr. Kaufman said. “Issues ranging from quality metrics, cost considerations, outcomes, enhancing practice efficiency, coding and reimbursement, integrated use of APNs/PAs in practice, contracting, medicolegal concerns-even a discussion on enhancing creativity and developing intuitive abilities-are integrated into the program.”
Of special interest, he said, are the Practice Management Course (separate registration required) that takes place Thursday and Friday at the Hilton Boston Logan Airport Hotel and several courses related to advanced practice nurses and physician assistants, including instructional courses on how best to integrate these providers into your practice. Other popular courses, reprised from prior years, include those on contract negotiation and an update on coding and reimbursement.
“Several moderated posters address the increasing use of PAs in urologic surgery, use of scribes to facilitate EHR use, and quality of life and shared decision-making practices, in addition to others on value of care,” Dr. Kaufman said. “For those who feel the presentations can be overwhelming, there is even a discussion of international urologist burnout.”
Epidemiologic Trends/Quality, Patient Safety
Dr. WolfNew findings about telemedicine, urologists’ role in quality improvement efforts, and the success (or lack thereof) of quality reporting programs are key topics to watch for in the poster and podium sessions on General Epidemiologic Trends/Value, Quality Improvement and Patient Safety, according to J. Stuart Wolf, MD, professor of urology at The Dell Medical School at the University of Texas, Austin.
Regarding these themes, Dr. Wolf said: “Telehealth, which is becoming increasingly supported at the regulatory level, has great potential to improve the cost-effectiveness of health care. Systematically engaging urologists in quality improvement efforts aimed at reducing cost and/or improving processes of care has demonstrated positive effects. Some federal quality reporting programs are effective and some are not.”
Specific abstracts will examine the cost-effectiveness of telehealth in the evaluation of hematuria, patients’ opinion of the United Kingdom’s “Consultant Outcome Publication” regarding individual surgeons’ outcomes, the relationship between the Centers for Medicare & Medicaid Services’ new Hospital Compare ranking system and outcomes after major urologic cancer surgery, whether individualized physician feedback improves adherence to a value-based care pathway, and the effect of the Hospital Readmission Reduction Program on targeted and non-targeted surgical conditions.
Here are the abstracts to watch for in this area, according to Dr. Wolf:
Vitaly Zholudev
Marc Williams
Deborah R. Kaye
Alan L. Kaplan
Tudor Borza
Epidemiologic Trends/Practice Patterns, Quality of Life
Dr. AlbertsenThree-year functional outcomes after commonly used treatments for localized prostate cancer, antimuscarinic use in the elderly, and a financial analysis of scribe use in ambulatory urologic practice are among the top papers in the “General & Epidemiologic Trends & Socieoconomics: Practice Patterns, Quality of Life and Shared Decision Making” portion of the program. That is the assessment of Peter C. Albertsen, MD, chief of urology at the University of Connecticut Health Center, Farmington.
These are the abstracts Dr. Albertsen says to watch for at this year's meeting:
Daniel Barocas
Daniel Pucheril
Mark Henry
Lindsey Herrel
Madeline Cancian
Kian Asanad
Prostate Cancer Markers/Surveillance
Dr. LoebDevelopments in markers for prostate cancer and active surveillance for men with low-risk disease continue to be major topics at the AUA annual meeting, says Stacy Loeb MD, MSc, assistant professor of urology and population health at New York University Langone and the Manhattan VA, New York.
“Several new serum and urine markers are being presented for use in prostate cancer diagnosis and prognostication. For men with prostate cancer, multiple studies look at the use of genomic tissue tests (eg, Prolaris, Oncotype Dx, and Decipher) to improve patient selection for upfront treatment versus active surveillance, or for decisions about secondary therapy,” she said.
Other major biomarker-related themes are the utility of commercially available markers in African-American men, the incremental value of marker tests in the context of multiparametric MRI, and the role of markers in advanced disease.
While active surveillance is now the recommended management option for most men with low-risk prostate cancer, some studies suggest that it remains underutilized in the United States, Dr. Loeb pointed out.
“Correspondingly, several studies attempt to define potential barriers to surveillance among health care providers and patients, such as the risk of prostate biopsy complications,” she said. “For men who choose active surveillance, look out for numerous studies on the role of MRI during follow-up and what is the optimal biopsy protocol to use.”
Specifically, Dr. Loeb pointed to these abstracts in the area of prostate cancer markers/surveillance:
Gregg Eure
Patrick Hurley
Melanie Adamsky
John Burns
John L. Gore
Björn Löppenberg
Edward Chang
Ahmed El Shafei
Localized Prostate Cancer Treatment
Dr. GomellaHow MRI use affects management of localized prostate cancer and the nuances of focal therapy are two of the hot topics in localized prostate cancer at this year’s meeting, according to Leonard G. Gomella, MD, professor and chairman of urology at Thomas Jefferson University, Philadelphia.
“The robot frenzy seems to be dying down and the interest in focal therapy seems to be the flavor of this year’s group of AUA papers,” Dr. Gomella said.
Here are Dr. Gomella's abstract picks in localized prostate cancer treatment:
Joseph A. Baiocco
Arjun Sivaraman
Arjun Sivaraman
Alexander Kenigsberg
Alessandro Branchi
Toshikazu Takeda
Vidit Sharma
Eric Kim
Khaled Refaai
Nazareno Suardi
Advanced Prostate Cancer
Dr. ThrasherJ. Brantley Thrasher, MD, pointed out several high-interest abstracts related to advanced prostate cancer treatment and prognosis, including a study comparing the time period from initiation of androgen deprivation therapy (ADT) to salvage chemotherapy in African American and Caucasian men with castrate-resistant disease, an investigation of metformin’s effect on survival in men receiving ADT, and multiple studies on whether the addition of radical prostatectomy to surgical castration improves survival in node-positive patients.
“Attendees will see a number of abstracts reviewing serum testosterone levels prior to and after ADT and the prognostic implications of these levels on patients with advanced disease,” said Dr. Thrasher, professor of urology at the University of Kansas Medical Center, Kansas City. “Also, several abstracts outline the use of radical surgery locally or at distant metastatic sites as an adjunct and the long-term oncologic outcomes. Multiple abstracts address the impact of ADT on multiple metabolic markers and medications that may affect the metabolic changes.”
Here are Dr. Thrasher's abstract picks in advanced prostate cancer:
Maria Uloko
Kyle Richards
Bimal Bhindi
Alaa Hamada
Thomas Seisen
William R. Boysen
Nicole Engel-Nitz
Stone Disease
Dr. MatlagaThree major themes emerge from the meeting’s sessions on surgical treatment of stone disease: the role of single-use ureteroscopes, hospital readmissions after stone surgery, and stone-free rate-as defined by computed tomography-after ureteroscopy. So says Brian R. Matlaga, MD, MPH, professor of urology at the Johns Hopkins University School of Medicine in Baltimore.
“Although single-use ureteroscopes have been around for some time, the recent introduction of a digital single-use ureteroscope has generated great interest in defining the role of these devices in clinical practice,” Dr. Matlaga said. “The podium and poster sessions at this year’s meeting will feature studies that will provide a better understanding of how these devices may fit into a urology practice.
“There are multiple studies which will nicely detail the clinical efficacy of these devices, characterizing how they may function in the surgical environment, he said, adding that other studies will provide an important understanding of how the cost of a single-use endoscope will affect the economics of a ureteroscopic procedure.
“The present health care environment is placing an increasing emphasis on the postoperative experience, particularly with regard to emergency department utilization and hospital readmission, following ureteroscopy,” Dr. Matlaga pointed out. “The annual meeting program has several studies which utilize large-scale datasets to provide better context for this increasingly important metric.”
In addition, studies will discuss stone-free rate, one of the primary criteria for treatment success with ureteroscopy.
“The published literature has great heterogeneity in the way in which stone-free is defined,” Dr. Matlaga said. “At the annual meeting, two centers will report on their stone-free outcome following ureteroscopic stone treatment. The unique nature of these studies is twofold: meticulous attention was paid to complete stone fragment extraction, and the stone-free outcome was rigorously defined with CT imaging.”
Specifically, these are the stone disease abstracts to take note of at this year's meeting, according to Dr. Matlaga:
Grzegorz Fojecki
Saum Ghodoussipour
Thomas Chi
Manint Usawachintachit
José A. Salvadó
Graham Machen
Kefu Du
Noah Canvasser
Nadya E. York
BPH/LUTS
Dr. Kaplan“This year’s abstracts in BPH are notable for examination of large databases in the use of both medical and surgical therapy for BPH,” said Steven A. Kaplan, MD, professor of urology, Icahn School of Medicine at Mount Sinai, New York. “There will be many presentations on the long-term use of laser and electrosurgical therapy. Updates on minimally invasive surgical alternatives including Rezum, UroLift, and Aquablation will be presented.
“Finally,” Dr. Kaplan said, “long-term data and adverse events of medical therapies for BPH as well as their predictive role in surgical therapy will be presented.”
Below are the BPH/LUTS abstracts to watch for at this year's meeting:
Jeffrey Leow
Bruce Kava
Katrina Hagberg
Peter Gilling
Nikhil Gupta
Christian P. Meyer
Sexual Dysfunction
Dr. BurnettIn reviewing the abstracts on sexual dysfunction, Arthur L. Burnett, II, MD, MBA, said several exciting presentations will be delivered on a range of sexual medicine topics.
“Penile prosthetics remain an area of focus,” said Dr. Burnett, professor of urology at Johns Hopkins University, Baltimore. “Highlights include presentations on: patient and disease risk factors as well as clinical practice trends that impact surgical outcomes; biomechanical properties and performance characteristics of prosthetic devices; and new prosthetic materials and design features as well as innovative surgical techniques.”
Male hypogonadism also continues to be a major area of interest, Dr. Burnett noted. “Presentations of particular interest center on: long-term studies and registry data pertaining to the indications, safety, and efficacy of testosterone therapy; and clinical and genetic associations for testosterone deficiency,” he said.
“Peyronie’s disease is a major condition with presentation highlights to include: studies on natural history and patient clinical characteristics and analyses of protocols and trends in utilization of surgery and intralesional collagenase clostridium histolyticum (XIAFLEX) therapy.”
Here are Dr. Burnett's abstract selections in sexual dysfunction:
Nancy Wang
Michael J. Lipsky
Osama Abdelwahab
Mohamad Habous
Michael Benson
Matthew Panizzon
Pediatric Urology
Dr. KoganStudies on various aspects of vesicoureteral reflux, circumcision’s effect on urinary tract infection in patients with hydronephrosis, an inguinal approach to ureteral reimplantation, and testing for adolescent varicocele are among the top abstracts in pediatrics this year, according to Barry A. Kogan, MD.
“Urinary tract infection and reflux continue to me topics of major interest in pediatric urology,” said Dr. Kogan, chief of urology at Albany Medical College, Albany, NY. “This is despite the fact that most clinicians feel reflux is not as significant a problem as we felt years ago. Clearly the biggest challenge is ‘risk assessment.’ We all want to limit workup and treatment to those of highest risk, and that is the subject of a number of abstracts.
“Testicular problems are also high on the list of interesting topics,” Dr. Kogan said. “This is particularly true for the topic of adolescent varicocele. We are still very anxious to find a test that will help determine who would benefit from early repair. Several abstracts help us to evaluate this question.”
Here are the abstracts Dr. Kogan says to watch for at this year's meeting:
Zhan Tao (Peter) Wang
Jonathan Ellison
Adam S. Howe
Kevin Ginsburg
Madeline Cancian
Bradley Morganstern
Interstitial Cystitis/Bladder Pain Syndrome
Dr. HannoThe 2017 AUA annual meeting “highlights how clinicians and investigators around the world are trying to move the field of bladder pain syndrome ahead,” said Philip M. Hanno, MD, MPH, clinical professor of urology at Stanford University School of Medicine, Stanford, CA. “The program committee scheduled both a podium session and a poster session focusing on the subject and including a total of 31 presentations combined.
“For the clinician, you may learn how safe and effective it is to limit botulinum toxin injections to 100 units confined to the trigone,” Dr. Hanno said.
“You will learn if the commonly held belief among patients and providers that recurrent hydrodistention tends to damage the bladder is true, and how often non-Hunner disease ‘progresses’ to Hunner type ESSIC 3C disease,” he added.
Meeting attendees should also watch for the presentation of data on the treatment of Hunner lesions with steroid intralesional injection.
“How good are you at predicting a Hunner lesion when you first see a patient? The answer may surprise you,” Dr. Hanno said.
Below are Dr. Hanno's abstract picks from this year's IC/BPS program:
Rui Pinto
Rita Matos
Peter Kirk
Laura Mateu Arrom
Elke Hessdorfer
H. Henry Lai
Infertility
Dr. HotalingThe top abstracts in infertility at the 2017 meeting discuss “novel uses of male androgen profiles and manipulations to help prognosticate and treat male factor infertility, profiling and culturing of human spermatogonial stem cells, and molecular profiling of men with nonobstructive azoospermia,” said James M. Hotaling, MD, MS, assistant professor of surgery (urology) at the University of Utah Health Care, Salt Lake City.
Specific meeting abstracts of interest, Dr. Hotaling pointed out, will examine the cost-effectiveness of fertility preservation in testis cancer patients, sex hormone-binding globulin as an independent predictor of oligospermia, how advanced paternal age will impact the next generation, and the effect of fellowship training on microsurgical operations for infertility.
Here are the infertility abstracts to watch for at this year's meeting, according to Dr. Hotaling:
Kirven Gilbert
Joshua Ring
Jiang Zhu
Dane Johnson
Female Urology
Dr. RazNew research in the area of female urology, including urodynamics and voiding dysfunction, will highlight two alternatives to tibial nerve stimulation presented at the meeting, according to Shlomo Raz, MD, professor of surgery/urology at the UCLA School of Medicine, Los Angeles.
“Posterior tibial nerve stimulation (PTNS) is used in the treatment of overactive bladder. The treatment requires frequent office visit and time off for weekly treatments,” Dr. Raz said. “Two alternatives are being presented at the meeting. One uses surface electrodes (similar to EKG pads). This is what I use in my practice. The patient buys a transcutaneous electric nerve stimulator unit ($30 at Amazon) and uses the tibial stimulation at home.
“The other paper describes the use of a small permanent implant in close proximity to the tibial nerve, eliminating the need of office treatments and insertion of acupuncture needles,” he said.
Dr. Raz also said meeting attendees should keep an eye out for abstracts discussing the use of physical therapy for pain and voiding symptoms in women with pelvic pain, effects of bariatric surgery on female pelvic floor disorders, and whether mid-urethral position is critical for continence following sling placement.
Here are Dr. Raz's can't-miss abstracts in female urology from this year's meeting:
Natalie Gaines
Asnat Groutz
Janine Oliver
Christopher J. Chermansky
Karl-Dietrich Sievert
Trauma/Reconstruction
Dr. MoreyData on the risk of complications related to delaying urethroplasty in patients with urethral stricture will be the focus of two key studies from the trauma and reconstruction poster and podium sessions, said Allen F. Morey, MD, professor of urology at UT Southwestern Medical Center, Dallas.
“Evidence indicates that urethral stricture patients not treated by early urethroplasty experience more complications,” Dr. Morey said.
Other high-interest abstracts in the trauma/reconstruction space include those discussing endoscopic realignment for pelvic fracture urethral injuries, outcomes of endoscopic treatment of stricture recurrence after urethroplasty, and perinephric hematoma size as an independent predictor of the need for urologic intervention in blunt renal trauma.
These are the key abstracts in trauma/reconstruction this year:
Paul H. Chung
Shyam Sukumar
Hoy Nathan
Boyd Viers
Logan Zemp
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