In this interview, Kevin M. Wymer, MD, shares the take-home messages from the recent Urology paper, “Evaluation of Private Payer and Patient Out of Pocket Costs Associated with the Surgical Management of Benign Prostatic Hyperplasia.” Wymer is an assistant professor of urology at Mayo Clinic in Rochester, Minnesota.
I'd love to say, "Yes, I can incorporate these into my daily practice." And I think a fair answer would be on a large scale, yes. But really, when it comes to patient-by-patient discussions, [I would say] no. These data are too 50,000-foot view for me to say, when I go into a patient room, "These are how costs are going to factor into your surgical decision." Now, I think from a large end, I can say there are going to be significant variations in your out-of-pocket costs, and it's important to think about that not only in the short-term setting, so this year, where are you at with your out-of-pocket max, your deductible, your premium and all of that, and how does this surgery [affect] that, but over the next [several] years, there are probably going to be differences in what you'll pay. So to that extent, on a large scale, yes, but where I see this going in the future is trying to get that to be more the case where we can incorporate this. The idea of price transparency is obviously somewhat of a hot topic. There was the CMS final rule that came out in 2021 mandating some level of price transparency, but the follow-through on that has been weak at best. But ultimately, if we can get to a point where we can accurately tell patients what their out-of-pocket costs are going to be based on their specific health plan factors, which vary widely, and the specific surgeries that they're choosing from, I think it will help them make that decision. Whether or not we like it, cost is a big part of that decision for a lot of patients. And I think it will help to better align what patients actually want with what they are paying for and what we as a health system are paying for. So that on one level, and then more broadly, the second part of that being policy changes, reimbursement changes. So these cost data impacting individual choices eventually, but also impacting policy-level choices in the long term.
Again, I think these are early data venturing into cost as a factor for BPH surgery and as urologists for other clinical decisions as well. I think my main takeaway would be cost matters, again, whether we like it or not, and it's something that a lot of us are not familiar with, but it's going to probably become more important both for patients and for policy. And we as clinicians and urologists should be part of that discussion and part of that decision. If we're going to have to, at some point, make changes with reimbursement and compensation and incentivizing certain things, we are the ones with the best knowledge, as far as what procedures are best for our patients [and] what procedures warrant the highest reimbursement. We need to be at the table for that, and having an understanding of some of these types of data will be helpful to at least have some sort of evidence-based, outcomes-based metrics to use in those discussions.
My main take-home here is this is sort of getting in entry-level cost data, but I see 2 big implications. How is this going to impact patient decisions and how do we incorporate price transparency into patient decisions? And then how can we use outcomes-based data and costs to inform policy guidelines and reimbursement?