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

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

Journal of Urology

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 July2019-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-June2021), 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), RTþADT (n=957), and ADT/sys-temic 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

Volume

211

Issue

5S

First Page

e1211

Comments

American Urological Association Annual Meeting, May 3-6, 2024, San Antonio, TX

DOI

10.1097/01.JU.0001008808.16085.aa.07

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