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Introduction: Various strategies have been explored to decrease the quantity of opioids prescribed for post-operative pain. The Michigan Opioid Prescribing Engagement Network, in partnership with BCBS-Michigan, has developed a pain optimization pathway for several surgical procedures, including prostatectomy. Urologists who follow the pain optimization pathway, which includes pre-operative patient education and limiting discharge opioids to 6 tablets of oxycodone 5 mg, can report a modifier for additional reimbursement. We explored the impact of this incentive on inpatient opioid prescribing practices following robotic assisted radical prostatectomy (RARP). Methods: Patients undergoing RARP between January 2017 and August 2019 at a single institution were retrospectively reviewed. This interval included cases both before, and after, the reimbursement incentive was implemented on July 1, 2018. Outcomes included quantity of opioid administered during hospitalization, reported in morphine milligram equivalents (MME), and average inpatient pain scores, reported with numerical pain scale. Results: A total of 300 patients underwent RARP, 209 prior to implementation of the reimbursement incentive, and 91 after. Mean MME administered during hospitalization decreased 18% after the incentive went into effect, from 73 to 54 MME (p=0.04). There was no difference in average pain scores or length of stay. Conclusion: For patients undergoing RARP, a reimbursement-based incentive tied to limiting outpatient opioid prescriptions was associated with a decrease in opioids administered during hospitalization, with no impact on subjective pain scores or length of stay. This may reflect the effectiveness of pre-operative patient education on the dangers of opioid use and alternative pain management options.


95th Annual Meeting of the North Central Section of the AUA, Chicago, IL, October 6-9, 2021.

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