Over the last 20 years, Medicare physician reimbursement rates for common urologic oncology surgeries have decreased, suggesting urologists should consider ways to cut costs, investigators reported at the 22nd annual meeting of the Society of Urologic Oncology.

Reimbursement for the 14 most common hospital-based urologic oncology surgeries based on CPT billing volume decreased by a mean 35.1% from 2000 to 2020, when adjusted to 2020 dollars, Benjamin Pockros, an MD/MBA student from Tufts University in Boston, Massachusetts, reported in a poster presentation. The 14 procedures were identified using the American College of Surgeon’s National Surgical Quality Improvement Project (NSQIP) database. They encompass prostatectomies, nephrectomies, transurethral resections of bladder tumor, cystectomies, orchiectomy, and cystourethroscopy.

During the same period, 2000 to 2020, relative value units (RVU) — which reflect physician work, practice expenses, and malpractice expenses per service and form the basis of Medicare reimbursement — increased by a mean 3.5%, “implying alternative factors are in effect,” according to investigators. They believe geographic practice cost indices and conversion factors are not adequately adjusting for inflation, which has increased 45% in the last 20 years. The conversion factor, which converts service into dollars, decreased by 4.7% over the period.

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“To remain financially viable, urologists should consider strategies to reduce costs, such as judicious use of expensive surgical equipment and performing more surgeries in ambulatory surgical centers,” Pockros’ team concluded, adding that greater advocacy for the specialty is needed. “An excellent starting place to learn more and make an impact in policy is the Annual Urology Advocacy Summit, scheduled for this upcoming March 14-16 in Washington DC.”


Pockros B, Finch D, Liang C. Trending Medicare reimbursement of the most common urologic oncology surgeries between 2000-2020. Presented at the 22nd annual meeting of the Society of Urologic Oncology. December 1-3, 2021. Poster 182.