Characteristics of Providers Performing Urogynecologic Procedures on Medicare Patients 2012-2014.

OBJECTIVE: To analyze the characteristics of providers performing stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures in the United States. METHODS: The Centers for Medicare Services public database, released for years 2012 through 2014, was queried for SUI-related and POP-related Healthcare Common Procedure Coding System. Providers were categorized as Female Pelvic Medicine and Reconstructive Surgery (FPMRS) providers and non-FPMRS providers, using a list of FPMRS board-certified providers compiled through the American Board of Medical Subspecialties website. Other physician specialties that submitted SUI and POP procedures claims were tabulated. RESULTS: Six hundred twenty-nine FPMRS and 833 non-FPMRS providers submitted claims for SUI and POP procedures. The SUI procedures claims had the following provider specialty distribution: obstetrics and gynecology (OB/GYN)-FPMRS, 46.7%; urology, 26.3%; OB/GYN, 12.2%; and urology-FPMRS, 13.9%, with the remaining 0.9% being performed by other specialties. The POP procedures had the following specialty distribution: OB/GYN-FPMRS, 63.4%; OB/GYN, 16.7%; urology, 8.3%; and urology-FPMRS, 7.1%, with the remaining 4.5% being performed by other specialties.Provider distribution was compared between transvaginal mesh and sling insertion procedures to transvaginal mesh and sling removal procedures. The FPMRS providers claimed 63.6% of sling and transvaginal mesh insertion procedures and performed 84.9% of mesh and sling removal procedures. CONCLUSIONS: Medicare reimbursement data provides a unique insight into the distribution of provider specialties performing SUI-related and POP-related procedures in the Medicare population. The OB/GYN-FPMRS providers submitted the majority of claims for SUI and POP procedures from 2012 to 2014. The FPMRS providers are also performing the majority of mesh removal procedures.

Retropubic Midurethral Sling Colonization With Staphylococcus lugdunensis.

BACKGROUND: We present a case of Staphylococcus lugdunensis colonization of a midurethral sling. Staphylococcus lugdunensis is a common skin colonizer and has been isolated in cases of implanted prosthetic devices. CASE: A 52-year-old female presented with suprapubic pain and recurrent urinary tract infections with S. lugdunensis starting 3 months after a retropubic sling procedure. After several months of continued pain and a suspicion of a mesh-related infection, the sling was removed. Culture of the sling material grew oxacillin-susceptible S. lugdunensis. Her symptoms resolved after sling removal and a postoperative course of antibiotics. CONCLUSIONS: To our knowledge, this is the first reported case of S. lugdunensis colonization of vaginal mesh. Surgeons should be aware and knowledgeable about the possible complications arising from insertion of midurethral slings.

Vietnamese Health Care Providers' Preferences Regarding Recommendation of HPV Vaccines.

Physician recommendation is an important predictor of HPV vaccine acceptance; however, physician willingness and preferences regarding HPV vaccination may be influenced by factors including patient age, vaccine type, and cost. A cross-sectional survey was administered to a convenience sample of health care providers in Da Nang, Vietnam, to evaluate awareness, perceptions about HPV and HPV vaccines, and willingness to vaccinate a female patient. Willingness to vaccinate was evaluated using a full-factorial presentation of scenarios featuring the following factors: vaccine cost (free vs 1,000,000 VND), patient age (12, 16, or 22 years), and HPV vaccine type (bivalent vs quadrivalent). Responses from 244 providers were analyzed; providers had a mean age of 34±11.9 years; a majority were female, married, and had children of their own. Thirty-six percent specialized in obstetrics/gynecology and 24% were providers in family medicine. Of the three factors considered in conjoint analysis, vaccine cost was the most important factor in willingness to vaccinate, followed by patient age, and vaccine type. The most favorable scenario for vaccinating a female patient was when the vaccine was free, the patient was 22 years of age, and the HPV4 vaccine was described. In multivariable analysis, older age, being a physician, being married, and having children were all associated with increased willingness to recommend HPV vaccination (p<0.05). Provider willingness is an important aspect of successful HPV vaccination programs; identifying preferences and biases in recommendation patterns will highlight potential areas for education and intervention.

Compounded estradiol cream: a cost conscious alternative.

BACKGROUND: Vaginal estrogen is a common therapy for many gynecologic conditions. Medication cost poses a barrier to medication compliance. The purpose of our study is to report patient cost savings by utilizing compounding pharmacies in the preparation of topical vaginal estrogen. METHODS: A survey of 10 topical vaginal estrogen compounding pharmacies was performed and prescription cost data was obtained. The University of Oklahoma Outpatient Pharmacy and the 2008 Wolters Kluwer Health Pharmaceutical Audit Suite were cost comparisons for compounded estrogen. All data was processed using statistical software yielding descriptive statistics. RESULTS: The average cost of compounded estrogen was $42.22. At the University of Oklahoma Outpatient Pharmacy, average cost for branded vaginal estrogen preparation was $137.70. The national cost average for branded vaginal estrogen preparations was $82.42. Cost savings of $94.98 (69%) locally and $40.20 (51%) nationally was identified. CONCLUSIONS: Compounded estrogen is a cost conscious alternative than branded preparations.