The use of TAP based on rectal swab testing significantly lowered our infectious complication rate for TRUSBx. TAP is now adopted as standard practice before TRUSBx in our center. The younger age and higher chance of prostate cancer on biopsy in the rectal swab group, we believe, is due to implementation of recent guidelines directing urologists be more selective in recommending prostate biopsy to older men.
both settings since 2014 to determine whether site of service affected stent utilization.Methods: Between 2014 and 2018, there were 739 total angioplasty or angioplasty with stenting procedures performed by our group; 599 were done in the hospital setting, whereas 140 were performed in an ambulatory facility, initially as a physician office site of service and since 2018 as an ambulatory surgery center. Patients' demographics and variables were compared.Results: There was no difference in any clinical or demographic variable between the hospital and nonhospital groups, other than a higher incidence of Medicaid patients in the hospital setting (P < .001). In hospital-treated patients, 190 of 599 procedures included adjunctive stenting (33.2%), whereas in the non-hospital-treated patients, 45 of 140 had stents (32.1%), despite financial incentives for both professional and facility reimbursement in favor of stenting (P ¼ .94).Conclusions: Whereas financial incentives have not yet had an appreciable influence in stent utilization within previous reimbursement paradigms, the dramatic changes proposed by CMS may well alter this dynamic and lead to substantially higher overall costs without proven clinical advantage. With very high failure and reintervention rates and increasingly expensive adjuncts (drug-coated balloons and stents, covered stents), the cost implications of attempts to incentivize interventionalists toward a specific site of care are substantial, and unintended negative consequences are likely to occur.
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