Benign Prostatic Hypertrophy 19% increase

Talk about opportunity!  Benign prostatic hyperplasia (BPH), DRG 725, will see a 19% increase in reimbursement for 2011.  In the last 15 years, there was a 50% decrease in surgical treatments for BPH due to advances in pharmacology and a focus on watchful waiting.  Still, BPH accounts for 375,000 hospital stays each year as a result of complications with the disease.

Since severely adjusted DRGs came into effect in 2007, the non-surgical treatment of BPH has been assigned to DRG 725 (benign prostatic hyperplasia W MCC) and DRG 726 (benign prostatic hyperplasia W/O MCC).  Reimbursement for DRG 725 has increased over 30% in the last two years to $6,580 while DRG 726 has been stable.  But, this dramatic increase does not represent a windfall for hospitals unless hospitals can focus on reducing the length of stay. 

Studies show that the medical management of BPH complications can be challenging.  Prostate infections (chronic bacterial prostatitis) resulting from BPH are harder to cure because antibiotics are unable to penetrate infected prostate tissue effectively.  Men with prostatitis typically require long-term treatment with a targeted antibiotic and ?-Blockers.

I spoke to Dr. Annette Ashizawa, Ph.D., epidemiologist at the Center for Disease Control (CDC) in Atlanta, GA, about how a hospital can be more effective in treating prostatitis. Dr. Ashizawa said, “Urinary infections tend to arise from a wider range of bacteria and sometimes from more than one type of bacteria at a time.  The first step is identifying the infecting organism and the drugs to which it is sensitive.”

Management is dependent on identifying the cause of the infection early so therapy can be prescribed.  Microbiology cultures are 90% accurate in diagnosing the cause, but the technology can be time consuming.  In comparison, molecular biological methods for the detection and characterization of microorganisms have sensitivity in the 98 to 99% range and results can be available in hours.  So, in order to take advantage of DRG 725, hospitals need to have the right tools available to assist physicians.

James Laskaris, EE, BME
James Laskaris, EE, BME, Clinical Analyst — Mr. James Laskaris is a senior emerging technology analyst at MD Buyline and has been with the company since 1994. With over 30 years of experience in the healthcare field, Mr. Laskaris is the primary analyst of high-end OR technology. He also covers issues related to the legislative and reimbursement effect on healthcare and authors a bimonthly “Issues that Matter” publication. Mr. Laskaris received his biomedical engineering degree from Southern Illinois University. His work has been published in hfm Magazine, Radiology Manager and Healthcare Purchasing News.