American Urological Association survey of transurethral prostatectomy and the impact of changing medicare reimbursement.

The American Urological Association, in a survey of all American urologists, found that TURP accounts for 38 per cent of their major surgery and also found that activities associated with the operation account for nearly 25 per cent of their total patient workload. American urologists regard TURP as complex, and they believe proficiency requires more practical case experience during residency training than is required for any other urologic operation. American urologists assign TURP a significantly higher relative value than that proposed in the pending national Medicare Fee Schedule formulated by medical economists and the Physician Payment Review Commission. The legislated reductions in allowable Medicare fees for TURP and the possible shift in management of benign prostatic hyperplasia to nonsurgical methods create a financial vulnerability for American urologists who remain economically dependent on this dominant operation. Adjustments in practice patterns and manpower policy planning may well be required.