Department of Urology, Michigan Medicine, Ann Arbor, MI.
Department of Surgery, Michigan Medicine, Ann Arbor, MI; Michigan Opioid Prescribing and Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, MI.
Urology. 2023 Jan;171:103-108. doi: 10.1016/j.urology.2022.09.023. Epub 2022 Oct 13.
To examine the percentage of patients who filled peri-procedural opioid prescriptions before and after Blue Cross Blue Shield of Michigan (BCBSM) launched a modifier 22 payment incentive for opioid-sparing vasectomies in Michigan on July 1, 2019.
We evaluated BCBSM administrative claims data from February 1, 2018 - November 16, 2020 for men 20 - 64 years old who underwent vasectomy or a control office-based urologic procedure (cystourethroscopy, prostate biopsy, circumcision, and transurethral destruction of prostate tissue.) The primary outcome was the percentage of patients who filled opioid prescriptions 30 days before to 3 days after their procedure. We performed an interrupted time series analysis to estimate changes in the percentage of patients who filled opioid prescriptions in the vasectomy and control group before and after July 1, 1019.
Our cohort included 4,559 men who had a vasectomy and 4,679 men who had a control procedure. Within each group, demographics and clinical factors were similar before and after July 1, 2019. Before implementation of the modifier 22 policy, 32.5% of men who had a vasectomy filled an opioid prescription whereas only 12.6% of men filled an opioid prescription after July 1, 2019 -a 19.9% absolute reduction and 61.0% relative reduction (P < .001). In the control group, there was no significant change in the percentage of patients who filled opioid prescriptions before and after July 1, 2019 (0.8% absolute increase, P = .671).
Implementation of modifier 22 based financial incentive for opioid-sparing vasectomies was associated with decrease in the percentage of men who filled opioid prescriptions after vasectomy.
检查密歇根州蓝十字蓝盾公司（BCBSM）于 2019 年 7 月 1 日为减少阿片类药物使用的输精管切除术推出Modifier 22 支付激励措施前后，患者在围手术期开具阿片类药物处方的比例。
我们评估了 2018 年 2 月 1 日至 2020 年 11 月 16 日期间 BCBSM 管理索赔数据，纳入年龄在 20-64 岁之间的接受输精管切除术或对照门诊泌尿科手术（膀胱尿道镜检查、前列腺活检、包皮环切术和经尿道前列腺组织破坏术）的男性。主要结局是患者在手术前 30 天至手术后 3 天内开具阿片类药物处方的比例。我们进行了中断时间序列分析，以估计在 2019 年 7 月 1 日前后，输精管切除术和对照组患者中开具阿片类药物处方的比例变化。
我们的队列纳入了 4559 名接受输精管切除术的男性和 4679 名接受对照手术的男性。在每个组中，2019 年 7 月 1 日前后，人口统计学和临床因素相似。在实施Modifier 22 政策之前，32.5%接受输精管切除术的男性开具了阿片类药物处方，而在 2019 年 7 月 1 日之后，只有 12.6%的男性开具了阿片类药物处方 -绝对减少 19.9%，相对减少 61.0%（P<.001）。在对照组中，2019 年 7 月 1 日前后，开具阿片类药物处方的患者比例没有显著变化（绝对增加 0.8%，P=.671）。
对减少阿片类药物使用的输精管切除术实施Modifier 22 基于财务激励措施与手术后男性开具阿片类药物处方的比例下降有关。
