Short-Term Medicare-Allowed Amounts Associated With Initial Treatments for Stress Urinary Incontinence: Analysis of a Large National Medicare Fee-for-Service Claims Database.

IMPORTANCE

Limited data describe short-term Medicare-allowed amounts associated with treatments for stress urinary incontinence (SUI).

OBJECTIVE

The objective of this study was to compare total Medicare-allowed amounts for pelvic floor muscle therapy (PFMT), pessary, and sling surgery as the first SUI treatments observed.

STUDY

DESIGN

We analyzed 5% Medicare fee-for-service claims from 2008 through 2016 for women aged 66 years or older with SUI or mixed urinary incontinence. Episode allowed amounts were summed for 90 days after PFMT or pessary treatment and 180 days after sling surgery, adjusted to 2016 dollars, and modeled using log-linear regression.

RESULTS

Among 16,695 beneficiaries (median age: 76 y; 92.9% White), 46.2% received pessary, 33.3% PFMT, and 20.5% sling surgery. From 2008 to 2016, PFMT increased from 24.8% to 43.5% of observed treatments, whereas sling surgery decreased from 27.9% to 9.8% (P<0.01 for both). Median total allowed amounts were $654 (IQR, $327-$1,340) for PFMT over 90 days, $766 (IQR, $458-$1,244) for pessary over 90 days, and $3,663 (IQR, $1,511-$4,173) for sling over 180 days. Facility-related amounts represented 73% of aggregate sling allowed amounts. Compared with pessary, sling was associated with a 3.3-fold higher allowed amount. Clinician specialty, urinary tract infection, geographic region, and Medicare-only coverage were independently associated with allowed amounts.

CONCLUSIONS

Short-term Medicare-allowed amounts varied by treatment, specialty, and region. Because observation windows differed and the data are historical, these estimates are treatment-specific benchmarks rather than current head-to-head comparisons.