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002 Penile Traction Does Not Improve Outcomes with Collagenase Clostridium Histolyticum for the Treatment of Peyronie's Disease
SMSNA Abstracts 001
002
SUCCESSFUL INTEGRATION OF AN ADVANCED PRACTICE PRACTITIONER (APP) INTO A SEXUAL AND REPRODUCTIVE MEDICINE PRACTICE Narus, J.; Mulhall, J.; Jenkins, L. MSKCC, United States
PENILE TRACTION DOES NOT IMPROVE OUTCOMES WITH COLLAGENASE CLOSTRIDIUM HISTOLYTICUM FOR THE TREATMENT OF PEYRONIE’S DISEASE Ziegelmann, M.; Viers, B.; Montgomery, B.; Avant, R.; Trost, L. Mayo Clinic, USA
Objectives: As the delivery of care model evolves with the increasing demand for healthcare, the utilization of APPs will increase. The AUA consensus statement on APPs provides guidance on a team-based approach to patient care. Despite this, significant concerns remain regarding the use of APPs specifically, the scope of practice and financial solvency. A successful delivery of care model was developed in an academic sexual medicine practice to expand new patient access to the department’s sole physician by enhancing efficiency. This study was undertaken to retrospectively evaluate the integration and productivity of the APP in this practice. Methods: A retrospective review of four years of billing and volume data (2011-14) was performed. The APP worked 9.37 hour shifts 4 days per week which comprised of 2.5 clinics per week (18 patients on full clinic days and 9 on half day) and one day spent on non-billable administrative issues that enhance physician productivity but are not captured within RVU data: managing lab results and pharmacologic management of patients. We also reviewed overall patient volume for the past 8 years. For each follow up visit the APP saw, the supervising physician was able to see one new patient visit, and for each intracavernosal injection (ICI) training session the APP saw, the supervising physician was able to see 3 new patients. Results: Over the last four years, our APP billed a mean of 1365 wRVUs per annum. This volume consisted of a mean of 1065 patient visits, comprised largely of the following E/M codes: office visit est. level 4-99214, est. level 3-99213, est. level 2-99212, office visit, new level 4-99204, intralesional injection for Peyronie’s disease-54200, and ICI-54235. When factoring the impact of the APP seeing follow-up visits and performing ICI training sessions, the supervising physician had a mean incremental increase in production of 1329 wRVUs per annum. Comparing average practice volume between having a full time APP and prior to having a full time APP, there was a 53% increase in total practice patient visits. Conclusion: This analysis demonstrates how an APP can be successfully integrated in a busy urology practice allowing improved new patient access, increased physician productivity. In addition, the APP’s productivity contributed to their salary and increased the revenue of the practice. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
Objective: Studies have shown that penile traction significantly improves stretched penile length and penile curvature in men with Peyronie’s Disease (PD). Here, we sought to evaluate outcomes in men undergoing Collagenase Clostridium Histolyticum (CCH) for PD based on the use of penile traction. Methods: We identified those patients who underwent CCH therapy for PD at our institution between March 2014 to May 2016. All patients underwent objective curvature assessment prior to the therapy, and all were recommended to undergo final curvature assessment after discontinuing therapy or completing four series. A prospective database was maintained, and a retrospective chart review was performed to obtain pertinent data including patient reported use of penile traction therapy. Statistical analysis was performed to identify differences in outcomes based on the use of penile traction. Results Obtained: Final curve assessment was available on 50 patients. Of these patients, 28 (56%) reported daily penile traction therapy for a median (IQR) of 2 hours (1;2) per day. Median (IQR) initial curvature was 64.9 (24.1). Overall, patients experienced a significant improvement in penile curvature, with a median (IQR) improvement of 20 degrees (5;35, p<0.0001). Interestingly, there was no significant difference in the degree of absolute curve improvement based on traction therapy, with a median absolute (IQR) curvature improvement of 22.5 (7;35) degrees and 20 (5;35) degrees in those who did and did not utilized traction, respectively (p¼0.94). Additionally, there was no association between penile traction and functional outcomes including restoration of penetrative intercourse and prevention of surgery after CCH therapy. Conclusions: CCH results in significant improvements in penile curvature. However, there is no difference in objective or functional outcomes based on the performance of penile traction therapy during the treatment course. Disclosure: Work supported by industry: no.
J Sex Med 2017;14:e1ee104
003 THE SAFETY AND EFFICACY OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM (CCH) IN COMBINATION WITH VACUUM THERAPY FOR THE TREATMENT OF PEYRONIE’S DISEASE Ralph, D.1; Raheem, A.2; Liu, G.3 1 Institute of Urology, University College London Hospitals, United Kingdom; 2Institute of Urology, University College e1
002
SUCCESSFUL INTEGRATION OF AN ADVANCED PRACTICE PRACTITIONER (APP) INTO A SEXUAL AND REPRODUCTIVE MEDICINE PRACTICE Narus, J.; Mulhall, J.; Jenkins, L. MSKCC, United States
PENILE TRACTION DOES NOT IMPROVE OUTCOMES WITH COLLAGENASE CLOSTRIDIUM HISTOLYTICUM FOR THE TREATMENT OF PEYRONIE’S DISEASE Ziegelmann, M.; Viers, B.; Montgomery, B.; Avant, R.; Trost, L. Mayo Clinic, USA
Objectives: As the delivery of care model evolves with the increasing demand for healthcare, the utilization of APPs will increase. The AUA consensus statement on APPs provides guidance on a team-based approach to patient care. Despite this, significant concerns remain regarding the use of APPs specifically, the scope of practice and financial solvency. A successful delivery of care model was developed in an academic sexual medicine practice to expand new patient access to the department’s sole physician by enhancing efficiency. This study was undertaken to retrospectively evaluate the integration and productivity of the APP in this practice. Methods: A retrospective review of four years of billing and volume data (2011-14) was performed. The APP worked 9.37 hour shifts 4 days per week which comprised of 2.5 clinics per week (18 patients on full clinic days and 9 on half day) and one day spent on non-billable administrative issues that enhance physician productivity but are not captured within RVU data: managing lab results and pharmacologic management of patients. We also reviewed overall patient volume for the past 8 years. For each follow up visit the APP saw, the supervising physician was able to see one new patient visit, and for each intracavernosal injection (ICI) training session the APP saw, the supervising physician was able to see 3 new patients. Results: Over the last four years, our APP billed a mean of 1365 wRVUs per annum. This volume consisted of a mean of 1065 patient visits, comprised largely of the following E/M codes: office visit est. level 4-99214, est. level 3-99213, est. level 2-99212, office visit, new level 4-99204, intralesional injection for Peyronie’s disease-54200, and ICI-54235. When factoring the impact of the APP seeing follow-up visits and performing ICI training sessions, the supervising physician had a mean incremental increase in production of 1329 wRVUs per annum. Comparing average practice volume between having a full time APP and prior to having a full time APP, there was a 53% increase in total practice patient visits. Conclusion: This analysis demonstrates how an APP can be successfully integrated in a busy urology practice allowing improved new patient access, increased physician productivity. In addition, the APP’s productivity contributed to their salary and increased the revenue of the practice. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
Objective: Studies have shown that penile traction significantly improves stretched penile length and penile curvature in men with Peyronie’s Disease (PD). Here, we sought to evaluate outcomes in men undergoing Collagenase Clostridium Histolyticum (CCH) for PD based on the use of penile traction. Methods: We identified those patients who underwent CCH therapy for PD at our institution between March 2014 to May 2016. All patients underwent objective curvature assessment prior to the therapy, and all were recommended to undergo final curvature assessment after discontinuing therapy or completing four series. A prospective database was maintained, and a retrospective chart review was performed to obtain pertinent data including patient reported use of penile traction therapy. Statistical analysis was performed to identify differences in outcomes based on the use of penile traction. Results Obtained: Final curve assessment was available on 50 patients. Of these patients, 28 (56%) reported daily penile traction therapy for a median (IQR) of 2 hours (1;2) per day. Median (IQR) initial curvature was 64.9 (24.1). Overall, patients experienced a significant improvement in penile curvature, with a median (IQR) improvement of 20 degrees (5;35, p<0.0001). Interestingly, there was no significant difference in the degree of absolute curve improvement based on traction therapy, with a median absolute (IQR) curvature improvement of 22.5 (7;35) degrees and 20 (5;35) degrees in those who did and did not utilized traction, respectively (p¼0.94). Additionally, there was no association between penile traction and functional outcomes including restoration of penetrative intercourse and prevention of surgery after CCH therapy. Conclusions: CCH results in significant improvements in penile curvature. However, there is no difference in objective or functional outcomes based on the performance of penile traction therapy during the treatment course. Disclosure: Work supported by industry: no.
J Sex Med 2017;14:e1ee104
003 THE SAFETY AND EFFICACY OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM (CCH) IN COMBINATION WITH VACUUM THERAPY FOR THE TREATMENT OF PEYRONIE’S DISEASE Ralph, D.1; Raheem, A.2; Liu, G.3 1 Institute of Urology, University College London Hospitals, United Kingdom; 2Institute of Urology, University College e1