The following is a summary of “Evaluating the Downstream Revenues of a Self-Pay Bi-Parametric Prostate MRI Program,” published in the JANUARY 2023 issue of Urology by Parikh, et al.

For a study, researchers sought to evaluate the downstream healthcare utilization and revenue associated with a self-pay bi-parametric prostate MRI (bpMRI) program. 

The medical records of 592 patients who underwent bpMRI between August 2017 and March 2020 were examined for follow-up clinical activities, which included prostate biopsy, radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, CT Chest, Abdomen, and Pelvis, PET/CT, MRI Pelvis, and Nuclear Medicine Bone Scans. The charges for each clinical activity were derived from the Medicare Physician Fee Schedule to estimate revenues conservatively. The patient population was divided into four groups based on whether or not they demonstrated an MRI lesion and underwent prostatectomy Patients in Group A had an MRI lesion and had a prostatectomy; those in Group B did not have an MRI lesion but had a prostatectomy; those in Group C had an MRI lesion but had not had a prostatectomy; and those in Group D had neither an Imaging lesion nor had they had a prostatectomy. The revenues for each group were then categorized by Urology, Radiation Oncology, and Radiology subspecialties.

The results showed that the self-pay bpMRI program generated $520 of downstream revenue per patient. Group A patients, who demonstrated an MRI lesion and underwent prostatectomy, yielded 47% of the total revenue ($1,974 per patient). Group B patients, who did not demonstrate lesions but underwent prostatectomy, yielded $1,828 per patient. Group C patients, who demonstrated lesions but did not undergo a prostatectomy, made up the largest group and grossed $398 per patient. Group D demonstrated the lowest per-patient revenue of $179. The study also found that Groups A and B yielded the most relative revenue for Urology, Group C yielded the most relative revenue for Radiation Oncology, and Group D yielded the most relative revenue for Radiology.

In conclusion, the study suggested that a self-pay bpMRI program could improve patient access to prostate cancer screening while remaining financially sustainable.

Reference: goldjournal.net/article/S0090-4295(22)00819-6/fulltext