Medicare Trends in Penile Prosthesis Surgery

November 25, 2015

Headlines are punchy. They are also potentially misleading. Consider that a CNN story recently highlighted a study documenting shrinking use of penile implants. What it did not do was explain why.

The study covered by CNN was published earlier this year in the Journal of Sexual Medicine. It examined use of penile prosthesis as a treatment for impotence in the years 2001 to 2010. Specifically, it looked at Medicare claims data over a 10-year period, which involved nearly two million men diagnosed with erectile dysfunction. Factors associated with use of a penile prosthesis were age 65–74, location in the American southwest, and higher comobidity scores. African Americans were more likely to have a malleable semi-rigid prosthesis compared with an inflatable prosthesisThe use of penile prosthesis decreased from around just under 5 percent to just under 2.5 percent, which was statistically significant. 

Here's the problem. The CNN article uses language that implies an explanation for the decline that is not substantiated by the data. For example, the story says that "implants are waning in popularity." Maybe, but maybe not. Just because fewer Medicare claims were submitted year over year does not mean that the implants are less popular. Other causes, such as poor public and medical education or crowding by other, more narrow education, such as television advertising for Viagra and Cialis, may be the explanation. We covered the troubling issue of deficient patient and provider education in a recent post about erectile dysfunction management among diabetics.

One might further note that the decline in use of penile prosthesis among Medicare members (what is happening in non-Medicare members?) coincides with rising rates of diabetes and obesity, two principal causes of erectile dysfunction. Accordingly, the mismatch between rising demand and shrinking utilization signals an almost certain issue with general access to care. We know based upon the phone calls that come to Surgeo regularly that many commercial insurance companies are not covering penile implant surgery. This means that we are dealing often and will probably increasingly deal with self-pay healthcare consumerism. This is a matter that we recently covered in a post relating to a patient from Canada and in a post about the potential that the government will stop paying for penile implant surgery

The CNN story does hit home a few key points, including the relationship of erectile dysfunction and heart disease. The other major point is that penile implants are associated with very high satisfaction rates generally.

It would appear that the general public is facing increasing need but lousy education and probably lousy access to penile implant surgery. This is something Surgeo is working to correct, partly with comprehensive, flat-fee, penile implant surgery package choices that any user can shop and compare. Surgeo also offers off-line support to men considering penile implant surgery, financing navigation, and complications protection, which offers tremendous value to any uninsured patient who needs this.

Data are fine, but should not be taken in isolation. Yes, penile implant among Medicare members declined from 2001 to 2010, but this may not be a good thing and may reflect lousy education and lousy access. These are things we can address as we remember that our objective is not to control cost but to deliver care.

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