We thank Dr. Loughlin for thoroughly discussing our study.1 In his commentary, Dr. Loughlin highlights several geographic and patient-level factors that contribute to variations in care, for example, by further expanding upon our finding that payer status predicted 30-day revisits.2 He also mentions the growing surgical armamentarium of minimally invasive procedures that can impact the value of urologic care.3 Taken together, this emphasizes the need to further understand why care setting matters when seeking to optimize the value of care in urology.4 Our study contributes to growing evidence that directing appropriately selected patients to the ambulatory setting is cost saving relative to being treated at an inpatient facility.5–7 This understanding that care pathways and resulting care settings are important drivers of cost has important policy implications in light of recent efforts to enhance high-value care to contain United States health care spending.8,9 Developing policies that ensure that appropriately selected patients undergoing bladder outlet obstruction surgery are directed toward not just the optimal procedure type but also care setting is one of the many mechanisms to reduce health care expenditure and enhance the value of the urologic care provided. Examples of such policies include incentivizing providers and health care systems to shift selected patients away from high-cost settings as well as removing systemic barriers to high-value care for disadvantaged populations.
Author Disclosure Statement
Q.-D.T. reports personal fees from Astellas, Bayer, Janssen, and Intuitive Surgical.
Funding Information
Q.-D.T. is supported by a Health Services Research pilot test grant from the Defense Health Agency and an unrestricted educational grant from the Vattikuti Urology Institute. D.F.F. is supported by a National Institutes of Health T32 training grant (2T32DK007527-33).
References
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