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Low opioid fill rates continue after termination of a financial incentive for opioid-free vasectomies

International Journal of Impotence Research (2025) Cite this article

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In the context of ongoing opioid epidemic, prior evaluations have demonstrated increased risk of persistent opioid use after being prescribed opioids post-vasectomy [1]. However, Doolittle et al. found that opioid-free management of vasectomy patients did not lead to additional unplanned health encounters [1]. On 7/7/2019, Blue Cross Blue Shield of Michigan (BCBSM) supported modifier 22 billing for opioid free vasectomy. In the United States, after a physician performed a vasectomy, he or she would bill the insurance program to be paid for their work. However, with the implementation of the modifier 22 incentive, BCBSM allowed for a doctor to add a modifier 22 to the bill to be able to receive up to 35% additional reimbursement for their opioid free vasectomy procedure [2]. In our prior work, we estimated that approximately 8473 fewer oxycodone 5 mg pills were dispensed in Michigan after implementation of modifier 22 [2]. On 12/31/2021, BCBSM ended the modifier-22 based financial incentive for opioid-free vasectomies. While the onset of financial incentives has been associated with physician behavior changes, it remains unknown whether behavior changes are sustained after financial incentives are terminated. Therefore, we evaluated the impact of the termination of this opioid-free modifier 22 incentive for vasectomies on peri-procedural opioid prescription fill rates before and after 12/31/2021.

Our detailed methods have been published previously [2]. In brief, we identified male patients aged 20–64 years with BSBSM preferred provider organization (PPO) coverage who underwent in-office vasectomy and previously identified urologic procedures from 11/1/2020 to 2/28/2023. We used definitions from the Michigan Opioid Prescribing Engagement Network [2]. Primary outcome was the percentage of patients who filled a peri-procedural opioid prescription before and after 12/31/2021. All analyses were conducted using Stata version 15.1 (Stata-Corp) and SAS version 9.4 (SAS Institute Inc) and p values < 0.05 were considered statistically significant.

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Fig. 1: Interrupted time series analysis of the percent of patients who filled a peri-operative opioid prescription before and after termination of a modifier 22 based quality incentive for opioid-free vasectomy on 12/31/21.
The alternative text for this image may have been generated using AI.

References

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Acknowledgements

The Michigan Value Collaborative (MVC) is a Blue Cross Blue Shield of Michigan funded collaborative quality initiative that includes over 100 hospitals and 40 physician organizations across the State of Michigan. MVC provides Michigan hospitals and POs with payment and utilization data for an episode of care from paid, adjudicated claims. For this analysis, MVC provided us with insurance claims data from the following payer sources: BCBSM Preferred Provider Organization (PPO) Commercial. Support for the Michigan Value Collaborative is provided by Blue Cross Blue Shield of Michigan as part of the BCBSM Value Partnerships program; however, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect those of BCBSM or any of its employees.

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Authors and Affiliations

  1. Department of Urology, Michigan Medicine, Ann Arbor, MI, USA

    Catherine S. Nam, Tudor Borza, Susan Linsell, Stephanie Ferrante & James M. Dupree

  2. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA

    Yen-Ling Lai, Hsou Mei Hu & Jennifer F. Waljee

  3. Michigan Opioid Prescribing and Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA

    Yen-Ling Lai, Hsou Mei Hu, Chad M. Brummett & Jennifer F. Waljee

  4. Department of Urology, Johns Hopkins Medicine, Baltimore, MD, USA

    Arvin K. George

  5. Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA

    Tudor Borza, Susan Linsell & Stephanie Ferrante

  6. Michigan Value Collaborative, Ann Arbor, MI, USA

    Michael P. Thompson

  7. Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA

    Michael P. Thompson

  8. Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, USA

    Chad M. Brummett

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  1. Catherine S. Nam
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  2. Yen-Ling Lai
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  11. James M. Dupree
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Contributions

CSN conceived and designed the work that led to the submission, acquired data, interpreted the results, drafted the manuscript, approved the final manuscript and agreed to be accountable for all aspects of the work. YLL and HMH designed the work that led to the submission, acquired data and played an important role in interpreting the results, revised the manuscript, approved the final version and agreed to be accountable for all aspects of the work. AKG, TB, SL, SF, MPT all designed the work that led to the submission, acquired data, revised the manuscript, approved the final version, and agreed to be accountable for all aspects of the work. CMB, JFW and JMD conceived and designed the work, played an important role in interpreting the results, revised the manuscript, approved the final version, and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Catherine S. Nam.

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Competing interests

JMD—Grant funding from NICHD, BCBSM (MVC), common stock in Lipocine, Medical Advisory Board and equity in Posterity Health, Scientific Advisory Board and equity in Maven Clinic, Vice President of Society for the Study of Male Reproduction, American Society for Reproductive Medicine Scientific Congress Program Committee and Board of Directors.

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Nam, C.S., Lai, YL., Hu, H.M. et al. Low opioid fill rates continue after termination of a financial incentive for opioid-free vasectomies. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01105-7

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