Variability in Medicare Utilization and Payment Among Urologists

Joan S. Ko, Heather Chalfin, Bruce J. Trock, Zhaoyong Feng, Elizabeth Humphreys, Sung Woo Park, H. Ballentine Carter, Kevin D. Frick, Misop Han

Research output: Contribution to journalArticle

Abstract

Objective To analyze variability in urologists' Medicare utilization and payment and estimate potential cost savings of standardized service utilization using information from the recently released Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF) and to highlight potential limitations of PUF analysis. Materials and Methods The Centers for Medicare and Medicaid Services just released the PUF with payment or utilization data for 8792 urologists participating in Medicare in 2012. Linear regression correlated total number of patient visits with total Medicare payments to each urologist. Physicians were categorized into quartiles by actual payment in excess of predicted payment modeled by this regression. Utilization variability was calculated as a relative risk for the 40 most highly reimbursed services per patient visit, comparing the highest vs lowest quartile of urologists. Potential cost savings for those 40 services were calculated if services per visit >50% above the median were eliminated. Results Medicare reimbursement was strongly predicted by the number of patient visits (R2 = 0.70). Utilization variability of services performed per visit had a relative risk up to 3.52. The potential cost savings was $125,199,007 (9.0% of total 2012 Medicare urologist reimbursements). Conclusion Overall Medicare payment to urologists was strongly predicted by number of patient visits. Substantial variability existed in utilization of services per patient visit. Standardized utilization may result in significant Medicare cost savings. However, future analyses accounting for variable patient characteristics are needed to accurately determine appropriate service utilization.

Original languageEnglish (US)
Article number19047
Pages (from-to)1045-1051
Number of pages7
JournalUrology
Volume85
Issue number5
DOIs
StatePublished - May 1 2015

ASJC Scopus subject areas

  • Urology

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