ACS 2018: Scrutinizing Medicare Payments to the Highest Paid Urologists Utilizing the Centers for Medicare and Medicaid Services Public Use Dataset

Boston, Massachusetts ( Yousef M. Abu-Salha, provided an overview of recent cost control efforts have focused on “hot-spotting,” or identifying the patients contributing the most cost within a community. They studied if “hotspotting” could be applied to clinicians to identify potential areas for improvement. They examined the public use dataset available from CMS for the calendar year 2015. A payment search tool allowed for examination, sorting, and comparison of a total of 8,986 urology providers who received Medicare fee-for-service payments in 2015. Comparisons were made between the top 50 versus the median 50 urology providers with regard to payments received. Specific payment outcomes analyzed: total payments, number unique patients, and payments related to evaluation and management (E+M), surgeries and procedures (Surgery), drugs, imaging (Image), lab tests (Lab), medical services (services), and other. A relative ratio (top 50: median 50) was also calculated for each variable.

They found averages for each variable were significantly different (p < 0.05) between the 2 groups for each variable analyzed. Looking at the entire dataset of urologists, the top 10 providers (0.1%) received more overall Medicare payments than the bottom 1100 providers (12%), and the top 1% greater than the bottom 26%.

They concluded significant differences exist between the top and median urology providers with regard to Medicare payments. The study has limitations and the available data may not present the full picture of a specific physician’s practice.

Presented by: Yousef M. Abu-Salha, Medical Student at UNC School of Medicine, University of North Carolina, Chapel Hill, NC 

Written by: Stephen B. Williams, MD., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, MD. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts