Methods: We merged 2022 Centers for Medicare & Medicaid Services (CMS) inpatient and outpatient hospital charge datasets with ZIP code-level workforce data to identify counties where CMS-billed urologic services were delivered without a collocated urologist. Straight-line distances were calculated between the ZIP code of such hospitals and the nearest ZIP code containing a urologist.
Results: Among 3428 hospitals, 3156 (92%) billed CMS for outpatient and 2202 (64%) for inpatient urologic care. CMS data revealed urologic services in 1428 counties; 350 (24%) of these counties had no resident urologist. Overall, 909 hospitals delivered CMS-billed care from ZIP codes lacking a urologist, with a median distance of 14.7 km to the nearest urologist-served ZIP code. Ninety-five hospitals (10%) were > 50 km away, predominantly in rural counties (median population 13,152).
Conclusions: One-quarter of US counties receiving CMS-reimbursed urologic care do so without an in-county urologist, and 1 in 10 service hospitals operate more than 50 km from the nearest urologist-served ZIP code. CMS charge data therefore uncover substantial hidden coverage provided through traveling specialists or nonurologists, highlighting the need for flexible workforce models, telehealth expansion, and targeted incentives to sustain rural urologic care.
Avi S Baskin,1 Max Bowman,2 Daniel A Barocas,1 Daniel D Joyce,1 Kelvin Moses1
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
- University of California, San Francisco, California.