Variability in Medicare utilization and payment among urologists.
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.


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 (R(2) = 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).


CONCLUSIONS
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.
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: jko16@jhmi.edu.
Joan S
JS
Ko
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Heather
H
Chalfin
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Bruce J
BJ
Trock
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Zhaoyong
Z
Feng
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Elizabeth
E
Humphreys
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Sung-Woo
SW
Park
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
H Ballentine
HB
Carter
The Johns Hopkins Carey Business School, Baltimore, MD.
Kevin D
KD
Frick
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Misop
M
Han
D017046:Cost Savings; D005102:Health Expenditures; D006801:Humans; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data*; D014481:United States; D014572:Urology / Q000191:economics* / Q000706:statistics & numerical data*