title: Physician Use of Sacral Neuromodulation Among Medicare Beneficiaries With Overactive Bladder and Urinary Retention.
abstract: OBJECTIVE
  To identify physician-level factors associated with high rates of sacral neuromodulation testing.
  
  
  METHODS
  We performed a retrospective cohort study using a 20% sample of national Medicare claims to identify physicians who performed sacral neuromodulation procedures between 2005 and 2010. Physician-level rates of device testing were determined based on the number of patients seen for overactive bladder and urinary retention diagnoses in the office in each calendar year. These rates were then used to fit a Poisson model to examine factors associated with high rates of device testing.
  
  
  RESULTS
  The number of physicians performing test procedures increased 4-fold from 2005 to 2010. Average rates of test procedures increased from 4.0 to 6.4 procedures per physician per year (P <.001), whereas rates of device implantation remained stable (P = .23). Physicians who had higher rates of device testing were associated with lower rates of device implantation (estimate, -1.76, P <.01). Other predictors of physicians with higher test rates included more recent calendar year, testing done in any setting other than an ambulatory surgery center, gynecology subspecialty, and geographic location in the South and West (all P values <.01).
  
  
  CONCLUSIONS
  Over time, physicians are testing more patients but are not implanting more devices. Additionally, there is an inverse relationship between rates of device testing and implantation, suggesting opportunities to improve efficiency and resource utilization.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA. Electronic address: Anne.Suskind@ucsf.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Suskind
authors.affiliation: Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
authors.affiliation: Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000368:Aged; D004599:Electric Stimulation Therapy / Q000191:economics / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D053201:Urinary Bladder, Overactive / Q000191:economics / Q000628:therapy*; D016055:Urinary Retention / Q000191:economics / Q000628:therapy*