Bergman Jonathan, Laviana Aaron A, Kwan Lorna, Lerman Steven E, Aronson William J, Bennett Carol J, Hu Jim J
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA.
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Surgery. 2017 Feb;161(2):312-319. doi: 10.1016/j.surg.2015.12.028. Epub 2016 Feb 26.
We investigated provider and regional variation in payments made to surgeons by the Centers for Medicare & Medicaid Services (CMS) by indexing payments to unique beneficiaries treated and examined the proportion of charges that resulted in payments. Understanding variation in care within CMS may prove actionable by identifying modifiable, and potentially unwarranted, variations.
We analyzed the Medicare Part B Provider Utilization and Payment Data released by CMS for 2012. We included Medicare B participants in the fee-for-service program. We calculated for each provider the ratio of number of services provided to individual beneficiaries, and the ratio of total submitted charges to total Medicare payments. We also categorized each provider into deciles of total Medicare payments, and calculated the means per decile of total Medicare payment for surgeons and urologists. To determine any associations with ratio of services to beneficiaries, we conducted multivariate linear regressions.
The 20th, 40th, 60th, and 80th percentiles for the services-per-beneficiary ratios are 1.6, 2.2, 3.1, and 5.0, respectively (n = 83,376). Greater-earning surgeons offered more services per beneficiary, with a precipitous increase from the lowest decile to the highest. Charges were consistently greater than payments by a factor of 3. In our multivariate analysis of services per beneficiary ratio, female providers had lower ratios (P < .01), and we noted significant regional variation in the ratio of services per unique beneficiary (P < .001 for each of the 10 Standard Federal Regions).
We found significant variation in patterns of payments for surgical care in CMS.
我们通过将支付金额与接受治疗的独特受益人进行索引，研究了医疗保险和医疗补助服务中心（CMS）向外科医生支付费用的提供者和地区差异，并检查了产生支付的收费比例。通过识别可修改的、可能不必要的差异，了解CMS内部护理的差异可能会被证明是可行的。
我们分析了CMS于2012年发布的医疗保险B部分提供者利用和支付数据。我们纳入了按服务收费计划中的医疗保险B参与者。我们为每个提供者计算提供给个体受益人的服务数量之比，以及提交的总收费与医疗保险总支付之比。我们还将每个提供者按医疗保险总支付的十分位数进行分类，并计算外科医生和泌尿科医生每十分位数的医疗保险总支付均值。为了确定与服务与受益人之比的任何关联，我们进行了多元线性回归。
每位受益人服务比例的第20、40、60和80百分位数分别为1.6、2.2、3.1和5.0（n = 83376）。收入较高的外科医生为每位受益人提供更多服务，从最低十分位数到最高十分位数急剧增加。收费始终比支付高出3倍。在我们对每位受益人服务比例的多变量分析中，女性提供者的比例较低（P <.01），并且我们注意到每位独特受益人的服务比例存在显著的地区差异（10个标准联邦地区中的每一个地区P <.001）。
我们发现CMS中外科护理支付模式存在显著差异。
