Kao Johnny, Zucker Amanda, Mauer Elizabeth A, Wong Andrew T, Christos Paul, Kang Josephine
Radiation Oncology, Good Samaritan Hospital Medical Center.
Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, New York-Presbyterian/Weill Cornell Medical Center.
Cureus. 2017 Apr 25;9(4):e1192. doi: 10.7759/cureus.1192.
In recent years, major changes in health care policy have affected oncology practice dramatically. In this context, we examined the effect of practice structure on volume and payments for radiation oncology services using the 2013 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) for New York State radiation oncologists.
The Medicare POSPUF data was queried, and individual physicians were classified into freestanding office-based and hospital-based practices. Freestanding practices were further subdivided into urology, hematology-oncology, and other ownership structures. Additional variables analyzed included gender, year of medical school graduation, and Herfindahl-Hirschman Index (HHI). Statistical analyses were performed to assess the impact of the above-mentioned variables on reimbursements.
There were 236 New York State radiation oncologists identified in the 2013 Medicare POSPUF dataset, with a total reimbursement of $91,525,855. Among freestanding centers, the mean global Medicare reimbursement was $832,974. Global Medicare reimbursement was $1,328,743 for urology practices, compared to $754,567 for hematology-oncology practices and $691,821 for other ownership structures (p < 0.05). The mean volume of on-treatment visits (OTVs) was 240.5 per year, varying by practice structure. The mean annual OTV volumes for urology practices, hematology-oncology practices, other freestanding practices, and hospital-based programs were 424.6, 311.5, 247.5, and 209.3, respectively. After correcting for gender, physician experience, and HHI, practice structure was predictive of freestanding reimbursement and on treatment visit volume.
Higher Medicare payment was significantly predicted by the type of practice structure, with urology-based and hematology-oncology practices accounting for the highest total reimbursement and OTV volume.
近年来，医疗保健政策的重大变化对肿瘤学实践产生了巨大影响。在此背景下，我们使用2013年医疗保险提供者利用和支付数据：纽约州放射肿瘤学家的医生及其他供应商公共使用文件（POSPUF），研究了实践结构对放射肿瘤学服务量和支付的影响。
查询医疗保险POSPUF数据，并将个体医生分为独立的门诊诊所和医院附属诊所。独立诊所进一步细分为泌尿外科、血液肿瘤学和其他所有制结构。分析的其他变量包括性别、医学院毕业年份和赫芬达尔-赫希曼指数（HHI）。进行统计分析以评估上述变量对报销的影响。
2013年医疗保险POSPUF数据集中识别出236名纽约州放射肿瘤学家，总报销额为91,525,855美元。在独立中心中，医疗保险全球平均报销额为832,974美元。泌尿外科诊所的医疗保险全球报销额为1,328,743美元，血液肿瘤学诊所为754,567美元，其他所有制结构为691,821美元（p < 0.05）。每年治疗期间就诊（OTV）的平均次数为240.5次，因实践结构而异。泌尿外科诊所、血液肿瘤学诊所、其他独立诊所和医院附属项目每年的平均OTV次数分别为424.6次、311.5次、247.5次和209.3次。在对性别、医生经验和HHI进行校正后，实践结构可预测独立诊所的报销和治疗期间就诊量。
实践结构类型可显著预测更高的医疗保险支付，其中泌尿外科和血液肿瘤学诊所的总报销额和OTV量最高。
