Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH.
Urology. 2019 Aug;130:65-71. doi: 10.1016/j.urology.2019.03.029. Epub 2019 Apr 25.
To investigate the impact of urologist practice structure on health care spending for men with prostate cancer. We hypothesize that 3 elements of urologist practice structure may influence spending for prostate cancer care: urologist participation within a multispecialty group (MSG), practice size among single specialty urology groups, and intensity-modulated radiation therapy (IMRT) ownership.
We used a 20% sample of fee-for-service Medicare beneficiaries to identify men newly diagnosed with prostate cancer between 2011 and 2014. We identified each man's urologist and used data from the Healthcare Relational Spheres provider files to identify practice type, size, and IMRT ownership for each urologist. We then fit generalized linear mixed models to estimate the association between these practice features and Medicare payments in the year after diagnosis. All models were adjusted for patient and healthcare market characteristics.
We identified 35,929 men with newly diagnosed prostate cancer who were treated by 6381 urologists. Medicare payments for men with newly diagnosed prostate cancer were significantly lower in MSGs ($19,181 v. $22,366 large single specialty group, P < 0.001) and significantly higher among practices with IMRT ownership ($23,801 v. $20,162 for non-owners, P < 0.001). These differences persisted in sensitivity analyses including only men treated with radiotherapy and examining only prostate cancer-related claims.
Urologist practice structure is associated with payments for prostate cancer care. MSGs had the lowest Medicare payments per episode of prostate cancer care while groups with IMRT ownership had the highest.
探讨泌尿科医生的执业结构对前列腺癌男性医疗保健支出的影响。我们假设泌尿科医生执业结构的 3 个要素可能会影响前列腺癌护理的支出：泌尿科医生在多专科小组（MSG）中的参与度、单一专科泌尿科小组的执业规模以及强度调制放射疗法（IMRT）的所有权。
我们使用了 20%的按服务收费的医疗保险受益人的样本，以确定在 2011 年至 2014 年间新诊断患有前列腺癌的男性。我们确定了每位男性的泌尿科医生，并使用 Healthcare Relational Spheres 提供者文件中的数据来确定每位泌尿科医生的执业类型、规模和 IMRT 所有权。然后，我们使用广义线性混合模型来估计这些执业特征与诊断后一年医疗保险支付之间的关联。所有模型均根据患者和医疗保健市场特征进行了调整。
我们确定了 35929 名新诊断为前列腺癌的男性，他们由 6381 名泌尿科医生进行治疗。在 MSG 中（22366 美元与大型单一专科组的 19181 美元相比，P<0.001）和拥有 IMRT 所有权的实践中（23801 美元与非所有者的 20162 美元相比，P<0.001），新诊断为前列腺癌的男性的医疗保险支付明显较低。在包括仅接受放疗治疗的男性和仅检查前列腺癌相关索赔的敏感性分析中，这些差异仍然存在。
泌尿科医生的执业结构与前列腺癌护理的支付有关。MSG 的前列腺癌护理每例的医疗保险支付最低，而拥有 IMRT 所有权的小组的医疗保险支付最高。
