Department of Urology, Mayo Clinic, Phoenix, AZ; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Urology. 2024 Sep;191:1-8. doi: 10.1016/j.urology.2024.03.037. Epub 2024 Apr 20.
To explore factors associated with productivity in urologic practice. Work-relative value units (wRVUs), the basis for Center for Medicare & Medicaid Services (CMS) and private payer reimbursements, commonly serve to estimate physician productivity. Limited data describes which practice factors predict increased wRVU productivity.
The 2017 and 2018 CMS databases were retrospectively queried for urologic Medicare provider demographics and procedural/service details. Medical school graduation year was used to estimate years in practice and generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients' demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict wRVU production.
Included were 6773 Medicare-participating urologists across the United States. Millennials produced 1115 wRVUs per year, while Gen X and Baby Boomers produced significantly more (1997 and 2104, respectively, P <.01). Post-War urologists produced numerically more (1287, P = .88). In adjusted analyses, predictors of Medicare wRVU productivity included female and pelvic medicine and reconstructive surgery (exponentiated beta estimate (β) 1.46, 95% CI 1.32-1.60), men's health (β 1.22, 95% CI 1.13-1.32), and oncologic subspecialization (β 1.08, 95% CI 1.02-1.14), female gender (β 0.87, 95% CI 0.82-0.92), wRVUs generated from inpatient procedures (β 1.08, 95% CI 1.06-1.09) and office visits (β 0.88, 95% CI 0.87-0.89), and the level of education (β 1.10, 95% CI 1.07-1.14) and percent impoverished patients (β 0.85, 95% CI 0.83-0.88) in provider's practice zip code.
Urologic experience, specialization, demographics, practice patterns, and patient demographics are significantly associated with wRVU productivity in Medicare settings. Further work should incorporate quality metrics into wRVUs and ensure patient demographics do not affect reimbursement.
探讨与泌尿科实践生产力相关的因素。工作相关价值单位（wRVU）是医疗保险和医疗补助服务中心（CMS）和私人支付方报销的基础，常用于估计医生的生产力。有限的数据描述了哪些实践因素可以预测 wRVU 生产力的提高。
回顾性查询了 2017 年和 2018 年 CMS 数据库中泌尿科 Medicare 提供者的人口统计学和程序/服务细节。医学生毕业年份用于估计行医年限和代际（千禧一代、X 世代、婴儿潮一代或战后一代）。获得了接受治疗的患者的人口统计学数据。进行了调整和未调整的线性混合模型，以预测 wRVU 的产生。
共纳入美国 6773 名参与 Medicare 的泌尿科医生。千禧一代每年产生 1115 个 wRVU，而 X 世代和婴儿潮一代的产生量明显更多（分别为 1997 个和 2104 个，P<.01）。战后一代泌尿科医生的数值更高（1287 个，P=.88）。在调整后的分析中，Medicare wRVU 生产力的预测因素包括女性和盆腔医学与重建外科（指数估计值（β）1.46，95%置信区间（CI）1.32-1.60）、男性健康（β 1.22，95%CI 1.13-1.32）和肿瘤学专业（β 1.08，95%CI 1.02-1.14）、女性（β 0.87，95%CI 0.82-0.92）、住院程序（β 1.08，95%CI 1.06-1.09）和门诊就诊（β 0.88，95%CI 0.87-0.89）生成的 wRVU 以及提供者执业邮政编码中教育程度（β 1.10，95%CI 1.07-1.14）和贫困患者百分比（β 0.85，95%CI 0.83-0.88）。
泌尿科经验、专业、人口统计学、实践模式和患者人口统计学与 Medicare 环境中的 wRVU 生产力显著相关。进一步的研究应将质量指标纳入 wRVU，并确保患者人口统计学不影响报销。
