Mp76-01 variation in physician-specific episode payments for major urologic cancer surgery: implications for mips

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-01 VARIATION IN PHYSICIAN-SPECIFIC EPISODE PAYMENTS FOR MAJOR UROLOGIC CANCER SURGERY: IMPLICATIONS FOR MIPS Deborah Kaye, Zaojun Ye, Lindsey Herrel, Jonathan Li, James Dupree, Chad Ellimootil, and David Miller Deborah KayeDeborah Kaye More articles by this author , Zaojun YeZaojun Ye More articles by this author , Lindsey HerrelLindsey Herrel More articles by this author , Jonathan LiJonathan Li More articles by this author , James DupreeJames Dupree More articles by this author , Chad EllimootilChad Ellimootil More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2569AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Starting in 2020, physicians that qualify for the Merit-based Incentive Payment System (MIPS) will have their Medicare reimbursement adjusted based on a measure of their average health care spending. In this context, we examined current physician variation in 90-day episode spending for prostatectomy, nephrectomy, and cystectomy. METHODS We utilized linked SEER-Medicare data to identify patients aged 66-99 years who underwent a prostatectomy, nephrectomy or cystectomy from 2008 to 2012. We attributed each surgical episode to a physician, constructed 90-day episodes of care, and calculated the corresponding episode payments. We then evaluated physician variation in total 90-day episode payments, determined which component payments (i.e., index admission, readmission, physician services, post-acute care, or hospice) drove the observed variation, and examined payment differences by geographic region, number of patient co-morbidities, and cancer stage. RESULTS We identified 14,585 patients who underwent a major urologic cancer surgery by one of 1,895 providers. There was wide variation in average 90-day surgeon payments for each condition (prostate: mean $11,036, range $7,046-$40,687; kidney: mean $17,964, range $8,855-$82,489; bladder: mean $36,247, range $11,617-180,602) (Figure 1). The primary drivers of differences between high and low spending physicians varied by condition. Physician payments were responsible for the largest component payment difference for prostate (29%), post-acute care for kidney (38%), and index admission for bladder cancer (36%). With the exception of prostate cancer, the drivers of payment differences did not vary across geographic region, number of patient co-morbidities, or cancer stage. CONCLUSIONS Variation exists in physician spending for 90-day surgical episodes of prostate, kidney, and bladder cancer. The main drivers of differences in procedure-specific episode costs vary by condition, but are consistent across geographic regions and patient characteristics. For cost-based measures to be successful in MIPS, additional research is needed to understand the degree to which accountable physicians can actually modify services that drive differences in episode spending. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1017-e1018 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Deborah Kaye More articles by this author Zaojun Ye More articles by this author Lindsey Herrel More articles by this author Jonathan Li More articles by this author James Dupree More articles by this author Chad Ellimootil More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...