Editorial Comment

Abstract

The authors 1 Ko J.S. Chalfin H. Trock B.J. et al. Variability in Medicare utilization and payment among urologists. Urology. 2015; 85: 1045-1051 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar rely on data released in a massive Medicare data dump earlier in 2014, regarding Medicare utilization by urologists in 2012. The nature of the data has been widely criticized for a number of inaccuracies. The authors 1 Ko J.S. Chalfin H. Trock B.J. et al. Variability in Medicare utilization and payment among urologists. Urology. 2015; 85: 1045-1051 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar acknowledge this severe shortcoming by referencing 2 newspaper articles (References 5 and 6 in Ko, et al. 1 Ko J.S. Chalfin H. Trock B.J. et al. Variability in Medicare utilization and payment among urologists. Urology. 2015; 85: 1045-1051 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar ). This reviewer cites a letter written by James Madara, MD, Executive VP and CEO of the American Medical Association, written to Marilyn Tavenner, Administrator of Centers for Medicare and Medicaid Services (http://thehill.com/blogs/congress-blog/healthcare/209039-cms-data-dump-tells-policymakers-nothing), pointing out a myriad of shortcomings from these data. The data are not stratified by severity of illness or even diagnosis—it is simply impossible to ascertain based on billing data whether a service is medically appropriate or not. As the authors 1 Ko J.S. Chalfin H. Trock B.J. et al. Variability in Medicare utilization and payment among urologists. Urology. 2015; 85: 1045-1051 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar point out, the data dump represents claims data information only based on individual practitioner National Provider Identifier number, it may incorrectly credit services to certain providers, particularly in subspecialty or group practices that perform particular services for a greater subset of providers—artificially increasing volume to some practitioners, whereas decreasing it for others. Variability in Medicare Utilization and Payment Among UrologistsUrologyVol. 85Issue 5PreviewTo analyze variability in urologists' Medicare utilization and payment and estimate potential cost savings of standardized service utilization using information from the recently released Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF) and to highlight potential limitations of PUF analysis. Full-Text PDF ReplyUrologyVol. 85Issue 5PreviewDineen1 has insightfully voiced some concerns that we shared when setting out to draft this article. We agree that underutilization is not necessarily the appropriate utilization, however, neither is overutilization. As we stated in the article, appropriate utilization can only be determined with additional information regarding the clinical characteristics of beneficiaries. Unfortunately, such data are not currently available. Because of the limitations in the data, we can only point to the significant amount of variability in service utilization among urologists and its correlation with reimbursement. Full-Text PDF