Surgical Stone Treatment: Patterns May Predict Performance on Episode Based Cost Measure in the Quality Payment Program.

Abstract

The Renal or Ureteral Stone Surgical Treatment Episode based Measure in the Quality Payment Program (QPP) evaluates clinicians' cost to Medicare for beneficiaries who receive surgical treatment for stones.1 The measure score is calculated from Medicare claims according to a complex methodology.2 This paper seeks to describe the stone treatment patterns of urologists and establish benchmarks for 2 surrogate measures- preoperative stenting and postoperative infection-which may predict clinician performance on the episode cost based measure. The study data were drawn from the adjudicated claims of 960 providers who performed at least 30 surgical stone treatments between January 1, 2020 and June 30, 2022. To allow for the correlation of procedures performed by same providers, generalized estimating equations logistic regression models were used to evaluate the rate of preoperative stenting and postoperative infection. 185,076 surgical episodes (113,799 [61.5%] ureteroscopy, 63,931 [34.5%] extracorporeal shock wave lithotripsy (ESWL), and 7,346 [4.0%] percutaneous nephrolithotripsy (PCNL)) were identified over the study period. Preoperative stenting was performed in 35,550 episodes (19.2%) and postoperative infection was documented in 13,114 episodes (7.1%). Preoperative stenting and postoperative infection were significantly more common in patients who were female (aOR 1.42, 1.38), in those undergoing ureteroscopy vs ESWL (aOR 3.24, 1.66), and in patients on Medicare vs Commercial insurance (aOR 1.19, 1.17). This large study of surgical stone treatments documents rates of events and associated attributes of patients that may increase episode cost and be relevant to urologists participating in the QPP.