Medicare Public Research Articles

Changing Dermatologic Procedural Patterns in the Medicare Population: A National Trend Analysis.

Dermatologists are trained in diagnostic and therapeutic procedures for cutaneous lesions, yet comparative trends for basic dermatologic procedures across dermatology providers are lacking at the national level. To trend common dermatologic procedures among general dermatologists, Mohs surgeons, primary care providers or primary care physicians (PCPs), and nonphysician clinicians (NPCs). Longitudinal analysis of 2016 to 2021 Medicare Public Use Files. Aggregate dermatologic procedural volume decreased 3.0%. Procedural volume declined among general dermatologists (-11.7%), Mohs surgeons (-16.7%), and PCPs (-41.7%) but increased among NPCs (+57.5%). The proportion of procedures by general dermatologists decreased substantially for premalignant destructions (-6.2%), skin biopsies and shave removals (-4.7%), and malignant excisions (-4.1%) and more notably in counties that were nonmetro (-7.1%), low in income (-6.1%), and with <4.0 dermatologists per 100,000 population (-7.0%). Aggregate procedural volume decreased across the study period with general dermatologists, Mohs surgeons, and PCPs performing a progressively smaller proportion. The increase in procedures by NPCs may help to address demand but underscores the value of formalized procedural training. The procedural decline by general dermatologists in rural and low-income counties and those with baseline dermatologist shortages may exacerbate existing unmet need. Primary limitation included lack of commercial data.

Growing Adoption of Immunohistochemistry by Mohs Micrographic Surgeons: A National Medicare Trend Analysis.

Immunohistochemical (IHC) staining can be used alongside Mohs micrographic surgery to aid in margin assessment of subtle tumors, yet existing estimates of IHC utilization have primarily relied on survey or older data that lacks stratification. To characterize national IHC utilization trends by Mohs surgeons, stratifying by surgeon characteristics and modeling future adoption. Longitudinal analysis of 2014 to 2021 Medicare Public Use Files. In 2021, 158 of 2,058 Mohs surgeons (7.7%) used IHC as compared with 4.0% in 2014 (average annual growth rate [AAGR] +3.6%). Adoption change was highest in the Northeast (AAGR +19.9%), whereas volume growth was greatest in the West (AAGR +25.2%). Multivariable regression revealed significantly greater utilization propensity among Mohs surgeons in academics (adjusted odds ratio [aOR] 3.36), American College of Mohs Surgery (ACMS) members (aOR 2.12), and Micrographic Dermatologic Surgery (MDS)-certified surgeons (aOR 1.66). Mohs surgeons are steadily incorporating IHC into practice across all regions, with volume growth driven by higher adoption rates. Greater utilization among ACMS members, recipients of MDS certification, and those in academics suggests value of formalized training in enhancing comfort. Additional educational opportunities at conferences may aid in recognition of value and help identify solutions to address integration challenges.

Rates of Laser Trabeculoplasty by Ophthalmologists and Optometrists: A Comparative Analysis of the CMS Medicare Public Use File.

To provide a comparative analysis of rates of laser trabeculoplasty (LTP) among eye care providers in the USA. This retrospective cohort analysis utilized the Centers for Medicare and Medicaid Services (CMS) Public Use File (PUF), 2015-2018. We used CPT code 65855 to select eye care providers who performed LTP in three key US states (KY, LA, and OK). Primary outcomes were eye provider differences in provider count, service count, unique beneficiary count, and Medicare-allowed payments. Asymptotic two-sided chi-squared tests were executed. Statistical significance was achieved at p<0.05. The sum of Medicare-allowed payments for LTP in all three states in 2018 was roughly 26% lower than in 2015. The proportion of Medicare-allowed payments furnished by optometrists increased from 11.3% to 17.9% between 2015 and 2018 (p<0.001). Relative to ophthalmologists, we observed significant increases in optometric Medicare-allowed payments in KY, LA, OK, and the all-inclusive tri-state cohort (all p<0.001). Furthermore, significant optometric increases in number of providers performing LTP (p=0.007), number of unique Medicare beneficiaries seen (p<0.001), and number of LTP services billed (p<0.001) were observed relative to ophthalmologists. The recent expansion of surgical authority by optometrists in key US states is creating a tangible impact on ophthalmologic and optometric practice patterns. The findings of this study may act as provision for policymakers in the context of continually evolving guidelines for optometric surgical expansion.

Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volumes Among Fellowship-Trained Glaucoma Subspecialists.

The change in glaucoma surgical volumes due to the coronavirus disease 2019 pandemic was not uniform across procedure types and was unequal between rural and urban practice locations. To quantify the impact of the coronavirus disease 2019 pandemic on surgical volumes performed by fellowship-trained glaucoma subspecialists. This retrospective cohort analysis of the Centers for Medicare and Medicaid Services Medicare Public Use File extracted all glaucoma surgeries, including microinvasive glaucoma surgeries (MIGSs), trabeculectomy, goniotomy, lasers, and cataract surgery, performed by fellowship-trained glaucoma surgeons in rural and urban areas between 2016 and 2020. Predicted estimates of 2020 surgical volumes were created utilizing linear squares regression. Percentage change between predicted and observed 2020 surgical volume estimates was analyzed. Statistical significance was achieved at P <0.05. In 2020, fellowship-trained glaucoma surgeons operated mostly in urban areas (N = 810, 95%). A 29% and 31% decrease in predicted cataract surgery volumes in urban and rural areas, respectively, was observed. Glaucoma surgeries experienced a 36% decrease from predicted estimates (N = 56,781). MIGS experienced an 86% and 75% decrease in rural and urban areas, respectively. Trabeculectomy in rural areas experienced a 16% increase relative to predicted estimates while urban areas experienced a decrease of 3% ( P > 0.05). The number of goniotomies decreased by 10% more in rural areas than in urban areas (-22% and -12%, respectively). Laser procedures decreased by 8% more in urban areas than in rural areas (-18% and -10%, respectively). Among glaucoma-trained surgeons, glaucoma surgeries experienced a greater volume loss than cataract surgeries. In urban US areas, relative reductions in MIGS and goniotomy volumes in urban areas may have been compensated by greater laser and trabeculectomy volumes. Trabeculectomies in rural areas were the only group exceeding predicted estimates. Glaucoma subspecialists may utilize these findings when planning for future events and in overcoming any remaining unmet need in terms of glaucoma care.

Mohs Surgeons Dominate Cutaneous Reconstructions in Cosmetically and Functionally Sensitive Sites: Medicare Trends From 2013 to 2019.

Although dermatologists perform more cutaneous reconstructions than any other specialists for the Medicare population, the perception of dermatologists as surgeons may not be as fully recognized. Mohs surgeons are trained in complex reconstructions of cosmetically and functionally sensitive (CFS) sites, although the proportion they account for is unknown. To quantify the proportion of cutaneous reconstructions in CFS sites performed by Mohs surgeons compared with other specialists, and to identify trends from 2013 to 2019. A cross-sectional analysis was performed using the Medicare Public Use Files for 2013 to 2019. Data were stratified by physician specialty, with dermatologists further subdivided into Mohs surgeons and non-Mohs dermatologists. Mohs surgeons performed 75.3% of all reconstructions in 2019, a significant increase from 2013 ( p < .0001). Mohs surgeons dominated nearly every type of CFS cutaneous reconstruction, with significant increases in proportion ( p < .0001) from 2013 to 2019 for every category except interpolation flaps. Complex repairs were the most commonly performed cutaneous reconstruction type. Mohs surgeons perform far more cutaneous reconstructive surgeries in CFS sites than any other specialty for the Medicare population, with significant increases in their lead over the study period.

Utilization of Medicare's chronic care management services by primary care providers

BackgroundMedicare billing codes introduced in 2015 reimburses primary care providers for non-face-to-face, chronic care management (CCM) services rendered by clinical staff. PurposeThe purpose of this manuscript was to describe provider trends in billed CCM services and identify factors associated with CCM utilization. MethodsObservational study using Medicare Public Use Files, 2015 to 2018. General, family, geriatric, and internal medicine physicians, nurse practitioners (NPs), and physician assistants (PAs) with billed primary care services were included. Multivariable analyses modeled associations between the CCM services and type of provider, adjusting for year, primary care services, practice, and patient characteristics. FindingsAmong 140,465 physicians and 141,118 NPs/PAs, CCM services increased each year, yet remained underutilized: 2% to 7% of physicians and 0.3% to 1.3% of NPs/PAs billed CCM in 2018. Increases in beneficiaries (p < .0001), percentage of dually enrolled (p = .0134), and primary care services (p < .0001) predicted higher CCM utilization. DiscussionCCM utilization reflects practice-based efforts to improve patient access to care by enhancing care delivery.

Practice Patterns for Mohs Surgeons of Varying Clinical Experience: A Cross-Sectional Analysis of a Medicare Claims Database.

Use of Mohs micrographic surgery (MMS) is highly prevalent, but little data are available on how surgeon experience affects surgical practice patterns. To determine differences in use of MMS among surgeons of varying experience. This cross-sectional study sampled from clinicians billing ≥200 mean annual Mohs surgery claims from the 2012 to 2018 Medicare Public Use File. The primary outcome was mean annual Mohs surgery claims for clinicians of varying experience. Secondary outcomes included use of flaps/grafts and prescribing of oral antibiotics, benzodiazepines, and opioids. Among 1,759 unique surgeons, those with 16 to 20 years of experience performed the most mean annual (95% confidence interval) Mohs surgical cases (578.7 [556.7-600.6]). Surgeons with 21 to 25 years of experience prescribed the most antibiotics (240.2 [216.5-263.8] mean annual claims), whereas those with >35 years of experience prescribed the longest courses (15.3 [14.2-16.4] days). Midcareer surgeons performed the most mean annual Mohs surgery cases, whereas later career surgeons prescribed more frequent and longer courses of antibiotics suggesting changing practice patterns with additional years of experience.

LB714 Differences in utilization of field therapy of Actinic Keratoses by varying practitioner type

We aimed to characterize trends in management of field cancerization of actinic keratoses by dermatologists and other clinicians. The 2013-2018 Medicare Public Use File and Physician Compare Tool were analyzed, including 116,441 unique clinicians. Specialties included dermatologists, primary care physicians (PCPs), and advanced practice providers (APPs). Claims of cryosurgery (Healthcare Common Procedure Coding System codes 17000, 17003, and 17004), topical therapies (fluorouracil, imiquimod, or ingenol mebutate), and photodynamic therapy (PDT) were compared. Utilization of each treatment modality was measured as a percentage of all field therapy claims filed. Mean proportions (standard deviation) of individual clinicians were compared. Utilization of each modality was compared versus practitioner type. Longitudinal analyses were performed by calendar year. Statistical significance for all analyses was determined using one-way analysis of variance. PCPs had the greatest mean proportion of cryosurgery (94.9% [21.3%], P<0.0001) vs. dermatologists (93.2% [19.7%]) or APPs (92.2% [22.7%]). APPs most often prescribed topical treatments (7.3%% [22.4%]), while PDT was most utilized by dermatologists (0.6% [3.2%]). Longitudinally, use of cryosurgery decreased from 2013 to 2018 for every specialty (P£0.0005 for all). Use of topicals increased for dermatologists and APPs (P<0.0001 for both) but decreased for PCPs (P=0.0035). PDT use decreased for dermatologists and APPs (P<0.0001 for both) but not PCPs (P=0.95). Our findings demonstrate an important practice gap for non-dermatologists managing field cancerization of actinic keratoses. It may be helpful to educate PCPs on more effective and tolerable therapies than cryosurgery of ill-defined actinic damage. Among dermatologists and APPs, it appears that topical therapies are becoming more prevalent in comparison with cryosurgery or PDT for field cancerization. This may perhaps represent changing reimbursement rates set by Medicare as well as availability of more tolerable topical treatments.

Medicare beneficiary panel characteristics associated with high Part D biologic disease-modifying anti-rheumatic drug prescribing for older adults among rheumatologists.

The aim of this study was to investigate beneficiary panel characteristics associated with rheumatologists’ prescribing of biologic DMARDs (bDMARDs) for older adults.In this retrospective observational study, we used Medicare Public Use Files (PUFs) to identify rheumatologists who met criteria for high-prescribing, defined as bDMARD prescription constituting ≥20% of their DMARD claims for beneficiaries ≥65 years of age. We first used descriptive analysis then multivariable regression model to test the association of high prescribing of bDMARDs with rheumatologists’ panel size and beneficiary characteristics. In particular, we quantified the proportion of panel beneficiaries ≥75 years of age to assess how caring for an older panel correlate with prescribing of bDMARDs.We identified 3197 unique rheumatologists, of whom 405 (13%) met criteria for high prescribing of bDMARDs for Medicare beneficiaries ≥65 years of age. The high-prescribers provided care to 12% of study older adults, and yet accounted for 21% of bDMARD prescriptions for them. High prescribing of bDMARDs was associated with smaller panel size, and their beneficiaries were more likely to be non-black, ≥75 years of age, non-dual eligible, have diagnosis of CHF, however, less likely to have CKD.Rheumatologists differ in their prescribing of bDMARDs for older adults, and those caring for more beneficiaries ≥75 years of age are more likely to be high-prescribers. Older adults are more prone to the side-effects of bDMARDs and further investigation is warranted to understand drivers of differential prescribing behaviors to optimize use of these high-risk and high-cost medications.

A Cross-Sectional Analysis of High-Acuity Professional Services Performed by Urban and Rural Emergency Care Physicians Across the United States

We seek to examine differences in the provision of high-acuity professional services between rural and urban physicians receiving reimbursement for emergency care evaluation and management services from Medicare fee-for-service Part B. Using the 2017 Medicare Public Use Files, we performed a cross-sectional analysis and defined the primary outcome, the proportion of high-acuity charts (PHAC), at the physician level as the proportion of services provided as 99285 and 99291 emergency care evaluation and management service codes relative to all such codes. After accounting for unique clinician-level characteristics, we categorized individual physicians by PHAC quintiles and conducted ordered logistic regression analyses reporting adjusted marginal probabilities to examine associations with rurality. A total of 34,256 physicians providing emergency care had a median PHAC of 66.8% (interquartile range 55.6% to 75.7%), with 89.2% practicing in an urban setting. Urban and rural physicians had respective median PHACs of 67.6% (interquartile range 57.1% to 76.2%) and 57.9% (interquartile range 42.7% to 69.4%). Urban and rural physicians had respective adjusted marginal probabilities of 15.2% and 11.8% of being in the highest PHAC quintile, and respective adjusted marginal probabilities of 14.3% and 18.2% of being in the lowest PHAC quintile. In comparison with rural physicians, urban physicians providing emergency care received reimbursements for a greater PHAC when caring for Medicare fee-for-service beneficiaries. Policymakers must consider these differences in the design and implementation of new emergency care payment policies.

Who provides what care? An analysis of clinical focus among the national emergency care workforce.

Clinician expertise has been associated with improved patient outcomes, yet ED clinicians often work in various clinical settings beyond the ED and, therefore, may risk expertise by having less clinical focus. We sought to describe clinical focus among the emergency care workforce nationally. Using the 2017 Medicare Public Use Files (PUF), we performed a cross-sectional analysis of clinicians receiving reimbursement for emergency care Evaluation & Management (E/M) services from Medicare fee-for-service Part B. Clinicians were categorized by type as EM physicians, non-EM physicians, and advanced practice providers (APPs). The primary outcome was the clinical focus of the individual clinician, defined as the proportion of E/M services within the ED setting relative to a clinician's total E/M services across all practice settings. Of 65,710 unique clinicians providing care to Medicare fee-for-service beneficiaries in the ED setting, 39,016 (59.4%) were classified as EM physicians, 8123 (12.4%) as non-EM physicians, and 18,571 (28.5%) as APPs. The individual clinician median focus was 92.8% (interquartile range [IQR]: 87.0, 100.0) for EM physicians, 45.2% (IQR: 5.1, 97.0) for non-EM physicians, and 100.0% (IQR: 96.3, 100.0) for APPs. EM physicians have twice as much clinical focus in comparison to non-EM physicians providing emergency care to Medicare fee-for-service beneficiaries. These findings underscore the importance of diverse training and certification programs to ensure access to clinically focused ED clinicians.

MP27-19 PROVIDER BEHAVIOR-SHAPING AS A STEPPING-STONE TO VALUE BASED CARE

INTRODUCTION AND OBJECTIVE: Legislators and regulatory bodies have indicated a desire to accelerate the transition to risk-based payment paradigms. To succeed in these models, providers must first measure and standardize utilization; such attempts have historically met with limited success. We sought to determine if prospective behavior-shaping tools implemented in a single large urology practice (Integrated Medical Professionals, PLLC; IMP) was effective in reducing variability and improving accuracy in evaluation and management (E/M) codes. METHODS: After educating IMP providers in billing accuracy from 2013-15, CPT codes for new (99201-5) and established (99211-5) E/M services for Medicare beneficiaries seen at IMP were compared to those urologists practicing nationally (US) as well as those practicing in groups of 10 or more (G10), using data from CMS Medicare Public Use Files for 2016. In addition to mean code level, coding variability for each CPT code was determined for each group. Coding inaccuracy was assessed determining frequency of a cluster coding (provider use of single E/M code >70% of the time) overall and for level 4/5 codes in aggregate. Statistical analysis was performed using Student’s pooled t-test. Variability in coding patterns was measured using f-test, and cluster coding was compared using two proportion z-test. RESULTS: We reviewed 1,032,623 new and 7,045,239 established E/M visits billed to CMS in 2016 by a total of 8,651 urologists nationally. Results are presented in Table 1. When compared to both G10 and US for new and established E/M visits, IMP mean code levels were both significantly shifted left and more uniform (p=0.00 and f=0.00, respectively for both visit types). Overall cluster coding rates for both new and established E/M codes were significantly lower for IMP when compared to both G10 and US (z=0.00 all categories); these differences were even more marked for level 4/5 new and established E/M codes (z=0.00 all categories). CONCLUSIONS: Institution of provider education and standardized review both improved accuracy and reduced variability in E/M coding. Institution of such programs may be an important stepping stone to developing value-based care models.Source of Funding: none

General Practitioners in US Medical Practice Compared With Family Physicians.

General practitioners (GPs) are part of the US physician workforce, but little is known about who they are, what they do, and how they differ from family physicians (FPs). We describe self-identified GPs and compare them with board-certified FPs. Analysis of data on 102,604 Doctor of Medicine and Doctor of Osteopathy physicians in direct patient care in the United States in 2016, who identify themselves as GPs or FPs. The study used linking databases (American Medical Association Masterfile, American Board of Family Medicine [ABFM], Area Health Resource File, Medicare Public Use File) to examine personal, professional, and practice characteristics. Of the physicians identified, 6,661 self-designated as GPs and 95,943 self-designated as FPs. Of the self-designated GPs, 116 had been ABFM certified and were excluded from the study. Of the remaining 102,488 physicians, those who self-designated as GPs but were never ABFM certified constituted the GP group (n = 6,545, 6%). Self-designated FPs that were ABFM certified made up the FP group (n = 79,449, 78%). The remaining self-designated FPs not ABFM certified constituted the uncertified group (n = 16,494, 16%). GPs differed from FPs in every characteristic examined. Compared with FPs, GPs are more likely to be older, male, Doctors of Osteopathy, graduates of non-US medical schools, and have no family medicine residency training. GPs practice location is similar to FPs, but GPs are less likely to participate in Medicare or to work in hospitals. GPs in the United States are a varied group that differ from FPs. Researchers, educators, and policy makers should not lump GPs together with FPs in data collection, analysis, and reporting.

State of the National Emergency Department Workforce: Who Provides Care Where?

We describe the current US emergency medicine workforce in terms of clinician type and examine rural and urban emergency medicine workforce differences. Using the 2014 Medicare Public Use Files, we performed a cross-sectional study of all clinicians receiving reimbursement for evaluation and management (E/M) services (levels 1 to 5) to Medicare fee-for-service Part B beneficiaries in the emergency department. Providers were defined as emergency physicians, nonemergency physicians, or advanced practice providers, corresponding with the Medicare Public Use Files data set. The primary outcome was the number of clinicians providing greater than 10 E/M claims tabulated as a distinct encounter. Urbanicity data were obtained from the National Bureau of Economic Research. Of 58,641 unique emergency medicine clinicians, 35,856 (61.1%) were classified as emergency physicians, 8,397 (14.3%) as nonemergency physicians, and 14,360 (24.5%) as advanced practice providers. Among nonemergency physicians categorized as emergency medicine clinicians, family practice and internal medicine predominated (41.7% and 19.9%, respectively). Among advanced practice providers, physician assistants (68.4%) and nurse practitioners (31.5%) predominated. A total of 58,565 emergency medicine clinicians were mapped to 2,291 US counties or equivalents. Urban counties had a higher proportion of emergency physicians (63.9%) compared with rural counties (44.8%); 27.1% of counties had no emergency medicine clinicians and 41.4% of counties had no emergency physicians reimbursed by Medicare fee-for-service Part B. This work establishes a new baseline estimate of the emergency care workforce, encompassing nearly60,000 emergency medicine clinicians, of whom fewer than 2 in 3 were emergency physicians. Notable differences exist in the type of clinician staffing of emergency care between urban and rural communities.

Trends in the Utilization of Penile Prostheses in the Treatment of Erectile Dysfunction in the United States.

The utilization of penile prosthesis (PP) insertion in the general population for medically refractory erectile dysfunction (ED) has not been well-characterized. This study assessed the national temporal trends in the surgical management of ED utilizing PP. An analysis of the 5% Medicare Public Use Files from 2001 to 2010 was performed to assess the use of PP. Regression analysis was performed to identify factors associated with PP placement, type of PP utilized, and factors associated with revisions. A total of 1,763,260 men were diagnosed with ED, 3% (53,180) of whom underwent PP insertion. The utilization of PP for ED decreased from 4.6% in 2002 to 2.3% in 2010 (P < 0.01). This temporal decline in utilization was significant across all demographic factors including age, ethnicity, and geographic location. Men aged 65-74, from the U.S. South and West, and those with Charlson comorbidity scores >1 were more likely to have a PP inserted for ED (P < 0.01). African American men were more likely to have a semirigid PP placed compared with a multicomponent inflatable PP, and were more likely to undergo a revision or removal of the PP compared with Caucasian men (P < 0.01). The surgical management of ED with PP changed significantly between 2001 and 2010. The overall utilization of PP decreased, but its use in patients with significant medical comorbidities increased. Age >65, ethnicity, and geography influenced the likelihood of PP placement, prosthesis type, as well as the likelihood of prosthesis removal or revision.

PD26-09 FACTORS INVOLVED IN THE REMOVAL OR REPLACEMENT OF PENILE PROSTHESES

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy I1 Apr 2015PD26-09 FACTORS INVOLVED IN THE REMOVAL OR REPLACEMENT OF PENILE PROSTHESES Bobby Najari, Daniel Lee, Wesley Davison, Bashir Al Hussein Al Awamlh, Fujun Zhao, John Mulhall, Darius Paduch, Bilal Chughtai, and Richard Lee Bobby NajariBobby Najari More articles by this author , Daniel LeeDaniel Lee More articles by this author , Wesley DavisonWesley Davison More articles by this author , Bashir Al Hussein Al AwamlhBashir Al Hussein Al Awamlh More articles by this author , Fujun ZhaoFujun Zhao More articles by this author , John MulhallJohn Mulhall More articles by this author , Darius PaduchDarius Paduch More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , and Richard LeeRichard Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1085AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile prosthesis (PP) insertion is the primary surgical treatment for medically refractory erectile dysfunction (ED). PP infection and mechanical failure however are critical complications that can occur. The factors associated with the removal or replacement of PP have not been well-characterized in large population-based studies. This study assesses the factors associated with and the national trends in PP removal and replacement. METHODS An analysis of the 5% Medicare Public Use Files from 2001 to 2010 was performed to assess the factors associated with PP replacement or removal over time in the treatment of ED. Regression analysis was performed to identify factors associated with PP replacement or removal. RESULTS A total 88,163 men were diagnosed with ED, 2.9% (2,600) of whom underwent PP insertion. Two-hundred forty (0.3%) underwent a PP removal, and 527 (0.6%) underwent a replacement. Of those who underwent either a removal or replacement, 627 (82.1%) were due to mechanical failure and 105 (13.7%) were due to PP-associated infection. Although the utilization of PP for ED decreased over time (from 4.6% in 2002 to 2.3% in 2010, p<0.01), the frequency of PP removal or replacement stayed consistent over time relative to the rate of new PP inserted per year, at approximately 1 replacement or removal per 4 new PP insertions. On multivariable regression analysis, age older than 70 and significant cardiovascular disease were independently associated with the PP replacement or removal (p<0.01). There were no differences in rates of PP removal or replacement according to diabetes status, region or race. CONCLUSIONS The surgical management of ED changed significantly between 2001 and 2010. Although the rate of PP removal or replacement have not changed significantly over time, older age and cardiovascular disease may have a significant impact on the risk of requiring a PP replacement or removal. These findings can be utilized to help counsel patients on the risks of obtaining a PP. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e569 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bobby Najari More articles by this author Daniel Lee More articles by this author Wesley Davison More articles by this author Bashir Al Hussein Al Awamlh More articles by this author Fujun Zhao More articles by this author John Mulhall More articles by this author Darius Paduch More articles by this author Bilal Chughtai More articles by this author Richard Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Trends and inequalities in the surgical management of ureteric calculi in the USA

To assess trends in the surgical management of ureteric calculi over a 10-year period. An analysis of the 5% Medicare Public Use Files, from 2001, 2004, 2007 and 2010, was performed to assess the use of ureteroscopy (URS), extracorporal shockwave lithotripsy (ESWL) and ureterolithotomy (UL) in treating ureteric calculi. Patients were identified using International Classification of Diseases 9th edition (Clinical Modification) and Current Procedure Terminology codes. Statistical analyses using the Fisher and chi-squared tests, and multivariate logistic regression analysis (dependent variables: URS, ESWL, UL, treatment, no treatment; independent variables: age, gender, ethnicity, geography and year of treatment) were performed. A total of 299 920 patients with ureteric calculi were identified. Of these, 115 200 underwent surgery. Men (odds ratio [OR] = 1.15, P < 0.001) were more likely, while patients from ethnic minorities (OR = 0.84, P = 0.004) were less likely to be treated. Patients in the West of the USA were also less likely to be treated (OR = 0.76, P < 0.001) as were patients aged <65 or >84 years old (P = 0.29). The predominant surgical approach was URS (65.2%), followed by ESWL (33.6%) and UL (1.2%). The use of URS increased over time, while the use of ESWL and UL declined. Women (OR = 1.25, P < 0.001) were more likely to undergo URS. Patients in the South of the USA (OR = 1.51, P < 0.001) and patients from ethnic minorities were more likely to undergo ESWL (OR = 1.23, P = 0.03). The surgical treatment of ureteric calculi changed significantly between 2001 and 2010. The use of URS expanded at the expense of ESWL and UL. Multiple inequalities existed in overall surgical treatment rates and in the choice of treatment; age, gender, ethnicity and geography influenced both whether patients underwent surgical intervention and the type of surgical approach used.

Trends in the Utilization of Percutaneous and Open Nephrolithotomy in the Treatment of Renal Calculi

To evaluate trends in the use of percutaneous nephrolithotomy (PCNL) and nephrolithotomy (NL) in patients with renal pelvis calculi. An analysis of the 5% Medicare Public Use Files (years 2001, 2004, 2007, and 2010) was performed to assess changes in the use of PCNL and NL over a 10-year period. Patients were identified using the International Classification of Diseases-9 (cm) and Current Procedure Terminology codes. Statistical analyses, including the Fisher and chi-square tests and multivariate regression analyses, were performed using SAS 9.3 (SAS Institute Inc, Cary, NC) and SPSS v20 (IBM Corp., Armonk, NY). A total of 26,100 patients underwent either PCNL or NL. Use of PCNL and NL decreased from 3.1% to 2.5% in patients with a diagnosis of stones (P<0.0001). Women (odds ration [OR]=1.19, P=0.003) were more likely to undergo surgery. Patients aged ≥65 years were less likely to be treated (OR=0.65-0.71, P<0.05). Patients treated after 2004 were less likely to undergo surgery (OR=0.77-0.84, P<0.05). The use of PCNL exceeded NL at a stable 10:1 ratio. The use of PCNL and NL for treatment of patients with stone disease slightly decreased from 2001 to 2010, although the number of patients with renal calculi increased. The use of PCNL vs NL was unchanged during this period. Multiple inequalities existed in overall surgical treatment rates and were influenced by sociodemographic factors such as age and sex.

Medicare Public Use Files and Alzheimer's disease factors in 2008 and 2010

A new set of files are available to researchers as free downloads and they contain nonidentifiable claim-specific information for Fee-for-Service (FFS) Medicare beneficia- ries. Data on use and payments per beneficiary for Part A, B, and D are available for Alzheimer’s disorders and 10 other chronic conditions, allowing for novel comparisons.

Gastrointestinal Surgery Risk Assessment Must Factor Into NSQIP, Medicare Public Reporting and Pay-for-Performance Measures: Bring CR-Possum Scoring to the U.S.

Gastrointestinal Surgery Risk Assessment Must Factor Into NSQIP, Medicare Public Reporting and Pay-for-Performance Measures: Bring CR-Possum Scoring to the U.S.