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INTRODUCTION
On April 9, 2014 the Centers of Medicare and Medicaid Services (CMS) released 10 million billings records of over 880,000 physicians and other healthcare providers. The records accounted for over billion dollars in Medicare payments distributed in 2012. Herein we present urologic specific data in the context of overall physician payments which to date not been published or analyzed.
METHODS
The zip file (tab delimited format, 1.7 GB) was downloaded at CMS.gov from the publically available Medicare provider utilization and payment database containing 2012 claims data. This was used to provide a database for analysis using Microsoft Excel, Access, and Tableau. The urology specialty was extracted in full detail, and other specialities were extracted only on a summary level. The urology dataset includes 27 database fields, 843 procedures/drugs/services, and a 32,491,668 total services count. Techniques including pivot tables, visual basic functions and macros, graphs, charts, and other methods were utilized for data analysis.
RESULTS
In 2012 a total of $1,385,385,000 was distributed to 8,784 Urologic Physician Providers for 194,554 Procedure claims. The average urologist was paid $157,700 by CMS in 2012. The top 5 paid claims were: established outpatient visits ($411,878,000), leuprolide injections ($141,465,800), cystoscopy ($126,700,838), new outpatient visits ($99,259,200), and cystoscopy and treatment ($52,857,100). The top 5 highest per procedure payments were: remove bladder/create pouch ($1,848), remove bladder/revise tract ($1,742), prostatic microwave thermotherapy ($1,714), kidney transplant ($1,679), prostatic rf thermotx ($1,678).
Of total medicare payments, 13.4 billion (17%) went to primary care, and 42 billion (55%) to specialty care. Of specialty care, Urology ranks 10th among subspecialties for total Medicare payments, with the top five being Opthalmology, Cardiology, Diagnostic Radiology, Hematology/Oncology, and Dermatology. Radiation oncology ranks 9th. Geographic analysis was performed by ranking states according to total paid, and adjusting for census population over age 65, revealing nonuniform distribution. Highest per capita spending was in FL, DE, DC, NJ.
CONCLUSIONS:
The release of an enormous amount of provider level claims data by CMS may potentially serve as a new tool to locate potential fraud, pinpoint needs, and assess levels of growth in care. This is the first report that broadly creates a picture of the urologic medicare landscape.