Dowling RA. et al., 2023: Surgical Stone Treatment: Patterns May Predict Performance on Episode-based Cost Measure in the Quality Payment Program.
Dowling Medical Director Services, Ft Worth, Texas.
Vanderbilt University Medical Center, Nashville, Tennessee.
Large Urology Group Practice Association, Chicago, Illinois.
Department of Urology, Crouse Hospital, Syracuse, New York.
Associated Medical Professionals, Downstate Health Sciences University, Syracuse, New York.
Abstract
Introduction: The Renal or Ureteral Stone Surgical Treatment Episode-based Measure in the Quality Payment Program evaluates clinicians' cost to Medicare for beneficiaries who receive surgical treatment for stones. The measure score is calculated from Medicare claims according to a complex methodology. 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.
Methods: 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 the same providers, generalized estimating equations logistic regression models were used to evaluate the rate of preoperative stenting and postoperative infection.
Results: A total of 185,076 surgical episodes (113,799 [61.5%] ureteroscopy, 63,931 [34.5%]
extracorporeal shock wave lithotripsy, and 7,346 [4.0%] percutaneous nephrolithotripsy) 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 (adjusted OR 1.42, 1.38), in those undergoing ureteroscopy vs extracorporeal shock wave lithotripsy (adjusted OR 3.24, 1.66), and in patients on Medicare vs commercial insurance (adjusted OR 1.19, 1.17).
Conclusions: 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 Quality Payment Program.
Urol Pract. 2023 May 5:101097UPJ0000000000000407. doi: 10.1097/UPJ.0000000000000407.
Online ahead of print.PMID: 37103884
Comments 1
This report is based on conditions that are representative for the care of patients with renal and ureteral stones in USA. It is in this perspective that the cost based on re-imbursement must be considered. It should be noted that 62% of the patients were treated with URS, 35% with SWL and 4% with PCNL. This information is of importance for the need of preoperative and postoperative internal stenting.
That women were more likely to develop infection is logical and so is the postoperative risk of infection in stented patients. The basic information was that 19.2% of the patients were stented and that 7.1% had postoperative infection. The relatively high rate of stenting is determined by the high rate of URS, but it is not clear why women were stented more commonly. The clinical indications for stenting are concealed. Further details broken down to the various health care systems are of interest only to the American urologists.
Details of the re-imbursement system is lacking and so is the actual cost. Important is that clinical experience was important for determining the cost level.
The Tables were initially difficult to read because what the authors present as % is not % but a fraction of the total which means 0.06 is 6% and nothing else.
Hans-Göran Tiselius