{"title":"通过工作相对价值单位预测泌尿科医疗保险实践中的峰值生产率。","authors":"","doi":"10.1016/j.urology.2024.03.037","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To explore factors associated with productivity in urologic practice. Work-relative value units (wRVUs), the basis for Center for Medicare & Medicaid Services (CMS) and private payer reimbursements, commonly serve to estimate physician productivity. Limited data describes which practice factors predict increased wRVU productivity.</p></div><div><h3>Methods</h3><p>The 2017 and 2018 CMS databases were retrospectively queried for urologic Medicare provider demographics and procedural/service details. Medical school graduation year was used to estimate years in practice and generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients’ demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict wRVU production.</p></div><div><h3>Results</h3><p>Included were 6773 Medicare-participating urologists across the United States. Millennials produced 1115 wRVUs per year, while Gen X and Baby Boomers produced significantly more (1997 and 2104, respectively, <em>P</em> <.01). Post-War urologists produced numerically more (1287, <em>P</em><span> = .88). In adjusted analyses, predictors of Medicare wRVU productivity included female and pelvic medicine and reconstructive surgery (exponentiated beta estimate (β) 1.46, 95% CI 1.32-1.60), men’s health (β 1.22, 95% CI 1.13-1.32), and oncologic subspecialization (β 1.08, 95% CI 1.02-1.14), female gender (β 0.87, 95% CI 0.82-0.92), wRVUs generated from inpatient procedures (β 1.08, 95% CI 1.06-1.09) and office visits (β 0.88, 95% CI 0.87-0.89), and the level of education (β 1.10, 95% CI 1.07-1.14) and percent impoverished patients (β 0.85, 95% CI 0.83-0.88) in provider’s practice zip code.</span></p></div><div><h3>Conclusion</h3><p>Urologic experience, specialization, demographics, practice patterns, and patient demographics are significantly associated with wRVU productivity in Medicare settings. Further work should incorporate quality metrics into wRVUs and ensure patient demographics do not affect reimbursement.</p></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predicting Peak Productivity in Urologic Medicare Practice via Work-Relative Value Units\",\"authors\":\"\",\"doi\":\"10.1016/j.urology.2024.03.037\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To explore factors associated with productivity in urologic practice. Work-relative value units (wRVUs), the basis for Center for Medicare & Medicaid Services (CMS) and private payer reimbursements, commonly serve to estimate physician productivity. Limited data describes which practice factors predict increased wRVU productivity.</p></div><div><h3>Methods</h3><p>The 2017 and 2018 CMS databases were retrospectively queried for urologic Medicare provider demographics and procedural/service details. Medical school graduation year was used to estimate years in practice and generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients’ demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict wRVU production.</p></div><div><h3>Results</h3><p>Included were 6773 Medicare-participating urologists across the United States. Millennials produced 1115 wRVUs per year, while Gen X and Baby Boomers produced significantly more (1997 and 2104, respectively, <em>P</em> <.01). Post-War urologists produced numerically more (1287, <em>P</em><span> = .88). In adjusted analyses, predictors of Medicare wRVU productivity included female and pelvic medicine and reconstructive surgery (exponentiated beta estimate (β) 1.46, 95% CI 1.32-1.60), men’s health (β 1.22, 95% CI 1.13-1.32), and oncologic subspecialization (β 1.08, 95% CI 1.02-1.14), female gender (β 0.87, 95% CI 0.82-0.92), wRVUs generated from inpatient procedures (β 1.08, 95% CI 1.06-1.09) and office visits (β 0.88, 95% CI 0.87-0.89), and the level of education (β 1.10, 95% CI 1.07-1.14) and percent impoverished patients (β 0.85, 95% CI 0.83-0.88) in provider’s practice zip code.</span></p></div><div><h3>Conclusion</h3><p>Urologic experience, specialization, demographics, practice patterns, and patient demographics are significantly associated with wRVU productivity in Medicare settings. Further work should incorporate quality metrics into wRVUs and ensure patient demographics do not affect reimbursement.</p></div>\",\"PeriodicalId\":23415,\"journal\":{\"name\":\"Urology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0090429524002838\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0090429524002838","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的探讨与泌尿科工作效率相关的因素。工作相对价值单位(wRVUs)是医疗保险和医疗补助服务中心(CMS)以及私人支付方报销的基础,通常用于估算医生的生产率。有限的数据说明了哪些实践因素可预测wRVU生产率的提高。方法回顾性查询了2017年和2018年CMS数据库中泌尿科医疗保险提供者的人口统计数据和程序/服务细节。医学院毕业年份用于估算从业年限和世代(千禧一代、X一代、婴儿潮一代或战后一代)。获得了接受治疗的患者的人口统计数据。结果包括全美 6773 名参加医疗保险的泌尿科医生。千禧一代每年产生 1115 个 wRVU,而 X 代和婴儿潮一代则明显更高(分别为 1997 年和 2104 年,P <.01)。战后泌尿科医生的产量更高(1287,P = .88)。在调整分析中,医疗保险 wRVU 生产率的预测因素包括女性和盆腔内科及整形外科(指数化贝塔估计值 (β) 1.46,95% CI 1.32-1.60)、男性健康(β 1.22,95% CI 1.13-1.32)、肿瘤亚专科(β 1.08,95% CI 1.02-1.14)、女性性别(β 0.87,95% CI 0.82-0.92)、住院手术产生的 wRVUs(β 1.08,95% CI 1.结论在医疗保险机构中,临床经验、专业、人口统计学、实践模式和患者人口统计学与 wRVU 生产率显著相关。进一步的工作应将质量指标纳入 wRVU,并确保患者人口统计学特征不会影响报销。
Predicting Peak Productivity in Urologic Medicare Practice via Work-Relative Value Units
Objective
To explore factors associated with productivity in urologic practice. Work-relative value units (wRVUs), the basis for Center for Medicare & Medicaid Services (CMS) and private payer reimbursements, commonly serve to estimate physician productivity. Limited data describes which practice factors predict increased wRVU productivity.
Methods
The 2017 and 2018 CMS databases were retrospectively queried for urologic Medicare provider demographics and procedural/service details. Medical school graduation year was used to estimate years in practice and generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients’ demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict wRVU production.
Results
Included were 6773 Medicare-participating urologists across the United States. Millennials produced 1115 wRVUs per year, while Gen X and Baby Boomers produced significantly more (1997 and 2104, respectively, P <.01). Post-War urologists produced numerically more (1287, P = .88). In adjusted analyses, predictors of Medicare wRVU productivity included female and pelvic medicine and reconstructive surgery (exponentiated beta estimate (β) 1.46, 95% CI 1.32-1.60), men’s health (β 1.22, 95% CI 1.13-1.32), and oncologic subspecialization (β 1.08, 95% CI 1.02-1.14), female gender (β 0.87, 95% CI 0.82-0.92), wRVUs generated from inpatient procedures (β 1.08, 95% CI 1.06-1.09) and office visits (β 0.88, 95% CI 0.87-0.89), and the level of education (β 1.10, 95% CI 1.07-1.14) and percent impoverished patients (β 0.85, 95% CI 0.83-0.88) in provider’s practice zip code.
Conclusion
Urologic experience, specialization, demographics, practice patterns, and patient demographics are significantly associated with wRVU productivity in Medicare settings. Further work should incorporate quality metrics into wRVUs and ensure patient demographics do not affect reimbursement.
期刊介绍:
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.