Rationale and Objectives
Meaningfully measuring physician outcomes and resource utilization requires appropriate
patient risk adjustment. We aimed to assess Medicare patient complexity by physician
specialty and to further identify radiologist characteristics associated with higher
patient complexity.
Materials and Methods
The average beneficiary Hierarchical Condition Category (HCC) risk scores (Medicare's
preferred measure of clinical complexity) were identified for all physicians using
2014 Medicare claims data. HCC scores were compared among physician specialties and
further stratified for radiologists based on a range of characteristics. Univariable
and multivariable analyses were performed.
Results
Of 549,194 physicians across 54 specialties, the mean HCC risk score was 1.62 ± 0.75.
Of the 54 specialties, interventional radiology ranked 4th (2.60 ± 1.29), nuclear
medicine ranked 16th (1.87 ± 0.45), and diagnostic radiology ranked 21st (1.75 ± 0.61).
Among 31,175 radiologists, risk scores were higher (P < 0.001) for those with teaching (2.03 ± 0.74) vs nonteaching affiliations (1.72 ± 0.61),
practice size ≥100 (1.94 ± 0.70) vs ≤9 (1.59 ± 0.79) members, urban (1.79 ± 0.69)
vs rural (1.67 ± 0.59) practices, and subspecialized (1.85 ± 0.81) vs generalized
(1.68 ± 0.42) practice patterns. Among noninterventional radiology subspecialties,
patient complexity was highest for cardiothoracic (2.09 ± 0.57) and lowest for breast
(1.08 ± 0.32) imagers. At multivariable analysis, a teaching affiliation was the strongest
independent predictor of patient complexity for both interventional (β = +0.23, P = 0.005) and noninterventional radiologists (β = +0.21, P < 0.001).
Conclusions
Radiologists on average serve more clinically complex Medicare patients than most
physicians nationally. However, patient complexity varies considerably among radiologists
and is particularly high for those with teaching affiliations and interventional radiologists.
With patient complexity increasingly recognized as a central predictor of clinical
outcomes and resource utilization, ongoing insights into complexity measures may assist
radiologists navigating emerging risk-based payment models.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- H.R.2—Medicare access and CHIP Reauthorization Act of 2015.(Available at:)
- Medicare program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models.(Available at:)https://www.gpo.gov/fdsys/pkg/FR-2016-11-04/pdf/2016-25240.pdfDate: 2016Date accessed: March 5, 2017
- Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013.(No. 222. Vol. 77; 69317–69318; Available at:)https://www.gpo.gov/fdsys/pkg/FR-2012-11-16/pdf/2012-26900.pdfDate: 2012Date accessed: March 18, 2017
- Temporal and patient variations potentially impacting new payment models.J Am Coll Radiol. 2017; 14: 452-458
- Risk adjustment for Medicare beneficiaries with Alzheimer's disease and related dementias.Am J Manag Care. 2010; 16: 191-198
- Evaluation of the CMS-HCC risk adjustment model.(Available at:)https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/downloads/evaluation_risk_adj_model_2011.pdfDate: 2011Date accessed: March 6, 2017
- Payment standardization and risk adjustment for the Medicare physician feedback and value modifier programs.(Available at:)https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/122111_Slide_Presentation.pdfDate: 2011Date accessed: March 18, 2017
- Medicare fee-for-service provider utilization & payment data physician and other supplier public use file: a methodological overview.(Available at:)
- Comparison of the performance of the CMS Hierarchical Condition Category (CMS-HCC) risk adjuster with the Charlson and Elixhauser comorbidity measures in predicting mortality.BMC Health Serv Res. 2010; 10: 245
- Metadata for dataset /pub/data/georef/zcta_master.(Available at:)http://mcdc.missouri.edu/data/georef/zcta_master.Metadata.htmlDate: 2013Date accessed: March 6, 2017
- Phsyician compare.(Available at:)https://www.medicare.gov/physiciancompare/Date accessed: March 6, 2017
- Accredited programs and sponsoring institutions.(ACGME website; Available at:)www.acgme.org/acgmeweb/tabid/172/GraduateMedicalEducation/AccreditedProgramsandSponsoringInstitutions.aspxDate accessed: September 22, 2015
- Journal club: radiologists' online identities: what patients find when they search radiologists by name.AJR Am J Roentgenol. 2016; 207: 952-958
- Academic radiologist subspecialty identification using a novel claims-based classification system.AJR Am J Roentgenol. 2017; 208: 1249-1255
- Private practice radiologist subspecialty classification using Medicare claims.J Am Coll Radiol. 2017; (Jun 30; Epub ahead of print)
- Neiman imaging types of service.(Available at:)http://www.neimanhpi.org/neiman-imaging-types-of-service-nitos/Date accessed: September 22, 2017
- (Available at:)www.openheatmap.comDate accessed: March 6, 2017
- MACRA, alternative payment models, and the physician-focused payment model: implications for radiology.J Am Coll Radiol. 2017; 14: 744-751
- Identifying radiology's place in the expanding landscape of episode payment models.J Am Coll Radiol. 2017; 14: 882-888
- Paying for graduate medical education: the debate goes on.Health Aff (Millwood). 2001; 20: 136-147
- Medicare financing of graduate medical education.J Gen Intern Med. 2002; 17: 283-292
- The ongoing gap in availability of imaging services at teaching versus nonteaching hospitals.Acad Radiol. 2016; 23: 1057-1063
- Academic medical centers and community hospitals integration: trends and strategies.J Am Coll Radiol. 2017; 14: 45-51
- Variation in the ratio of physician charges to Medicare payments by specialty and region.JAMA. 2017; 317: 315-318
- Proposed changes to the CMS-HCC risk adjustment model for payment year 2017.(Available at:)https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/RiskAdj2017ProposedChanges.pdfDate: 2015Date accessed: March 18, 2017
- The complexity of disease combinations in the Medicare population.Popul Health Manag. 2011; 14: 161-166
- Differences in nursing home quality between Medicare advantage and traditional Medicare patients.J Am Med Dir Assoc. 2016; 17 (960.e969–960.e914)
- Measuring coding intensity in the Medicare advantage program.Medicare Medicaid Res Rev. 2014; 4
Article info
Publication history
Published online: November 03, 2017
Accepted:
September 11,
2017
Received in revised form:
September 9,
2017
Received:
June 7,
2017
Footnotes
Funding sources: Authors Rosenkrantz and Duszak are supported by research grants from the Harvey L. Neiman Health Policy Institute.
Identification
Copyright
© 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
