Surgical Stone Treatment: Patterns May Predict Performance on Episode-based Cost Measure in the Quality Payment...

Area of Science:

• Urology
• Health Economics
• Quality Improvement

Background:

• The Quality Payment Program uses an episode-based measure for renal and ureteral stone surgical treatment costs.
• Understanding treatment patterns and associated costs is crucial for clinician performance evaluation.

Purpose of the Study:

• To describe urologist surgical stone treatment patterns.
• To establish benchmarks for preoperative stenting and postoperative infection rates.
• To identify predictors of clinician performance on episode cost measures.

Main Methods:

• Analysis of adjudicated Medicare claims from 960 urologists performing at least 30 stone treatments.
• Utilized generalized estimating equations logistic regression to assess preoperative stenting and postoperative infection rates.
• Data covered surgical episodes between January 1, 2020, and June 30, 2022.

Main Results:

• 185,076 surgical episodes were analyzed, including ureteroscopy, extracorporeal shock wave lithotripsy, and percutaneous nephrolithotripsy.
• Preoperative stenting occurred in 19.2% of cases; postoperative infection in 7.1%.
• Higher rates of stenting and infection were observed in female patients, those undergoing ureteroscopy, and Medicare beneficiaries.

Conclusions:

• This study provides benchmarks for key events in surgical stone treatment episodes.
• Identified patient and procedural factors influencing episode costs are relevant for urologists in the Quality Payment Program.
• Findings aid in understanding and potentially improving clinician performance metrics.