Declining Medicare Participation, Patient Volume, and Reimbursement Among Urologists in Ohio: Implications for Access...

To evaluate changes in traditional fee-for-service Medicare participation, patient volume, and inflation-adjusted reimbursement among Ohio urologists from 2019 to 2023 METHODS: Retrospective analysis of Centers for Medicare & Medicaid Services (CMS) Doctors and Clinicians (DAC) and Medicare Physician & Other Practitioners Public Use File (PUF) data, 2019-2023, linked at the National Provider Identifier (NPI) level. Outcomes were estimated using provider-level linear mixed-effects models with a random intercept per NPI. A cross-specialty comparator analysis covered ten other Ohio surgical specialties, and a Healthcare Common Procedure Coding System (HCPCS)-level decomposition analysis characterized payment-mix shifts.

The analysis included 411 unique Ohio urologists contributing 1,612 provider-year observations. Traditional fee-for-service Medicare participation declined by 6.1 percentage points (85.9% to 79.8%; 1.1 percentage points/year, P<0.001), while median beneficiaries per provider declined 15% (518 to 440; P<0.001) and median services per provider declined 35% (2,257 to 1,457; P=0.007). Inflation-adjusted Medicare payment per beneficiary declined 16% ($300 to $252; P<0.001). Similar declines were observed across ten comparator Ohio surgical specialties; payment compression was broadly distributed across evaluation-and-management, procedural, and drug billing.

Traditional fee-for-service Medicare participation, beneficiary volume, and inflation-adjusted reimbursement declined among Ohio urologists from 2019 to 2023. Growth in Medicare Advantage may contribute to observed declines in the traditional fee-for-service panel and cannot be distinguished using these data. Concurrent declines in inflation-adjusted payment per service nevertheless demonstrate real reimbursement compression within traditional Medicare.