OBJECTIVE: To identify physician-level factors associated with high rates of sacral neuromodulation testing.
MATERIALS AND METHODS: We performed a retrospective cohort study using a 20% sample of national Medicare claims to identify physicians who performed sacral neuromodulation procedures between 2005 and 2010. Physician-level rates of device testing were determined based on the number of patients seen for overactive bladder and urinary retention diagnoses in the office in each calendar year. These rates were then used to fit a Poisson model to examine factors associated with high rates of device testing.
RESULTS: The number of physicians performing test procedures increased 4-fold from 2005 to 2010. Average rates of test procedures increased from 4.0 to 6.4 procedures per physician per year (P < .001), whereas rates of device implantation remained stable (P = .23). Physicians who had higher rates of device testing were associated with lower rates of device implantation (estimate, -1.76, P < .01). Other predictors of physicians with higher test rates included more recent calendar year, testing done in any setting other than an ambulatory surgery center, gynecology subspecialty, and geographic location in the South and West (all P values < .01).
CONCLUSION: Over time, physicians are testing more patients but are not implanting more devices. Additionally, there is an inverse relationship between rates of device testing and implantation, suggesting opportunities to improve efficiency and resource utilization.
Written by:
Suskind AM, Clemens JQ, Zhang Y, Hollenbeck BK. Are you the author?
Department of Urology, University of California, San Francisco, San Francisco, CA; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Reference: Urology. 2015 May 27. pii: S0090-4295(15)00337-4.
doi: 10.1016/j.urology.2015.04.003
PubMed Abstract
PMID: 26026856