Claims from January 1 through December 31, 2011 with exactly 90 day runout

Beneficiaries were attributed to 1 TIN based on primary care claims. EPs were assigned 1 predominant specialty as the specialty with the largest share of carrier claim costs.Each TIN had a specialty-adjusted cost per capita benchmark calculated as the sum of its constituent specialty benchmarks weighted by:

1) the percent of the TIN's charges incurred by EPs of that specialty. The denominator was TIN charges incurred by EPs.2) the percent of the TIN's EPs with that main specialty.

To calculate the TIN benchmark adjusted for number of EPs, the EP-adjusted national specialty benchmark was used.The mean and standard deviation of this specialty-adjusted per capita cost were taken over all TINs.Data:Beneficiaries who did not receive primary care from a primary care physician were attributed to the TIN with the largest share of primary care costs and at 

which they had at least 1 primary care claim by a physician.Beneficiaries with primary care from a primary care physician were attributed to the TIN with the largest share of primary care costs incurred by a primary care physician.In the original analysis, TINs with per capita cost more than 1 standard deviation below the mean were categorized as low cost; TINs with per capita cost more 

than 1 standard deviation above the mean were categorized as high cost; all other TINs were categorized as medium cost. The 5th and 95th percentiles of bootstrapped per capita cost were not used for this analysis.TINs with a specialty-adjusted per capita cost more than 1 standard deviation below the mean were categorized as low cost; TINs with specialty-adjusted per 

capita cost more than 1 standard deviation above the mean were categorized as high cost; all other TINs were categorized as medium cost.

Specifications:The standardized risk-adjusted per capita cost for each TIN was calculated as the ratio of it beneficiaries' total standardized costs over its beneficiaries' total 

predicted costs, multiplied by the national average standardized cost.

A national cost per capita benchmark was calculated for each specialty. The cost per capita for each TIN in which the specialty had billing EPs was weighted by that specialty's share of TIN EPs and the number of beneficiaries attributed to that TIN. This product was summed over all TINs and divided by the summed 

specialty share times the number of TIN beneficiaries. This benchmark reflects the average cost of beneficiaries attributed to groups of physicians with that specialty and avoids attributing costs to individual physicians.For each TIN, the specialty-adjusted per capita cost was calculated as the ratio of the TIN's per capita cost to its per capita cost benchmark, multiplied by the 

national average standardized cost per beneficiary.When adjusting for the number of EPs per TIN, the terms under summation in both the numerator and denominator were multiplied by the number of EPs of that specialty in the TIN.

h	  
  =

hh h	    =    h	 !  h   h 

 

=    h	 !  h   "# 

 

"# h h	   

=

∑      !   h   "# ! #     ! 

 

∑   h   "# ! #     !   "# 

 

"# &' h	  
 
Low Medium High

Addiction medicine 4.7% 94.1% 1.2%

Allergy/immunology 5.3% 92.4% 2.3%

Anesthesiology 1.6% 93.5% 4.9%

Cardiac Electrophysiology 1.9% 95.7% 2.4%

Cardiac surgery 0.5% 92.9% 6.6%

Cardiology 4.4% 92.2% 3.3%

Chiropractic 3.1% 88.7% 8.2%

Colorectal surgery 3.1% 89.2% 7.6%

Critical care (intensivists) 1.7% 91.9% 6.4%

Dermatology 30.6% 68.0% 1.4%

Diagnostic radiology 0.7% 92.7% 6.6%

Emergency medicine 3.7% 89.1% 7.2%

Endocrinology 9.2% 89.1% 1.7%

Family practice 1.3% 91.7% 7.0%

Gastroenterology 4.4% 93.3% 2.2%

General practice 5.7% 84.8% 9.5%

General surgery 1.6% 90.1% 8.3%

Geriatric medicine 1.5% 83.8% 14.7%

Geriatric Psychiatry 0.0% 82.5% 17.5%

Gynecologist/oncologist 1.7% 88.5% 9.8%

Hand surgery 3.1% 95.6% 1.3%

Hematology 0.7% 89.1% 10.2%

Hematology/oncology 1.0% 87.3% 11.8%

Hospice and Palliative Care 0.3% 87.9% 11.8%

Infectious disease 2.5% 90.6% 6.9%

Internal medicine 1.3% 87.4% 11.3%

Interventional Pain Management 2.9% 89.7% 7.4%

Interventional radiology 0.7% 93.0% 6.2%

Maxillofacial surgery 0.9% 94.7% 4.4%

Medical oncology 0.5% 83.4% 16.1%

Nephrology 7.6% 89.3% 3.0%

Neurology 5.0% 92.4% 2.6%

Neuropsychiatry 4.0% 90.7% 5.3%

Neurosurgery 1.4% 83.7% 14.9%

Nuclear medicine 2.2% 90.5% 7.3%

Obstetrics/gynecology 7.7% 89.0% 3.3%

Ophthalmology 17.7% 80.9% 1.5%

Note: Billing relationships are defined as an instance of an EP billing under a given TIN. Each EP 

can have multiple billing relationships, as can each TIN.

Table 3. EP Specialty Composition of Each Cost Range for TINs with 1+ EPs and 20+ Beneficiaries - 

Specialty Weighted by Percent of TIN Charges

Specialty

Cost Range Composition for EPs of each Specialty:

Adjusted for Specialty Composition and Number of EPs per TIN
Low Medium High

Specialty

Cost Range Composition for EPs of each Specialty:

Adjusted for Specialty Composition and Number of EPs per TIN

Oral surgery (dentists only) 1.5% 92.4% 6.1%

Orthopedic surgery 3.1% 91.5% 5.5%

Osteopathic manipulative therapy 5.7% 85.8% 8.5%

Otolaryngology 13.4% 84.3% 2.3%

Pain Management 1.5% 86.0% 12.6%

Pathology 2.4% 91.2% 6.4%

Pediatric medicine 1.2% 92.6% 6.2%

Peripheral vascular disease 0.0% 94.4% 5.6%

Physical medicine and rehabilitation 2.1% 87.9% 9.9%

Plastic and Reconstructive surgery 4.2% 90.4% 5.4%

Podiatry 2.2% 91.3% 6.5%

Preventive medicine 3.0% 91.4% 5.6%

Psychiatry 5.0% 88.8% 6.2%

Pulmonary disease 3.3% 92.0% 4.7%

Radiation oncology 4.4% 83.5% 12.1%

Rheumatology 3.9% 93.5% 2.6%

Single or Multispecialty clinic or group practice 5.9% 85.1% 9.1%

Sports Medicine 2.6% 94.8% 2.6%

Surgical oncology 1.6% 82.5% 16.0%

Thoracic surgery 0.1% 92.3% 7.6%

Urology 3.9% 93.2% 2.9%

Vascular surgery 0.3% 93.7% 6.0%

*Note: red indicates that a specialty has a high proportion of its billing relationships in high cost 

TINs. Blue indicates that a specialty has a low proportion of its billing relationships in high cost 

TINs.