Claims from January 1 through December 31, 2011 with exactly 90 day runoutBeneficiaries 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 EPsof 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 numberof 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 froma primary care physician were attributed to the TIN with the largest share of primary care costs andatwhich they had at least 1 primary care claim by a physician.Beneficiaries with primary care from a primary carephysician were attributed to the TIN with the largest share of primary care costs incurred by a primarycare physician.In the original analysis, TINs with per capita costmore than 1 standard deviation below the mean werecategorized as low cost; TINs with per capita costmorethan 1 standard deviation above the mean were categorized as high cost; all other TINs were categorized as medium cost. The 5th and 95th percentiles ofbootstrapped per capita cost were not used for thisanalysis.TINs with a specialty-adjusted per capita cost morethan 1 standard deviation below the mean were categorized as low cost; TINs with specialty-adjusted percapita 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 foreach TIN was calculated as the ratio of it beneficiaries' total standardized costs over its beneficiaries' totalpredicted costs, multiplied by the national averagestandardized cost.A national cost per capita benchmark was calculatedfor each specialty. The cost per capita for eachTIN in which the specialty had billing EPs was weighted bythat specialty's share of TIN EPs and the number ofbeneficiaries attributed to that TIN. This product was summed over all TINs and divided by the summedspecialty share times the number of TIN beneficiaries. This benchmark reflects the average cost of beneficiaries attributed to groups of physicians withthatspecialty 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 thenational 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 ofthat specialty in the TIN.h=hhh=h!hh=h!h"#"#hh=∑!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.