File: Specialty_Adjusting_With_vs_Without_EP_Adjusment_TIN_per_Capita_Cost_24MAY2013.xlsx

Objective: Claims from January 1 through December 31, 2011 with exactly 90 day runout Specialty_Benchmarks Comparison of national cost per capita for EP specialties with and without adjusting for number of EPs EP_Distribution_Charge EP_Distribution_Charge_Diff EP_Distribution_NPI EP_Distribution_NPI_Diff Rank_Correlation_Charge Rank_Correlation_NPI Cost_Range_Stability Oncology specialties have some of the highest national benchmarks, generally somewhat higher than when not adjusting for the number of EPs per TIN. By specialty, comparison and difference between rank by percent of specialty EP relationships with high cost TINs with and without adjusting for number of EPs per TIN, weighted by percent of TIN charges By specialty, comparison and difference between rank by percent of specialty EP relationships with high cost TINs with and without adjusting for number of EPs per TIN, weighted by percent of TIN EPs Investigate the specialty-level impacts in TINs of 1+ EPs of adjusting for the number of EPs per TIN when calculating the cost per capita

By specialty, comparison of EP-TIN relationships by cost range with and without adjusting for number of EPs per TIN, weighted by charges By specialty, comparison of EP-TIN relationships by cost range with and without adjusting for number of EPs per TIN, weighted by EPs By specialty, difference between EP-TIN cost range distribution with and without adjusting for number of EPs per TIN, weighted by charges By specialty, difference between EP-TIN cost range distribution with and without adjusting for number of EPs per TIN, weighted by EPs Data: Worksheets: Comparison of cost per capita, specialty-adjusted benchmark, and specialty-adjusted cost per capita for TINs used by 1+ EPs with and without adjusting for number of EPs per TIN TIN_Distribution

Adjusting for the number of EPs per TIN makes little difference in the distribution of per capita costs, specialty-adjusted benchmarks, or specialty-adjusted per capita costs at the TIN level (TIN_Distribution). For each weighting method, the percent of TINs by cost range that switch to new cost range when adjusting for the number of EPs. Conclusions: There are four other oncology specialties in the top ten. Medical oncology has the highest national specialty benchmark at $14,928 while geriatric psychiatry and geriatric medicine rank second and third, respectively (Specialty_Benchmarks).Medical oncology and geriatric psychiatry rank first and second in terms of percent of EPs in high cost TINs (EP_Distribution tabs). Geriatric psychiatry, geriatric medicine, and neurosurgery also have high proportions of EPs in high cost TINs.

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. Beneficiaries who did not receive primary care froma 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. 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. Adjusting for the number of EPs per TIN does reduce the proportion of oncology EPs in high cost TINs (e.g. medical oncology fell from 10 percentage points from 26% to 16%), but oncology specialties remain very highly ranked with 4-5 oncology specialties ranked in the top ten. There is very little shifting of rank by proportion of EPs in high cost TINs. At least 80% of specialties ranked in the same quintile both with and without the adjustment for number of EPs per TIN (Rank_Correlation tabs). Additionally, very few TINs change cost range between the two analyses. At least 94% of TINs in each cost range (low, medium, high relative to the mean) stay in that range when adjusting for number of EPs (Cost_Range_Stability). Overall, adjusting for the number of EPs per TIN does reduce the % of oncologists who are in high cost TINs. However, it does not significantly change the relative ranking of specialties. It is important to note that oncologists comprise a small percentage of the EPs profiled by the per capita cost measure, and only a small percentage of oncologists are included in the per capita cost measure (due to the primary care attribution rule).

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.The mean and standard deviation of this specialty-adjusted per capita cost were taken over all TINs.

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. 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.Specialty_Adjusting_With_vs_Without_EP_Adjusment_TIN_per_Capita_Cost_24MAY2013.xlsx

Comparison of national cost per capita for EP specialties with and without adjusting for number of EPs

Oncology specialties have some of the highest national benchmarks, generally somewhat higher than when not adjusting for the number of EPs per TIN. By specialty, comparison and difference between rank by percent of specialty EP relationships with high cost TINs with and without adjusting for number of EPs per TIN, weighted by percent of TIN charges By specialty, comparison and difference between rank by percent of specialty EP relationships with high cost TINs with and without adjusting for number of EPs per TIN, weighted by percent of TIN EPs Investigate the specialty-level impacts in TINs of 1+ EPs of adjusting for the number of EPs per TIN when calculating the cost per capita

By specialty, comparison of EP-TIN relationships by cost range with and without adjusting for number of EPs per TIN, weighted by charges By specialty, comparison of EP-TIN relationships by cost range with and without adjusting for number of EPs per TIN, weighted by EPs By specialty, difference between EP-TIN cost range distribution with and without adjusting for number of EPs per TIN, weighted by charges By specialty, difference between EP-TIN cost range distribution with and without adjusting for number of EPs per TIN, weighted by EPs Data: Worksheets: Comparison of cost per capita, specialty-adjusted benchmark, and specialty-adjusted cost per capita for TINs used by 1+ EPs with and without adjusting for number of EPs per TIN

Adjusting for the number of EPs per TIN makes little difference in the distribution of per capita costs, specialty-adjusted benchmarks, or specialty-adjusted per capita costs at the TIN level (TIN_Distribution). For each weighting method, the percent of TINs by cost range that switch to new cost range when adjusting for the number of EPs. Conclusions: There are four other oncology specialties in the top ten. Medical oncology has the highest national specialty benchmark at $14,928 while geriatric psychiatry and geriatric medicine rank second and third, respectively (Specialty_Benchmarks).Medical oncology and geriatric psychiatry rank first and second in terms of percent of EPs in high cost TINs (EP_Distribution tabs). Geriatric psychiatry, geriatric medicine, and neurosurgery also have high proportions of EPs in high cost TINs.

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. To calculate the TIN benchmark adjusted for number of EPs, the EP-adjusted national specialty benchmark was used. Beneficiaries who did not receive primary care froma 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. 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. Adjusting for the number of EPs per TIN does reduce the proportion of oncology EPs in high cost TINs (e.g. medical oncology fell from 10 percentage points from 26% to 16%), but oncology specialties remain very highly ranked with 4-5 oncology specialties ranked in the top ten. There is very little shifting of rank by proportion of EPs in high cost TINs. At least 80% of specialties ranked in the same quintile both with and without the adjustment for number of EPs per TIN (Rank_Correlation tabs). Additionally, very few TINs change cost range between the two analyses. At least 94% of TINs in each cost range (low, medium, high relative to the mean) stay in that range when adjusting for number of EPs (Cost_Range_Stability). Overall, adjusting for the number of EPs per TIN does reduce the % of oncologists who are in high cost TINs. However, it does not significantly change the relative ranking of specialties. It is important to note that oncologists comprise a small percentage of the EPs profiled by the per capita cost measure, and only a small percentage of oncologists are included in the per capita cost measure (due to the primary care attribution rule).

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.The mean and standard deviation of this specialty-adjusted per capita cost were taken over all TINs. 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. 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.