File: Specialty_Adjusting_With_vs_Without_EP_Adjusment_TIN_per_Capita_Cos

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 adj

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 

By specialty, comparison and difference between rank by percent of specialty 

without adjusting for number of EPs per TIN, weighted by percent of TIN charg

By specialty, comparison and difference between rank by percent of specialty 

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 n

cost per capita

By specialty, comparison of EP-TIN relationships by cost range with and witho

weighted by charges

By specialty, comparison of EP-TIN relationships by cost range with and witho

weighted by EPs

By specialty, difference between EP-TIN cost range distribution with and witho

weighted by charges

By specialty, difference between EP-TIN cost range distribution with and witho

weighted by EPs

Data:

Worksheets:

Comparison of cost per capita, specialty-adjusted benchmark, and specialty-a

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-

per capita costs at the TIN level (TIN_Distribution).

For each weighting method, the percent of TINs by cost range that switch to n

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 ger

respectively (Specialty_Benchmarks).
Medical oncology and geriatric psychiatry rank first and second in terms of percent of EPs in high cost TINs (EP_

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 ben

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

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 us

Beneficiaries who did not receive primary care froma primary care physician were attributed to the TIN with the l

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 

physician.

Specifications:

The standardized risk-adjusted per capita cost for each TIN was calculated as the ratio of it beneficiaries' total stan

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 

that specialty's share of TIN EPs and the number of beneficiaries attributed to that TIN. This product was summed 

specialty share times the number of TIN beneficiaries. This benchmark reflects the average cost of beneficiaries a

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. m

from 26% to 16%), but oncology specialties remain very highly ranked with 4-5 oncology specialties ranked i

There is very little shifting of rank by proportion of EPs in high cost TINs. At least 80% of specialties ranked in t

adjustment for number of EPs per TIN (Rank_Correlation tabs). Additionally, very few TINs change cost range b

TINs in each cost range (low, medium, high relative to the mean) stay in that range when adjusting for number 

Overall, adjusting for the number of EPs per TIN does reduce the % of oncologists who are in high cost TINs. Ho

relative ranking of specialties. It is important to note that oncologists comprise a small percentage of the EPs pr

only a small percentage of oncologists are included in the per capita cost measure (due to the primary care attr

When adjusting for the number of EPs per TIN, the terms under summation in both the numerator and denomina

that specialty in the TIN.

Benchmark for Specialty i =

Charge weighted benchmark for TIN j = specialty i national benchma

all i

= specialty i national benchma

all i

EP weighted benchmark for TIN j

=

 TIN j per capita cost x specialty i sh

all j

 specialty i share of TIN 

all j

EP Adjusted Benchmark for Specialty i
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 categorize

than 1 standard deviation above the mean were categorized as high cost; all other TINs were categorized as medi

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 a

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

For each TIN, the specialty-adjusted per capita cost was calculated as the ratio of the TIN's per capita cost to its pe

national average standardized cost per beneficiary.

= specialty i national benchma

all i

EP weighted benchmark for TIN j
Adjusment_TIN_per_Capita_Cost_24MAY2013.xlsx

 specialties with and without adjusting for number of EPs

omewhat higher than when not adjusting for the number of EPs per TIN.

een rank by percent of specialty EP relationships with high cost TINs with and 

weighted by percent of TIN charges

een rank by percent of specialty EP relationships with high cost TINs with and 

weighted by percent of TIN EPs

s of 1+ EPs of adjusting for the number of EPs per TIN when calculating the 

ps by cost range with and without adjusting for number of EPs per TIN, 

ps by cost range with and without adjusting for number of EPs per TIN, 

range distribution with and without adjusting for number of EPs per TIN, 

range distribution with and without adjusting for number of EPs per TIN, 

sted benchmark, and specialty-adjusted cost per capita for TINs used by 1+ EPs 

 per TIN

on of per capita costs, specialty-adjusted benchmarks, or specialty-adjusted 

Ns by cost range that switch to new cost range when adjusting for the number 

while geriatric psychiatry and geriatric medicine rank second and third, 
ent of EPs in high cost TINs (EP_Distribution tabs).

portions of EPs in high cost TINs.

 of carrier claim costs.

m of its constituent specialty benchmarks weighted by:

enominator was TIN charges incurred by EPs.

onal specialty benchmark was used.

e attributed to the TIN with the largest share of primary care costs and at which 

the TIN with the largest share of primary care costs incurred by a primary care 

ratio of it beneficiaries' total standardized costs over its beneficiaries' total 

per capita for each TIN in which the specialty had billing EPs was weighted by 

t TIN. This product was summed over all TINs and divided by the summed 

e average cost of beneficiaries attributed to groups of physicians with that 

ogy EPs in high cost TINs (e.g. medical oncology fell from 10 percentage points 

4-5 oncology specialties ranked in the top ten.

st 80% of specialties ranked in the same quintile both with and without the 

ry few TINs change cost range between the two analyses. At least 94% of 

nge when adjusting for number of EPs (Cost_Range_Stability).

ts who are in high cost TINs. However, it does not significantly change the 

a small percentage of the EPs profiled by the per capita cost measure, and 

re (due to the primary care attribution rule). 

th the numerator and denominator were multiplied by the number of EPs of 

ty i national benchmark x specialty i share of TIN j charges 

ty i national benchmark x specialty i share of TIN j EPs 

a cost x specialty i share of TIN j EPs x # beneficiaries in TIN j x TIN j EPs with specia

ecialty i share of TIN j EPs x # beneficiaries in TIN j x TIN j EPs with specialty i 
aken over all TINs.

below the mean were categorized as low cost; TINs with per capita cost more 

r TINs were categorized as medium cost. The 5th and 95th percentiles of 

ow the mean were categorized as low cost; TINs with specialty-adjusted per 

high cost; all other TINs were categorized as medium cost.

the TIN's per capita cost to its per capita cost benchmark, multiplied by the 

ty i national benchmark x specialty i share of TIN j EPs 

x TIN j EPs with specialty i 

with specialty i