Linking Physician Characteristics and Medicare Claims Data

Baldwin, Laura‐Mae; Adamache, Walter; Klabunde, Carrie N.; Kenward, Kevin; Dahlman, Celia; Warren, Joan L.

doi:10.1097/00005650-200208001-00012

Cited by 95 publications

(19 citation statements)

References 12 publications

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“…We examined Medicare claims for ambulatory-based evaluation and management services representing routine office visits (Current Procedural Terminology codes 99201–99205, 99211–99215) (19) and identified the physician specialty associated with each claim using the Medicare provider specialty field (20). The PCPs were defined as general practice, family medicine, primary care internal medicine, geriatric medicine, and obstetrics–gynecology.…”

Section: Methodsmentioning

confidence: 99%

Primary Care Utilization and Colorectal Cancer Incidence and Mortality Among Medicare Beneficiaries

et al. 2013

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Background Utilization of primary care may decrease colorectal cancer (CRC) incidence and death through greater receipt of CRC screening tests. Objective To examine the association of primary care utilization with CRC incidence, CRC deaths, and all-cause mortality. Design Population-based, case–control study. Setting Medicare program. Participants Persons aged 67 to 85 years diagnosed with CRC between 1994 and 2005 in U.S. Surveillance, Epidemiology, and End Results (SEER) regions matched with control patients (n = 205 804 for CRC incidence, 54 160 for CRC mortality, and 121 070 for all-cause mortality). Measurements Primary care visits in the 4- to 27-month period before CRC diagnosis, CRC incidence, CRC mortality, and all-cause mortality. Results Compared with persons having 0 or 1 primary care visit, persons with 5 to 10 visits had lower CRC incidence (adjusted odds ratio [OR], 0.94 [95% CI, 0.91 to 0.96]) and mortality (adjusted OR, 0.78 [CI, 0.75 to 0.82]) and lower all-cause mortality (adjusted OR, 0.79 [CI, 0.76 to 0.82]). Associations were stronger in patients with late-stage CRC diagnosis, distal lesions, and diagnosis in more recent years when there was greater Medicare screening coverage. Ever receipt of CRC screening and polypectomy mediated the association of primary care utilization with CRC incidence. Limitation This study used administrative data, which made it difficult to identify potential confounders and prevented examination of the content of primary care visits. Conclusion Medicare beneficiaries with higher utilization of primary care have lower CRC incidence and mortality and lower overall mortality. Increasing and promoting access to primary care in the United States for Medicare beneficiaries may help decrease the national burden of CRC. Primary Funding Source American Cancer Society.

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Section: Methodsmentioning

confidence: 99%

Primary Care Utilization and Colorectal Cancer Incidence and Mortality Among Medicare Beneficiaries

et al. 2013

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“…Medical oncologists were identified by an associated Medicare specialty code for medical oncology or hematology/oncology or having submitted a claim for chemotherapy. 7-9 Radiation oncologists were defined by a Medicare specialty code for radiation oncology or having submitted a claim for radiation planning or administration.…”

Section: Methodsmentioning

confidence: 99%

Receipt of Appropriate Surgical Care for Medicare Beneficiaries With Cancer

et al. 2011

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“…Accountable care organizations share many similarities with managed care organizations, including their emphasis on containing costs while improving quality. 23 Since many of their principles (e.g., care coordination, de-emphasis on fee-for-service incentives, and focus on primary care providers) originate from the managed care model, 8,9 understanding the dissemination of technology under the auspices of managed care may help predict how accountable care organizations will handle promising new technologies on the horizon. On one hand, with a similar focus on reducing costs, accountable care organizations may discourage the dissemination of new technologies in an effort to increase shared savings.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, with a greater emphasis on patient engagement and quality measurement, accountable care organizations may be better able to promote the use of new technologies with the most value (i.e., high quality, low cost) while discouraging the use of those with no added benefit. 9 …”

Section: Discussionmentioning

confidence: 99%

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Managed Care and the Dissemination of Robotic Prostatectomy

et al. 2014

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Objective Robotic prostatectomy has rapidly disseminated over the past decade. How managed care, thought by many to be a barrier to new technology, influences the dissemination of robotics is unknown. We sought to better understand the relationship between a market’s managed care penetration and the dissemination of robotic prostatectomy. Methods We used SEER-Medicare data from 2003 through 2007 to identify men ≥ 66 years of age treated with radical prostatectomy for prostate cancer. We categorized Health Service Areas (HSAs) according to the degree of managed care penetration (i.e., low vs. high). We assessed adoption of robotic prostatectomy and utilization among adopting HSAs using Cox proportional-hazards and Poisson regression models, respectively. Results Compared with markets with little managed care, highly penetrated markets had more racial diversity (24% vs. 15% non-white, p<0.01), higher population densities (1987 vs. 422 people/square mile, p<0.01), and higher median incomes ($49,374 vs. $36,236, p<0.01). Robotic prostatectomy adoption and utilization increased over time in both HSA categories. Compared with low managed care markets, those with high managed care adopted robotic prostatectomy more rapidly (e.g., probability 0.37 [low] vs. 0.52 [high] in 2007; p<0.01). However, the post-adoption utilization of robotic prostatectomy was constrained in these highly penetrated markets (e.g., probability 0.66 [low] vs. 0.52 [high] in 2007; p<0.01). Conclusions High managed care penetration was associated with more rapid robotic prostatectomy adoption. However, once adopted, utilization increased more slowly in these markets. Understanding this paradox is important, as more technologies are unveiled in an increasing cost-conscious healthcare environment.

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Linking Physician Characteristics and Medicare Claims Data

Abstract: Administrative databases, such as SEER-Medicare data linked to AMA Masterfile or UPIN Registry data, are an important resource for investigators interested in assessing the relationship between physicians' personal and practice characteristics and the content or outcomes of clinical care.

Cited by 95 publications

References 12 publications

Primary Care Utilization and Colorectal Cancer Incidence and Mortality Among Medicare Beneficiaries

Primary Care Utilization and Colorectal Cancer Incidence and Mortality Among Medicare Beneficiaries

Receipt of Appropriate Surgical Care for Medicare Beneficiaries With Cancer

Managed Care and the Dissemination of Robotic Prostatectomy

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