UPJ INSIGHT Surgical Stone Treatment: Patterns May Predict Performance on Episode-based Cost Measure in the Quality Payment Program

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UPJ INSIGHT Surgical Stone Treatment: Patterns May Predict Performance on Episode-based Cost Measure in the Quality Payment Program

By: Robert A. Dowling, MD, Dowling Medical Director Services, Fort Worth, Texas; Qingxia Chen, PhD, Vanderbilt University Medical Center, Nashville, Tennessee; Evan Goldfischer, MD, Large Urology Group Practice Association, Chicago, Illinois; David M. Albala, MD, Crouse Hospital, Syracuse, New York, Associated Medical Professionals, Downstate Health Sciences University, Syracuse, New York | Posted on: 30 Aug 2023

Dowling RA, Chen Q, Goldfischer E, Albala DM. Surgical stone treatment: patterns may predict performance on episode-based cost measure in the quality payment program. Urol Pract. 2023;10(4):300-310.

Study Need and Importance

Field testing of the Renal or Ureteral Stone Surgical Treatment Episode-based Measure in the Quality Payment Program demonstrated that performance was statistically associated with 2 themes derived from the claims data: preoperative stenting and postoperative infection (higher rates = higher costs). We set out to determine the incidence of these themes in stone treatment episodes derived from a large data set of claims filed by community urologists. These benchmarks may offer urologists context within which to assess their own practices and predict their performance on this measure in the Quality Payment Program.

What We Found

We identified 185,076 surgical stone treatment episodes from 42 urology practices and 1,181 individual providers over a 2-year period. Preoperative stenting was performed in 19.2% of all episodes, and postoperative infection seen in 7.1% of episodes. Both events were more common in patients who were female, in those undergoing ureteroscopy vs extracorporeal shock wave lithotripsy, and in patients on Medicare vs commercial insurance (see Table). We describe a method for the reader to perform their own calculations of these metrics and compare to these benchmarks.

Table. Events by Treatment and Selected Patient Attributes

	Treatment episodes, No.	Preoperative stenting, No. (%)	Postoperative infection, No. (%)
Treatment type
UUO	113,799	28,153 (0.25)	9,170 (0.08)
ESWL	63,931	6,539 (0.10)	3,208 (0.05)
PCNL	7,346	858 (0.12)	736 (0.10)
Total	185,076	35,550 (0.19)	13,114 (0.07)
Gender
M	95,628	15,799 (0.17)	4,301 (0.04)
F	89,305	19,732 (0.22)	8,806 (0.10)
Payer class
Commercial	100,949	17,818 (0.18)	6,028 (0.06)
Medicare	49,426	10,668 (0.22)	4,714 (0.10)
Abbreviations: ESWL, extracorporeal shock wave lithotripsy; PCNL, percutaneous nephrolithotripsy; UUO, ureteroscopy.

Limitations

Our data are limited to practice level claims and may not accurately reflect the relative total costs of the entire treatment episode. While our data set is very large, it is sourced from independent (privately owned) urology practices, and the results may not be generalizable to all practices—including but not limited to academic settings. Our analysis is not risk adjusted for comorbidities, and claims data may not always reflect actual clinical scenarios (infection, for example).

Interpretation for Patient Care

While further study is needed to determine whether these surrogate measures correlate with actual performance in the Cost Category, this paper offers the reader a way to compare their own practice patterns to peers and consider changes in practice if appropriate.