Urology · 2025
Urologist Participation in Medicare Are Impacted by Subspecialty, Tenure, and Practice Type: A Retrospective Analysis of Opt-out Affidavits.
СтатьяНазвание и аннотация: Перевод в очереди
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Rajan Thriaksh, Revnew Andre, Lee Daniel, Najari Bobby, Thirumavalavan Nannan, Abou Ghayda Ramy
Аннотация
OBJECTIVE: To examine (1) trends in the incidence and duration of Medicare opt-outs among urologic surgeons, (2) the demographic and professional characteristics of urologists opting out, and (3) the surgeon-level predictors associated with the timing of Medicare opt-outs.
METHODS: This retrospective study analyzed data from the Centers for Medicare & Medicaid Services (CMS) Opt-Out Affidavits. Surgeon-level data were linked to public professional profiles using National Provider Identifiers to extract information on demographics, training, years in practice, practice type, subspecialty, and geographic location.
RESULTS: The incidence of Medicare opt-outs among urologic surgeons remained low between 2012 and 2025, averaging 3.9 opt-outs per year (n=51). Most opt-outs were male (92.2%) generalists (64.7%) in independent practice settings (54.9%) with more than 30 years of experience (56.9%). Opt-out lengths significantly declined over time, from an average of 5113.5 days in 2012 to 730.5 days in 2025. Predictors of later opt-out included female sex (+2.4years), fewer years in practice (+3.6years for <19years), and subspecialty in female urology (+4.8years) or sexual medicine (+2.3years). In contrast, earlier opt-out was associated with academic affiliation (-2.3years) and subspecialty in male infertility (-4.8years) or urologic oncology (-4.6years).
CONCLUSION: Although Medicare opt-outs remain rare among urologic surgeons, temporal trends reveal shortening durations of opt-out and distinct demographic and practice-related patterns in participation. These findings underscore the need for targeted efforts to support late-career and independently practicing urologists, while addressing evolving payment structures and retention strategies within Medicare to maintain workforce engagement.
LEVEL OF EVIDENCE: Level III.
METHODS: This retrospective study analyzed data from the Centers for Medicare & Medicaid Services (CMS) Opt-Out Affidavits. Surgeon-level data were linked to public professional profiles using National Provider Identifiers to extract information on demographics, training, years in practice, practice type, subspecialty, and geographic location.
RESULTS: The incidence of Medicare opt-outs among urologic surgeons remained low between 2012 and 2025, averaging 3.9 opt-outs per year (n=51). Most opt-outs were male (92.2%) generalists (64.7%) in independent practice settings (54.9%) with more than 30 years of experience (56.9%). Opt-out lengths significantly declined over time, from an average of 5113.5 days in 2012 to 730.5 days in 2025. Predictors of later opt-out included female sex (+2.4years), fewer years in practice (+3.6years for <19years), and subspecialty in female urology (+4.8years) or sexual medicine (+2.3years). In contrast, earlier opt-out was associated with academic affiliation (-2.3years) and subspecialty in male infertility (-4.8years) or urologic oncology (-4.6years).
CONCLUSION: Although Medicare opt-outs remain rare among urologic surgeons, temporal trends reveal shortening durations of opt-out and distinct demographic and practice-related patterns in participation. These findings underscore the need for targeted efforts to support late-career and independently practicing urologists, while addressing evolving payment structures and retention strategies within Medicare to maintain workforce engagement.
LEVEL OF EVIDENCE: Level III.