Journal of neuro-oncology · 2026
Geographic distribution of medicare fee-for-service pituitary surgery providers is associated with community-level social vulnerability and access barriers.
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Sibih Youssef E, Herr Sanjeev, Perera Sudheesha, Aghi Manish
Аннотация
PURPOSE: To evaluate geographic variation in Medicare fee-for-service (FFS) pituitary surgery provider availability, straight-line distance to care, and community-level sociodemographic correlates across the contiguous United States.
METHODS: We performed a cross-sectional ecological geospatial analysis of 3,007 counties grouped into 40 provider catchment areas during 2018-2022. Qualifying providers were identified in CMS Medicare Physician & Other Practitioners data using a claims-based annual volume criterion for CPT codes 61,546, 61,548, or 62,165. County characteristics were aggregated to catchment areas. Outcomes were population-weighted straight-line distance to the nearest qualifying provider and provider density per 100,000 population. Associations were evaluated at the catchment-area level using univariable linear regression.
RESULTS: Sixty-four of 88 observed providers (72.7%) met the claims-based criterion. Mean catchment-area provider density was 0.03 ± 0.03 per 100,000 population, and mean distance was 74.48 ± 33.82 miles. In univariable ecological analyses, longer distance was associated with higher proportions of American Indian/Alaska Native residents and with greater prevalence of cognitive difficulty, hearing impairment, vision difficulty, and depression. Provider density correlated positively with population density and the proportion of households without a vehicle, an urbanicity-related pattern, while Latino residential isolation was associated with lower provider density.
CONCLUSION: Medicare FFS claims demonstrate substantial geographic variation and ecological associations between access measures and community characteristics. These findings neither enumerate the national pituitary surgical workforce nor establish individual-level or causal relationships. They support further evaluation of regional referral networks, transportation support, and telehealth as potential access strategies.
METHODS: We performed a cross-sectional ecological geospatial analysis of 3,007 counties grouped into 40 provider catchment areas during 2018-2022. Qualifying providers were identified in CMS Medicare Physician & Other Practitioners data using a claims-based annual volume criterion for CPT codes 61,546, 61,548, or 62,165. County characteristics were aggregated to catchment areas. Outcomes were population-weighted straight-line distance to the nearest qualifying provider and provider density per 100,000 population. Associations were evaluated at the catchment-area level using univariable linear regression.
RESULTS: Sixty-four of 88 observed providers (72.7%) met the claims-based criterion. Mean catchment-area provider density was 0.03 ± 0.03 per 100,000 population, and mean distance was 74.48 ± 33.82 miles. In univariable ecological analyses, longer distance was associated with higher proportions of American Indian/Alaska Native residents and with greater prevalence of cognitive difficulty, hearing impairment, vision difficulty, and depression. Provider density correlated positively with population density and the proportion of households without a vehicle, an urbanicity-related pattern, while Latino residential isolation was associated with lower provider density.
CONCLUSION: Medicare FFS claims demonstrate substantial geographic variation and ecological associations between access measures and community characteristics. These findings neither enumerate the national pituitary surgical workforce nor establish individual-level or causal relationships. They support further evaluation of regional referral networks, transportation support, and telehealth as potential access strategies.