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Purpose <p>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.</p> Methods <p>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 &amp; 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.</p> Results <p>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.</p> Conclusion <p>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.</p>

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Geographic distribution of medicare fee-for-service pituitary surgery providers is associated with community-level social vulnerability and access barriers

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Youssef E. Sibih,
  • Sanjeev Herr,
  • Sudheesha Perera,
  • Manish Aghi

摘要

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.