Provider Trends in Atherectomy Volume between Office-Based Laboratories and Traditional Facilities
Provider Trends in Atherectomy Volume between Office-Based Laboratories and Traditional Facilities
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DOI：
10.1016/j.avsg.2018.12.059
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发表时间：
2019-07-01
影响因子：
1.5
通讯作者：
Osborne, Nicholas H.
中科院分区：
文献类型：
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作者：
Smith, Margaret E.;Sutzko, Danielle C.;Osborne, Nicholas H.
背景：随着患者护理越来越多地从医院转移到门诊环境，人们对开发基于办公室的血管造影套件（即基于办公室的实验室）越来越感兴趣。基于办公室的护理与提高效率和提高患者满意度相关，并且直接向提供护理的医生提供更高的报销。先前的研究表明，血运重建手术转向办公室实验室，同时旋磨术的使用也随之增加，与其他外周血运重建技术相比，这种手术的报销比例过高。我们试图确定提供者在血管内手术量、设置和实践中随时间变化的趋势，特别是旋切术。方法：使用 2013 年至 2015 年医疗保险和医疗补助服务中心提供者利用和支付数据公共使用文件，我们确定了进行诊断性血管造影 (DA)、经皮腔内血管成形术 (PTA)、支架置入 (支架) 和旋切术的提供者，并在提供者处汇总了手术水平。分析了在办公室实验室和设施环境中执行的程序的趋势。使用办公室实验室手术的总数和比例对斑块旋切术进行了专门分析，并根据病例数量将提供者分为五分位数。结果：2013 年至 2015 年间，确定了 5,298 名提供者。在此期间，进行旋切术的提供者数量增加了 25.7%，最高五分位的旋切术提供者平均执行 263 例（范围 109-1,455）。从 2013 年到 2015 年，仅在办公室进行斑块旋切术的医生比例从 39.8% 增加到 50.7%，而 2015 年仅在办公室实验室进行 DA、PTA 或支架植入术的医生中只有 20.8%。在2015年斑块切除量最高的医生中，77.8%仅在办公室进行手术，这些医生在研究期间将斑块切除量增加至114.1%。在研究期间转向完全基于办公室的实验室实践的那些医生中，斑块切除术体积增加了 63.4%，这与他们的 DA、PTA 和支架体积的增长不成比例。 结论：在这个短暂的研究期间，外周干预迅速转向办公室环境，伴随着斑块切除术体积的增加，与其他外周干预措施的增加不成比例。尽管缺乏数据支持优于 PTA/支架的数据，但办公室实验室旋切术的增加是在手术报销增加的情况下发生的。
Background: As patient care is being increasingly transitioned out of the hospital and into the outpatient setting, there is a growing interest in developing office-based angiography suites, that is, office-based laboratories. Office-based care has been associated with increased efficiency and greater patient satisfaction, with substantially higher reimbursement directly to the physicians providing care. Prior studies have demonstrated a shift of revascularization procedures to office-based laboratories with a concomitant increase in atherectomy use, a procedure with disproportionately high reimbursement in comparison to other peripheral revascularization techniques. We sought to determine provider trends in endovascular procedure volume, settings, and shifts in practice over time, specific to atherectomy.Methods: Using Centers for Medicare & Medicaid Services Provider Utilization and Payment Data Public Use Files from 2013 to 2015, we identified providers who performed diagnostic angiography (DA), percutaneous transluminal angioplasty (PTA), stent placement (stent), and atherectomy, and procedures were aggregated at the provider level. Trends in procedures performed in office-based laboratory and facility-based settings were analyzed. Atherectomy was specifically analyzed using the total number and proportion of office-based laboratory procedures, and providers were stratified into quintiles by case volume.Results: Between 2013 and 2015, 5,298 providers were identified. Over this time period, the number of providers performing atherectomy increased 25.7%, with the highest quintile of atherectomy providers performing an average of 263 cases (range 109-1,455). The proportion of physicians who performed atherectomy only in the office increased from 39.8% to 50.7% from 2013 to 2015, whereas only 20.8% of physicians who performed DA, PTA, or stent in 2015 did so only in an office-based laboratory. Of the physicians with the highest atherectomy volume, 77.8% operated only in the office in 2015, and these physicians increased their atherectomy volume to 114.1% during the study period. Of those physicians who transitioned to a solely office-based laboratory practice over the study period, atherectomy volume increased 63.4%, which was disproportionate compared with the growth of their DA, PTA, and stent volume.Conclusions: Over this short study period, a rapid shift into the office setting for peripheral intervention occurred, with a concomitant increase in atherectomy volume that was disproportionate to the increase in other peripheral interventions. This increase in office-based laboratory atherectomy occurred in the setting of increased reimbursement for the procedure and despite a lack of data supporting superiority over PTA/stent.