Exploring the rapid expansion of office-based laboratories and peripheral vascular interventions across the United States.
Exploring the rapid expansion of office-based laboratories and peripheral vascular interventions across the United States.
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探索美国各地办公室实验室和外周血管干预的快速扩张。
DOI：
10.1016/j.jvs.2021.01.061
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发表时间：
2021-09
影响因子：
4.3
通讯作者：
Osborne NH
中科院分区：
文献类型：
--
作者：
Brown CS;Smith ME;Kim GY;Sutzko DC;Henke PK;Corriere MA;Siracuse JJ;Goodney PP;Osborne NH
表征办公室实验室利用与外周血管干预的医疗保险支付之间的关系。使用2014年至2017年医疗保险和医疗补助服务提供者使用和支付数据公共使用文件中心，我们确定了进行经皮腔内血管成形术（PTA）、支架置入（stent）和动脉粥样硬化切除术的提供者。程序在提供者和医院转诊区域（HRR）级别汇总。2014年至2017年期间，2641名提供者进行了308247次手术。2017年OBL支架的平均费用为4383.39美元，而OBL动脉粥样硬化切除术的平均费用为13079.63美元。在研究期间，平均支付额的变化差别很大，从146 HRR中每个受益人减少16.97美元到11 HRR中每个受益人增加43.77美元。PVI率的变化也有很大差异，并与各hrr的支付变化适度相关（R2=0.40, p<0.001）。大多数HRRs经历了OBLs内PVI率的增加，这与支付的变化密切相关（R2=0.85, p<0.001）。此外，支付变化的85%的差异可以用OBL动脉粥样硬化切除术的增加来解释（p<0.001）。在一些人力资源资源中心内，私人投资机构迅速转移到办公室环境，这在地理上有很大的差异，与付款密切相关。政策制定者应该重新审视当前OBL使用的支付结构，特别是动脉粥样硬化切除术，以更好地使政策与预期目标保持一致。这项研究为美国办公室实验室动脉粥样硬化切除术率上升背后的经济动机提供了证据，这一发现与支架植入术的关系形成对比，并且对目前动脉粥样硬化切除术的支付结构提出了质疑。
To characterize the relationship between office-based laboratory utilization and Medicare payments for peripheral vascular interventions. Using Centers for Medicare and Medicaid Services Provider Utilization and Payment Data Public Use Files from 2014 to 2017, we identified providers who performed percutaneous transluminal angioplasty (PTA), stent placement (stent), and atherectomy. Procedures were aggregated at the provider and hospital referral region (HRR) level. Between 2014 and 2017, 2,641 providers performed 308,247 procedures. Mean payment for OBL stent in 2017 was $4383.39, while mean payment for OBL atherectomy was $13079.63. Change in mean payment varied significantly, from a decrease of $16.97 in HRR 146 to an increase of $43.77 per beneficiary over the study period in HRR 11. Change in the rate of PVI also varied substantially, and moderately correlated with change in payment across HRRs (R2=0.40, p<0.001). The majority of HRRs experienced an increase in rate of PVI within OBLs, which strongly correlated with changes in payments (R2=0.85, p<0.001). Furthermore, 85% of the variance in change in payment was explained by increases in OBL atherectomy (p<0.001). A rapid shift into the office setting for PVIs occurred within some HRRs which was highly geographically variable and was strongly correlated with payments. Policymakers should revisit the current payment structure for OBL utilization, and, in particular atherectomy, to better align the policy with the intended goals. This study provides evidence for the financial motivation behind increasing rates of office-based laboratory atherectomy in the US, a finding which is in contrast to the relationship found for stenting and additionally calls into question the current payment structure for atherectomy.
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影响因子：
1.5
作者：
Smith, Margaret E.;Sutzko, Danielle C.;Osborne, Nicholas H.
通讯作者：
Osborne, Nicholas H.
影响因子：
4.3
作者：
Mukherjee, Dipankar;Hashemi, Homayoun;Contos, Brian
通讯作者：
Contos, Brian
影响因子：
4.3
作者：
Hicks, Caitlin W.;Holscher, Courtenay M.;Makary, Martin A.
通讯作者：
Makary, Martin A.
DOI：
10.1161/circoutcomes.108.775247
发表时间：
2008-09-01
影响因子：
6.9
作者：
Mahoney, Elizabeth M.;Wang, Kaijun;Bhatt, Deepak L.
通讯作者：
Bhatt, Deepak L.
影响因子：
5.5
作者：
Levy, Benjamin;Paulozzi, Leonard;Jones, Christopher M.
通讯作者：
Jones, Christopher M.