Assessment of Patterns of Atherectomy Use.
Assessment of Patterns of Atherectomy Use.
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DOI：
10.1161/jaha.121.023356
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发表时间：
2022-11-15
影响因子：
5.4
通讯作者：
Osborne, Nicholas H.
中科院分区：
文献类型：
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作者：
Brown, Craig S.;Eton, Ryan E.;Yaser, Jessica M.;Syrjamaki, John D.;Corriere, Matthew A.;Henke, Peter K.;Englesbe, Michael J.;Osborne, Nicholas H.
动脉粥样硬化切除术已成为美国增长最快的基于导管的外周血管介入治疗，过度使用与报销增加有关，但使用模式尚未得到很好的表征。我们使用密歇根州首选提供商组织的Blue Cross Blue Shield和密歇根州价值协作组织的医疗保险服务费专业索赔数据，针对2019年接受基于办公室的实验室斑块切除术的患者，计算斑块切除术的使用，报销，治疗的血管数量和每位患者的斑块切除术数量。我们还计算了每位提供者在90天内将新患者访视转换为血管内手术的比率。用简单线性回归评估参数之间的相关性。纳入了在研究期间完成≥ 20例基于办公室的实验室动脉粥样硬化切除术和≥ 20例新患者评价的提供者。共纳入了59名提供者，他们进行了4060例基于办公室的实验室动脉粥样硬化切除术。每例手术的专业报销中位数为4671.56美元（四分位数范围[IQR]，2403.09 - 7723.19美元）从密歇根州的蓝十字蓝盾和14854.49美元（IQR，$9414.80-$18816.33），而来自两个支付者的专业报销总额从每年$2452到$6880402不等。中位90天转换率为5.0%（IQR，2.5%-10.0%），而每例患者接受治疗的供应商水平平均血管数中位数为1.20（IQR，1.13 - 1.31），每例患者接受治疗的供应商水平平均血管数中位数为1.38（IQR，1.26 - 1.63）。每位医疗服务提供者的年度报销总额与新患者手术转换率（R 2 = 0.47; P <0.001）、每例患者接受治疗的平均血管数量（R 2 = 0.31; P <0.001）和每例患者接受治疗的平均数量（R 2 = 0.33; P <0.001）直接相关。少数提供者执行大多数程序，与大多数提供者相比，每个程序的报销额要高得多。手术转换率、血管数量和每位患者的治疗次数代表了遏制过度使用的潜在政策杠杆。
Atherectomy has become the fastest growing catheter‐based peripheral vascular intervention performed in the United States, and overuse has been linked to increased reimbursement, but the patterns of use have not been well characterized. We used Blue Cross Blue Shield of Michigan Preferred Provider Organization and Medicare fee‐for‐service professional claims data from the Michigan Value Collaborative for patients undergoing office‐based laboratory atherectomy in 2019 to calculate provider‐specific rates of atherectomy use, reimbursement, number of vessels treated, and number of atherectomies per patient. We also calculated the rate that each provider converted a new patient visit to an endovascular procedure within 90 days. Correlations between parameters were assessed with simple linear regression. Providers completing ≥20 office‐based laboratory atherectomies and ≥20 new patient evaluations during the study period were included. A total of 59 providers performing 4060 office‐based laboratory atherectomies were included. Median professional reimbursement per procedure was $4671.56 (interquartile range [IQR], $2403.09–$7723.19) from Blue Cross Blue Shield of Michigan and $14 854.49 (IQR, $9414.80–$18 816.33) from Medicare, whereas total professional reimbursement from both payers ranged from $2452 to $6 880 402 per year. Median 90‐day conversion rate was 5.0% (IQR, 2.5%–10.0%), whereas the median provider‐level average number of vessels treated per patient was 1.20 (IQR, 1.13–1.31) and the median provider‐level average number of treatments per patient was 1.38 (IQR, 1.26–1.63). Total annual reimbursement for each provider was directly correlated with new patient‐procedure conversion rate (R 2=0.47; P<0.001), mean number of vessels treated per patient (R 2=0.31; P<0.001), and mean number of treatments per patient (R 2=0.33; P<0.001). A minority of providers perform most procedures and are reimbursed substantially more per procedure compared with most providers. Procedural conversion rate, number of vessels, and number of treatments per patient represent potential policy levers to curb overuse.