The disproportionate growth of office-based atherectomy
The disproportionate growth of office-based atherectomy
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DOI：
10.1016/j.jvs.2016.08.112
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发表时间：
2017-02-01
影响因子：
4.3
通讯作者：
Contos, Brian
中科院分区：
文献类型：
--
作者：
Mukherjee, Dipankar;Hashemi, Homayoun;Contos, Brian
目的：本研究的目的是评估自医疗保险和医疗补助服务中心制定报销政策变更以来，下肢闭塞性疾病外周血管介入治疗（PVIs）的手术量、临床护理地点和医疗保险支出的趋势，这些政策变更扩大了医生拥有的办公室实验室（OBL）手术的支付范围。我们分析了2011年至2014年的按服务收费的医疗保险索赔数据，以获得按类型、护理环境和医生专业划分的肺静脉隔离的使用频率。我们还通过setting.Results评估了PVI的医疗保险总成本的变化：2011年至2014年期间，医疗保险受益人中的斑块切除术病例增加了60%。在同一时期，OBL经历了298%的斑块切除量增加，而医院门诊增加了27%，住院医院减少了11%。2014年，OBL是斑块切除术的最常见设置。非斑块切除术PVI的增长更为温和，仅为3%，但也经历了护理部位的变化。2014年，血管外科医生和心脏病专家占办公室PVI的大多数。从2011年到2014年，PVIs的医疗保险总成本增加了18%。住院费用下降1%，而门诊PVI费用增加41%，医生办公室费用增加258%.Conclusions：下肢外周动脉闭塞性疾病的血运重建手术继续从住院转移到门诊，尤其是OBL。已观察到在下肢动脉系统的所有节段中越来越多地使用斑块切除术，特别是在OBL中，文献中没有实质性证据表明与标准血管成形术（伴或不伴支架植入）相比有效性增加。慷慨的医疗保险报销办公室斑块切除术程序可能有助于观察到的数量变化。
Objective: The purpose of this study was to evaluate the trends in procedure volume, clinical sites of care, and Medicare expenditure for peripheral vascular interventions (PVIs) for lower extremity occlusive disease since the Centers for Medicare and Medicaid Services instituted reimbursement policy changes that broadened payment for procedures performed in physician-owned office-based laboratories (OBLs).Methods: We analyzed fee-for-service Medicare claims data from 2011 to 2014 to obtain the frequency of use of PVI by type, care setting, and physician specialty. We also assessed changes in the total Medicare cost for PVI by setting.Results: There was a 60% increase in atherectomy cases among Medicare beneficiaries between 2011 and 2014. During the same period, OBLs experienced a 298% increase in atherectomy volume vs a 27% increase in hospital outpatient settings and an 11% decrease for inpatient hospital settings. In 2014, OBLs were the most common setting for atherectomy. Nonatherectomy PVIs grew more modestly at just 3% but also experienced site of care shifts. Vascular surgeons and cardiologists accounted for the majority of office-based PVIs in 2014. Total Medicare costs for PVIs increased 18% from 2011 to 2014. Hospital inpatient costs declined 1%, whereas costs for hospital outpatient PVIs increased by 41% and physician office costs increased by 258%.Conclusions: The migration of revascularization procedures for lower extremity peripheral arterial occlusive disease continues from the inpatient to the outpatient setting and especially to OBLs. Increased use of atherectomy in all segments of the lower extremity arterial system has been observed, particularly in OBLs, without substantial evidence in the literature of increased efficacy compared with standard angioplasty with or without stenting. Generous Medicare reimbursement for in-office atherectomy procedures is likely contributing to the volume shifts observed.