Mid-South Imaging and Therapeutics, Memphis, Tennessee 38120, USA.
J Am Coll Radiol. 2010 Nov;7(11):859-64. doi: 10.1016/j.jacr.2010.04.013.
The aim of this study was to evaluate national trends in paracentesis and thoracentesis procedures and the relative roles of specialty groups providing these services.
Medicare Physician Supplier Procedure Summary Master Files from 1993 to 2008 were analyzed for paracentesis and thoracentesis procedure codes. Using physician specialty identifier codes, procedure volumes were extracted for radiologists, primary care physicians, and surgeons for both procedures. Volume data were extracted for gastroenterologists and pulmonary and critical care medicine physicians, respectively, for paracentesis and thoracentesis. Frequency by site of service was similarly evaluated. Relative changes were calculated.
Between 1993 and 2008, paracentesis procedures on Medicare fee-for-service beneficiaries increased by 133% (from 64,371 to 149,699), and thoracentesis procedures decreased by 14% (from 147,363 to 127,444). Services by radiologists increased by 964% (from 10,456 to 111,275) and 358% (from 14,531 to 66,602), respectively, while all other targeted groups experienced declines. For paracentesis, radiologist and gastroenterologist procedure shares changed from 16% and 32%, respectively, in 1993 to 74% and 6% in 2008. For thoracentesis, radiologist and pulmonary and critical care medicine physician shares changed from 10% and 49% to 52% and 27%. Relative shifts in site of service to the hospital outpatient setting occurred for both procedures.
Since 1993, paracentesis procedures on Medicare beneficiaries have more than doubled, while thoracentesis volumes have declined slightly. Radiologists now far exceed gastroenterologists and pulmonary and critical care medicine physicians, respectively, as the predominant providers of these services. Those shifts are likely attributable to both the incremental safety of imaging guidance and also the unfavorable economics of these procedures.
本研究旨在评估全国经皮穿刺术和胸腔穿刺术的趋势以及提供这些服务的专业团体的相对作用。
对 1993 年至 2008 年的医疗保险医师供应商程序摘要主文件进行分析，以获取经皮穿刺术和胸腔穿刺术的程序代码。使用医师专业标识符代码，分别提取放射科医师、初级保健医师和外科医师进行这两种程序的操作量。分别为胃肠病学家和肺科及危重病医学医师提取经皮穿刺术和胸腔穿刺术的操作量。按服务地点的频率进行类似评估。计算相对变化。
1993 年至 2008 年间，医疗保险服务费用受益人的经皮穿刺术增加了 133%（从 64371 例增至 149699 例），胸腔穿刺术减少了 14%（从 147363 例降至 127444 例）。放射科医师的服务量分别增加了 964%（从 10456 例增至 111275 例）和 358%（从 14531 例增至 66602 例），而其他所有目标群体的服务量均有所下降。对于经皮穿刺术，放射科医师和胃肠病学家的程序比例从 1993 年的 16%和 32%分别变为 2008 年的 74%和 6%。对于胸腔穿刺术，放射科医师和肺科及危重病医学医师的比例从 10%和 49%变为 2008 年的 52%和 27%。这两种操作的服务地点都相对转移到了医院门诊。
自 1993 年以来，医疗保险受益人的经皮穿刺术增加了一倍以上，而胸腔穿刺术的数量略有下降。放射科医师现在远远超过胃肠病学家和肺科及危重病医学医师，成为这些服务的主要提供者。这些转变可能归因于影像学引导的安全性提高，以及这些程序的经济效益不佳。
