Andrus Bruce W, Welch H Gilbert
Section of Cardiology, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):31-6. doi: 10.1161/CIRCOUTCOMES.111.961813. Epub 2012 Jan 10.
Services provided by cardiologists represent a major portion of Medicare expenditures for specialist physicians. The absolute growth and distribution of these services over the past decade have not been well described.
We analyzed fee-for-service Medicare Part B claims for each year from 1999-2008 and selected claims from physicians whose specialty code was cardiology. We then grouped approximately 1000 CPT-9 codes into 45 specific service groups that were then further aggregated into 3 broad service categories: evaluation and management, noninvasive procedures, and invasive procedures. Our main outcome measures were services and allowed charges per 1000 beneficiaries. Sample size ranged from 30.9 million beneficiaries in 1999 to 31.7 million in 2008. During this 10-year period, the number of claims from cardiologists increased 44% (from 2082-2997 per 1000 beneficiaries) while the allowed charges increased 28% after adjusting for inflation (in 2008 dollars, from $181,397-231,728 per 1000 beneficiaries). Evaluation and management services and invasive procedures contributed relatively little to this growth. Instead, most of the growth involved noninvasive procedures--with a 70% increase in claims. Although the most dramatic increases in noninvasive procedures involved emerging imaging technologies (cardiac CT, MRI, and PET scanning), the bulk of the growth occurred in two established technologies: resting echocardiograms and stress tests with nuclear imaging.
Most of the growth in services provided by cardiologists over the past decade is the result of increased noninvasive imaging.
心脏病专家提供的服务在医疗保险用于专科医生的支出中占很大一部分。过去十年中这些服务的绝对增长情况和分布尚未得到很好的描述。
我们分析了1999年至2008年每年按服务收费的医疗保险B部分索赔，并从专业代码为心脏病学的医生中选取索赔。然后我们将大约1000个CPT - 9代码分组为45个特定服务组，这些服务组又进一步汇总为3个广泛的服务类别：评估与管理、非侵入性程序和侵入性程序。我们的主要结果指标是每1000名受益人的服务和允许收费。样本量从1999年的3090万受益人到2008年的3170万。在这10年期间，心脏病专家的索赔数量增加了44%（从每1000名受益人2082例增至2997例），而在调整通货膨胀后允许收费增加了28%（以2008年美元计算，从每1000名受益人181397美元增至231728美元）。评估与管理服务和侵入性程序对这种增长的贡献相对较小。相反，大部分增长涉及非侵入性程序——索赔增加了70%。尽管非侵入性程序中最显著的增长涉及新兴成像技术（心脏CT、MRI和PET扫描），但大部分增长发生在两种成熟技术上：静息超声心动图和核成像负荷试验。
过去十年中心脏病专家提供的服务增长大部分是由于非侵入性成像增加所致。
