Department of Diagnostic Imaging, Rhode Island Hospital, Brown University, Providence, 02903, USA.
AJR Am J Roentgenol. 2012 Apr;198(4):866-8. doi: 10.2214/AJR.11.7411.
Although intervention in asymptomatic carotid artery stenosis remains controversial, most carotid interventions are performed in asymptomatic individuals. Carotid duplex ultrasound is the diagnostic test that precedes more than 90% of carotid interventions. In terms of economic incentives, providers who perform carotid artery revascularization may experience synergy if they also provide carotid duplex ultrasound, because the diagnostic service is reimbursed and also can lead to referrals for revascularization procedures. To test the hypothesis that providers of revascularization services are incentivized to increase utilization of carotid duplex ultrasound, we compared the utilization of carotid duplex ultrasound among Medicare beneficiaries by three specialties that perform revascularization for carotid stenosis (interventional radiology, vascular surgery, and cardiology) with one that usually does not (diagnostic radiology).
We analyzed 100% of procedure-specific claims submitted to Medicare by the four specialties during 2000, 2002, 2004, 2005, 2006, and 2007. Only professional and global components of services approved by Medicare were included. Compounded annual growth rates were used to compare utilization by different specialties.
Utilization by diagnostic radiology increased at a compound annual growth rate of 1% during 2000-2007. Interventional radiology and vascular surgery experienced higher compound annual growth rates of 3% and 6%, respectively. Utilization by cardiology increased at a rate 11 times that of diagnostic radiology, translating into an additional 960 procedures per 100,000 Medicare beneficiaries by cardiology in 2007 than in 2000.
Medicare beneficiaries are increasingly being tested for carotid artery stenosis, especially by specialties that perform revascularization for carotid stenosis. The health benefits of this practice are uncertain.
尽管对无症状颈动脉狭窄的干预措施仍存在争议，但大多数颈动脉介入治疗都是针对无症状个体进行的。颈动脉双功能超声检查是超过 90%的颈动脉介入治疗所采用的诊断检测手段。从经济激励的角度来看，如果进行颈动脉血管再通术的提供者同时提供颈动脉双功能超声检查，他们可能会获得协同效应，因为诊断服务可以获得报销，并且还可以为血管再通术提供转诊。为了验证这样一个假设，即血管再通术服务的提供者有动机增加颈动脉双功能超声检查的使用率，我们比较了医疗保险受益人为颈动脉狭窄进行血管再通术的三个专业（介入放射科、血管外科和心脏病学）与一个通常不进行该手术的专业（放射诊断科）之间颈动脉双功能超声检查的使用率。
我们分析了 2000 年、2002 年、2004 年、2005 年、2006 年和 2007 年期间这四个专业向医疗保险提交的所有特定程序的索赔。仅包括医疗保险批准的专业和整体服务部分。采用复合年增长率来比较不同专业的使用率。
放射诊断学的使用率在 2000 年至 2007 年期间以每年 1%的复合增长率增长。介入放射学和血管外科学的复合年增长率分别为 3%和 6%。心脏病学的使用率增长速度是放射诊断学的 11 倍，这意味着在 2007 年，与 2000 年相比，心脏病学为每 10 万名医疗保险受益人均额外增加了 960 例手术。
接受颈动脉狭窄检测的医疗保险受益人的数量在不断增加，尤其是接受颈动脉血管再通术的专业。这种做法的健康效益尚不确定。
