1 Department of Radiology, Neuroradiology Division, University of Virginia, PO Box 800170, Charlottesville, VA 22908-0170.
AJR Am J Roentgenol. 2015 Jan;204(1):15-9. doi: 10.2214/AJR.14.12622.
The purpose of this study is to evaluate national trends in lumbar puncture (LP) procedures and the relative roles of specialty groups providing this service.
Aggregated claims data for LPs were extracted from Medicare Physician Supplier Procedure Summary master files annually from 1991 through 2011. LP procedure volumes by specialty group and place of service were studied.
Between 1991 and 2011, the overall numbers of LP procedures increased, with a slight increase in diagnostic LP procedures (90,460 vs 90,785) and a marked increase in therapeutic LP procedures (2868 vs 6461) in Medicare fee-for-service beneficiaries. Although radiologists performed 11.3% (n = 10,533) of all LP procedures in 1991, they performed 46.6% (n = 45,338) in 2011. For diagnostic LPs, radiology (11.4% [n = 10,272] in 1991 and 48.0% [n = 43,601] in 2011) now exceeds emergency medicine, neurosciences, and all others as the dominant provider group. For therapeutic LP procedures, radiology now performs the second greatest number of LP procedures (9.0% [n = 261] in 1991 and 26.9% [n = 1737] in 2011). Although volumes remain small (< 10% of all procedures), midlevel practitioners have experienced over 100-fold growth for most services. The inpatient hospital setting remains the dominant site of service (71,385 in 1991 vs 44,817 in 2011: -37%), followed by procedures performed in the emergency department (297 in 1991 vs 26,117 in 2011: 8794%).
Over the last 2 decades, LP procedures on Medicare beneficiaries have increased, with radiology now the dominant overall provider. Although this trend may have relatively negative financial implications for radiology practices in current fee-for-service payment models, it has the potential to cement radiology's more central position through direct involvement in patient care in emerging accountable care organizations.
本研究旨在评估腰椎穿刺（LP）程序的国家趋势以及提供该服务的专业团体的相对作用。
从 1991 年至 2011 年，每年从 Medicare 医师供应商程序摘要主文件中提取 LP 汇总索赔数据。研究了按专业团体和服务地点划分的 LP 程序量。
1991 年至 2011 年间，总体 LP 程序数量增加，诊断性 LP 程序略有增加（90460 次 vs 90785 次），治疗性 LP 程序显著增加（2868 次 vs 6461 次）在 Medicare 按服务收费的受益人群中。尽管放射科医生在 1991 年进行了所有 LP 程序的 11.3%（n=10533），但在 2011 年进行了 46.6%（n=45338）。对于诊断性 LP，放射科（1991 年为 11.4%[n=10272]，2011 年为 48.0%[n=43601]）现在超过了急诊医学、神经科学和其他所有专业，成为主导服务群体。对于治疗性 LP 程序，放射科现在进行的 LP 程序数量排名第二（1991 年为 9.0%[n=261]，2011 年为 26.9%[n=1737]）。尽管数量仍然很小（<所有程序的 10%），但中级从业者的大多数服务增长了 100 多倍。住院医院仍然是主要的服务地点（1991 年为 71385 次，2011 年为 44817 次：-37%），其次是在急诊科进行的程序（1991 年为 297 次，2011 年为 26117 次：8794%）。
在过去的 20 年里，Medicare 受益人的 LP 程序有所增加，放射科现在是整体上的主要提供者。尽管这种趋势在当前的按服务收费支付模式下可能对放射科实践产生相对负面的财务影响，但它有可能通过在新兴的责任医疗组织中直接参与患者护理，巩固放射科更核心的地位。
