Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
J Am Coll Cardiol. 2015 Mar 10;65(9):920-7. doi: 10.1016/j.jacc.2014.12.048.
Peripheral vascular intervention (PVI) is an effective treatment option for patients with peripheral artery disease (PAD). In 2008, Medicare modified reimbursement rates to encourage more efficient outpatient use of PVI in the United States.
The purpose of this study was to evaluate trends in the use and clinical settings of PVI and the effect of changes in reimbursement.
Using a 5% national sample of Medicare fee-for-service beneficiaries from 2006 to 2011, we examined age- and sex-adjusted rates of PVI by year, type of procedure, clinical setting, and physician specialty.
A total of 39,339 Medicare beneficiaries underwent revascularization for PAD between 2006 and 2011. The annual rate of PVI increased slightly from 401.4 to 419.6 per 100,000 Medicare beneficiaries (p = 0.17), but the clinical setting shifted. The rate of PVI declined in inpatient settings from 209.7 to 151.6 (p < 0.001), whereas the rate expanded in outpatient hospitals (184.7 to 228.5; p = 0.01) and office-based clinics (6.0 to 37.8; p = 0.008). The use of atherectomy increased 2-fold in outpatient hospital settings and 50-fold in office-based clinics during the study period. Mean costs of inpatient procedures were similar across all types of PVI, whereas mean costs of atherectomy procedures in outpatient and office-based clinics exceeded those of stenting and angioplasty procedures.
From 2006 to 2011, overall rates of PVI increased minimally. However, after changes in reimbursement, PVI and atherectomy in outpatient facilities and office-based clinics increased dramatically, neutralizing cost savings to Medicare and highlighting the possible unintended consequences of coverage decisions.
外周血管介入（PVI）是治疗外周动脉疾病（PAD）患者的有效治疗选择。2008 年，医疗保险修改了报销率，以鼓励在美国更有效地在门诊使用 PVI。
本研究旨在评估 PVI 的使用和临床环境的趋势，以及报销变化的影响。
使用 2006 年至 2011 年医疗保险按服务付费受益人的 5%全国样本，我们按年份、手术类型、临床环境和医生专业检查了 PVI 的年龄和性别调整后的比率。
2006 年至 2011 年，共有 39339 名 Medicare 受益人为 PAD 进行了血运重建。每年 PVI 的比率从 401.4 略微增加到 419.6 每 100000 Medicare 受益人（p=0.17），但临床环境发生了变化。住院环境中的 PVI 比率从 209.7 下降到 151.6（p<0.001），而门诊医院（184.7 至 228.5；p=0.01）和诊所（6.0 至 37.8；p=0.008）的比率增加。在研究期间，门诊医院环境中的旋切术使用率增加了两倍，诊所中的使用率增加了 50 倍。所有类型的 PVI 中，住院程序的平均成本相似，而门诊和诊所中旋切术程序的平均成本超过了支架和血管成形术程序的成本。
从 2006 年到 2011 年，PVI 的总体比率略有增加。然而，在报销变化之后，门诊和诊所中的 PVI 和旋切术大幅增加，抵消了医疗保险的成本节约，并突出了覆盖决策可能带来的意外后果。
