Smith Margaret E, Sutzko Danielle C, Beck Adam W, Osborne Nicholas H
Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI.
Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI.
Ann Vasc Surg. 2019 Jul;58:83-90. doi: 10.1016/j.avsg.2018.12.059. Epub 2019 Jan 23.
As patient care is being increasingly transitioned out of the hospital and into the outpatient setting, there is a growing interest in developing office-based angiography suites, that is, office-based laboratories. Office-based care has been associated with increased efficiency and greater patient satisfaction, with substantially higher reimbursement directly to the physicians providing care. Prior studies have demonstrated a shift of revascularization procedures to office-based laboratories with a concomitant increase in atherectomy use, a procedure with disproportionately high reimbursement in comparison to other peripheral revascularization techniques. We sought to determine provider trends in endovascular procedure volume, settings, and shifts in practice over time, specific to atherectomy.
Using Centers for Medicare & Medicaid Services Provider Utilization and Payment Data Public Use Files from 2013 to 2015, we identified providers who performed diagnostic angiography (DA), percutaneous transluminal angioplasty (PTA), stent placement (stent), and atherectomy, and procedures were aggregated at the provider level. Trends in procedures performed in office-based laboratory and facility-based settings were analyzed. Atherectomy was specifically analyzed using the total number and proportion of office-based laboratory procedures, and providers were stratified into quintiles by case volume.
Between 2013 and 2015, 5,298 providers were identified. Over this time period, the number of providers performing atherectomy increased 25.7%, with the highest quintile of atherectomy providers performing an average of 263 cases (range 109-1,455). The proportion of physicians who performed atherectomy only in the office increased from 39.8% to 50.7% from 2013 to 2015, whereas only 20.8% of physicians who performed DA, PTA, or stent in 2015 did so only in an office-based laboratory. Of the physicians with the highest atherectomy volume, 77.8% operated only in the office in 2015, and these physicians increased their atherectomy volume to 114.1% during the study period. Of those physicians who transitioned to a solely office-based laboratory practice over the study period, atherectomy volume increased 63.4%, which was disproportionate compared with the growth of their DA, PTA, and stent volume.
Over this short study period, a rapid shift into the office setting for peripheral intervention occurred, with a concomitant increase in atherectomy volume that was disproportionate to the increase in other peripheral interventions. This increase in office-based laboratory atherectomy occurred in the setting of increased reimbursement for the procedure and despite a lack of data supporting superiority over PTA/stent.
随着患者护理越来越多地从医院转向门诊环境，人们对开发基于办公室的血管造影套件（即基于办公室的实验室）的兴趣日益浓厚。基于办公室的护理与提高效率和更高的患者满意度相关联，直接为提供护理的医生提供的报销大幅增加。先前的研究表明，血管重建手术向基于办公室的实验室转移，同时旋切术的使用增加，与其他外周血管重建技术相比，该手术的报销比例过高。我们试图确定血管内手术量、手术地点的提供者趋势以及随着时间推移的实践转变，特别是针对旋切术。
使用医疗保险和医疗补助服务中心2013年至2015年的提供者利用和支付数据公共使用文件，我们确定了进行诊断性血管造影（DA）、经皮腔内血管成形术（PTA）、支架置入术（支架）和旋切术的提供者，并在提供者层面汇总手术。分析了在基于办公室的实验室和基于设施的环境中进行的手术趋势。使用基于办公室的实验室手术的总数和比例对旋切术进行了具体分析，并根据病例数量将提供者分为五等份。
在2013年至2015年期间，确定了5298名提供者。在此期间，进行旋切术的提供者数量增加了25.7%，旋切术提供者的最高五分之一平均进行263例手术（范围为109 - 1455例）。仅在办公室进行旋切术的医生比例从2013年的39.8%增加到2015年的50.7%，而2015年进行DA、PTA或支架置入术的医生中只有20.8%仅在基于办公室的实验室进行这些手术。在旋切术量最高的医生中，77.8%在2015年仅在办公室开展手术，并且这些医生在研究期间将其旋切术量增加到了114.1%。在研究期间过渡到仅在基于办公室的实验室开展实践的医生中，旋切术量增加了63.4%，与他们的DA、PTA和支架置入术量的增长相比不成比例。
在这个简短的研究期间，外周干预迅速转向办公室环境，同时旋切术量增加，与其他外周干预的增加不成比例。基于办公室的实验室旋切术的这种增加发生在该手术报销增加的背景下，尽管缺乏数据支持其优于PTA/支架。
