Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ.
Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ.
Ann Vasc Surg. 2021 Jan;70:20-26. doi: 10.1016/j.avsg.2020.07.010. Epub 2020 Jul 29.
Public focus on health care spending has increased attention on variation in practice patterns and overutilization of high-cost services. Mainstream news reports have revealed that a small number of providers account for a disproportionate amount of total Medicare payments. Here, we explore variation in Medicare payments among vascular surgeons and compare practice patterns of the most highly reimbursed surgeons to the rest of the workforce.
2016 Medicare Provider Utilization Data were queried to identify procedure, charge, and payment data to vascular surgeons, identified by National Provider Identification taxonomy. Commonly performed services (>10/year) were stratified into categories (endovascular, open surgery, varicose vein, evaluation and management, etc.). Practice patterns of vascular surgeons comprising the top 1% Medicare payments (n = 31) were compared with the remainder of the workforce (n = 3,104).
In 2016, Medicare payments to vascular surgeons totaled $589 M. 31 vascular surgeons-1% of the workforce-received $91 million (15% of total payments). Practice patterns of the 1% differed significantly from the remainder of vascular surgeons (P < 0.05), with endovascular procedures accounting for 85% of their reimbursement. Specifically, the 1% received 49% of total Medicare payments for atherectomy ($121 M), 98% of which were performed in the office setting.
One percentage of vascular surgeons receive an inordinate amount of total Medicare payments to the specialty. This discrepancy is due to variations in volume, utilization, and site of service. Disproportionate use of outpatient atherectomy in a small number of providers, for example, raises concerns regarding appropriateness and overutilization. Given current scrutiny over health care spending, these findings should prompt serious discussion regarding the utility of personal and societal self-regulation.
公众对医疗保健支出的关注增加了对实践模式的差异和高成本服务过度利用的关注。主流新闻报道揭示，少数提供者占 Medicare 总付款的不成比例的大部分。在这里，我们探讨了血管外科医生之间的 Medicare 付款差异，并比较了报销最高的外科医生与其他工作人员的实践模式。
2016 年 Medicare 提供者使用数据被查询，以确定血管外科医生的程序、收费和付款数据，这些数据由国家提供者识别分类法确定。经常进行的服务（> 10/年）分为几类（血管内、开放手术、静脉曲张、评估和管理等）。构成 Medicare 支付前 1%的血管外科医生（n = 31）的实践模式与其余工作人员（n = 3104）进行了比较。
2016 年，血管外科医生的 Medicare 支付总额为 5.89 亿美元。31 名血管外科医生-占劳动力的 1%-获得了 9100 万美元（占总付款的 15%）。1%的医生实践模式与其余的血管外科医生有显著差异（P < 0.05），其中血管内手术占其报销的 85%。具体来说，1%的医生获得了总 Medicare 支付的 49%用于旋磨术（1.21 亿美元），其中 98%是在办公室进行的。
1%的血管外科医生获得了该专业 Medicare 总付款的不成比例的大部分。这种差异是由于数量、利用率和服务地点的差异造成的。例如，少数提供者过度使用门诊旋磨术，引起了对其适当性和过度使用的关注。鉴于当前对医疗保健支出的审查，这些发现应该促使人们就个人和社会自我监管的效用进行认真讨论。
