University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, United States of America.
University of Pittsburgh Medical Center (UPMC), Department of Radiology, PUH Suite 200, 200 Lothrop Street, Pittsburgh, PA 15213, United States of America.
Clin Imaging. 2021 Oct;78:201-205. doi: 10.1016/j.clinimag.2021.05.008. Epub 2021 May 18.
The purpose of this study is to provide an update on trends in physician volume and payments for enteric tube placement and maintenance procedures by method, provider specialty, and practice setting amongst Medicare beneficiaries from 2010 to 2018.
Claims from the Medicare Part B Physician/Supplier Procedure Summary Master File (PSPSMF) for the years 2010 to 2018 were extracted using current procedural terminology (CPT) codes for gastrostomy and jejunostomy placement, as well as conversion of gastrostomy to gastrojejunostomy, fluoroscopy guided and non-image guided replacement. Total volumes and provider reimbursement were analyzed by provider specialty and practice setting.
Volume of de novo placement of all enteric tubes decreased from 157,123 to 106,549 (-32.2%). While endoscopic placement decreased from 133,658 to 81,171 (-39.3%), the volume of fluoroscopic placement increased from 17,999 to 21,277 (18.2%). Fluoroscopic placement was largely performed by interventional radiology (IR) (91.7% in 2018). Surgical placement decreased from 5466 to 4101 (-25.0%). Volume of fluoroscopic replacement increased from 24,799 to 38,470 (55.1%), while non-image guided replacements decreased from 61,377 to 55,116 (-10.2%). Share of both fluoroscopic and non-image guided replacements by advanced practice providers (APPs) more than doubled over this time period.
De novo placement of enteric tubes decreased from 2010 to 2018, likely related to increased awareness of the complications and limited benefits in scenarios such as end of life care. In contrast to the diminishing volume for gastroenterologists, there was increased participation by IR in both placement and maintenance procedures under fluoroscopic guidance.
Decreasing placement of enteric tubes suggests shifting attitudes and recommendations around end-of-life care. Increase in role by IR/APPs highlights the need for comprehensive care in these patients.
本研究旨在提供 2010 年至 2018 年期间，医疗保险受益人群中，通过方法、提供者专业和实践环境对肠内管放置和维护程序的医师数量和支付情况的最新趋势。
从 Medicare 部分 B 医师/供应商程序摘要主文件（PSPSMF）中提取 2010 年至 2018 年的使用当前程序术语（CPT）代码的胃造口术和空肠造口术的放置，以及胃造口术到胃空肠吻合术、透视引导和非图像引导的转换。根据提供者专业和实践环境分析总数量和提供者报销情况。
所有肠内管的新放置数量从 157123 减少到 106549（-32.2%）。虽然内镜放置从 133658 减少到 81171（-39.3%），但透视放置的数量从 17999 增加到 21277（18.2%）。透视放置主要由介入放射学（IR）完成（2018 年为 91.7%）。手术放置从 5466 减少到 4101（-25.0%）。透视更换数量从 24799 增加到 38470（55.1%），而非图像引导的更换从 61377 减少到 55116（-10.2%）。在这段时间内，高级实践提供者（APPs）的透视和非图像引导的更换比例增加了一倍以上。
从 2010 年到 2018 年，肠内管的新放置数量减少，可能与人们对并发症的认识提高以及在生命末期护理等情况下的有限获益有关。与胃肠病学家的数量减少形成对比的是，在透视引导下，IR 参与了放置和维护程序的数量增加。
肠内管放置数量的减少表明人们对生命末期护理的态度和建议发生了变化。IR/APPs 作用的增加凸显了这些患者全面护理的必要性。
