University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.
Department of Radiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Suite E204, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
Abdom Radiol (NY). 2022 Feb;47(2):885-890. doi: 10.1007/s00261-021-03390-4. Epub 2021 Dec 27.
The purpose of this study is to analyze trends in Medicare volume and reimbursement for percutaneous and surgical ablation as well as laparoscopic and open partial nephrectomy for treatment of small renal tumors from 2010 to 2018.
Claims from the Medicare Part B Physician/Supplier Procedure Summary from 2010 to 2018 were extracted using CPT codes for percutaneous and surgical renal ablation and surgical and laparoscopic partial nephrectomy. Facility reimbursement and relative value units (RVUs) were obtained using the Centers for Medicare & Medicaid Services physician fee schedule look-up tool.
Volume of percutaneous ablation increased from 2539 to 4571 procedures (80.0%). Specifically, percutaneous cryoablation became the dominant technique, increasing from 1434 to 2981 procedures (107.9%). Overall, volume of partial nephrectomy also increased by 40.4%, driven by an increase in laparoscopic partial nephrectomy from 3227 to 7770 procedures (140.8%) with a decrease in open partial nephrectomy from 3489 to 1661 (- 52.4%). Volume of surgical ablations also decreased 72.7% from 1260 to 344 procedures. In 2018, reimbursement was $358.56 for percutaneous radiofrequency ablation, $481.32 for percutaneous cryoablation, $1216.43 for surgical radiofrequency ablation, $1269.35 for surgical cryoablation, $1381.67 for open partial nephrectomy, and $1552.66 for laparoscopic partial nephrectomy.
There has been a trend toward minimally invasive techniques for treatment of small renal tumors among Medicare patients. Laparoscopic partial nephrectomy has become the dominant treatment. In the setting of evidence showing comparable outcomes with surgery as well as lower costs to insurers, the volume of percutaneous ablation has also markedly increased.
本研究旨在分析 2010 年至 2018 年期间，医疗保险对经皮和手术消融术以及腹腔镜和开放性部分肾切除术治疗小肾肿瘤的数量和报销的趋势。
使用 2010 年至 2018 年医疗保险 B 部分医生/供应商程序摘要中的 CPT 代码提取经皮和手术肾消融术以及手术和腹腔镜部分肾切除术的索赔。使用医疗保险和医疗补助服务中心医生费用表查询工具获取设施报销和相对价值单位 (RVU)。
经皮消融术的数量从 2539 例增加到 4571 例（80.0%）。具体来说，经皮冷冻消融术成为主要技术，从 1434 例增加到 2981 例（107.9%）。总体而言，部分肾切除术的数量也增加了 40.4%，这是由于腹腔镜部分肾切除术从 3227 例增加到 7770 例（140.8%），而开放性部分肾切除术从 3489 例减少到 1661 例（减少 52.4%）。手术消融术的数量也从 1260 例减少到 344 例，减少了 72.7%。2018 年，经皮射频消融术的报销金额为 358.56 美元，经皮冷冻消融术为 481.32 美元，手术射频消融术为 1216.43 美元，手术冷冻消融术为 1269.35 美元，开放性部分肾切除术为 1381.67 美元，腹腔镜部分肾切除术为 1552.66 美元。
医疗保险患者治疗小肾肿瘤的趋势是采用微创技术。腹腔镜部分肾切除术已成为主要治疗方法。在有证据表明手术效果相当且对保险公司成本更低的情况下，经皮消融术的数量也显著增加。
