Division of Vascular and Endovascular Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA.
Neurosurgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
J Neurointerv Surg. 2023 Sep;15(9):909-913. doi: 10.1136/jnis-2022-019297. Epub 2022 Aug 12.
This study aims to define the proportion of Medicare neuroendovascular procedures performed by different specialists from 2013 to 2019, map the geographic distribution of these specialists, and trend reimbursement for these procedures.
The Medicare Provider Utilization Database was queried for recognized neuroendovascular procedures. Data on specialists and their geographic distribution were tabulated. Reimbursement data were gathered using the Physician Fee Schedule Look-Up Tool and adjusted for inflation using the United States Bureau of Labor Statistics' Consumer Price Index Inflation calculator.
The neuroendovascular workforce in 2013 and 2019, respectively, was as follows: radiologists (46% vs 44%), neurosurgeons (45% vs 35%), and neurologists (9% vs 21%). Neurologists increased proportionally (p=0.03). Overall procedure numbers increased across each specialty: radiology (360%; p=0.02), neurosurgery (270%; p<0.01), and neurology (1070%; p=0.03). Neuroendovascular revascularization (CPT 61645) increased in all fields: radiology (170%; p<0.01), neurosurgery (280%; p<0.01), neurology (240%; p<0.01); central nervous system (CNS) permanent occlusion/embolization (CPT61624) in neurosurgery (67%; p=0.03); endovascular temporary balloon artery occlusion (CPT61623) in neurology (29%; p=0.04). In 2019, radiologists were the most common neuroendovascular specialists everywhere except in the Northeast where neurosurgeons predominated. Inflation adjusted reimbursement decreased for endovascular temporary balloon occlusion (CPT61623, -13%; p=0.01), CNS transcatheter permanent occlusion or embolization (CPT61624, -13%; p=0.02), non-CNS transcatheter permanent occlusion or embolization (CPT61626, -12%; p<0.01), and intracranial stent placement (CPT61635, -12%; p=0.05).
The number of neuroendovascular procedures and specialists increased, with neurologists becoming more predominant. Reimbursement decreased. Coordination among neuroendovascular specialists in terms of training and practice location may maximize access to acute care.
本研究旨在确定 2013 年至 2019 年期间不同专家进行的医疗保险神经血管程序的比例，绘制这些专家的地理分布图，并分析这些程序的报销趋势。
从医疗保险提供者使用数据库中查询了公认的神经血管程序。对专家及其地理分布的数据进行了制表。使用医师费用表查询工具收集报销数据，并使用美国劳工统计局消费者价格指数通胀计算器对其进行通胀调整。
2013 年和 2019 年的神经血管劳动力分别为：放射科医生（46%对 44%）、神经外科医生（45%对 35%）和神经科医生（9%对 21%）。神经科医生的比例呈比例增长（p=0.03）。每个专业的手术数量都有所增加：放射科（360%；p=0.02）、神经外科（270%；p<0.01）和神经科（1070%；p=0.03）。神经血管再血管化（CPT 61645）在所有领域均增加：放射科（170%；p<0.01）、神经外科（280%；p<0.01）、神经科（240%；p<0.01）；中枢神经系统（CNS）永久性闭塞/栓塞（CPT61624）在神经外科中增加（67%；p=0.03）；血管内临时球囊动脉闭塞（CPT61623）在神经科中增加（29%；p=0.04）。2019 年，放射科医生是除东北以外所有地区最常见的神经血管专家，而在东北，神经外科医生则占主导地位。通胀调整后的报销减少了血管内临时球囊闭塞（CPT61623，-13%；p=0.01）、中枢神经系统经导管永久性闭塞或栓塞（CPT61624，-13%；p=0.02）、非中枢神经系统经导管永久性闭塞或栓塞（CPT61626，-12%；p<0.01）和颅内支架放置（CPT61635，-12%；p=0.05）。
神经血管程序和专家的数量增加，神经科医生的比例上升。报销减少。在培训和实践地点方面，神经血管专家之间的协调可以最大限度地提高急性护理的可及性。
