Study Shows Increase in Rate of Outpatient PVI Following Medicare Reimbursement Adjustment

The rate of peripheral vascular intervention (PVI) and atherectomy in outpatient facilities and office-based clinics increased dramatically following a change in Medicare reimbursement rates to PVI, according to a study published March 2 in the Journal of the American College of Cardiology. The modification, which took place in 2008, was intended to encourage more efficient outpatient use of PVI in the U.S.

Using data from 39,339 fee-for-service Medicare beneficiaries, researchers examined the rate of PVI from 2006 – 2011, specifically evaluating the type of procedure and clinical setting. During the five years of the study, 31,248 patients underwent PVI – 27 percent angioplasty, 22 percent atherectomy, and 50 percent stent implantation – 7,325 had surgical revascularization procedures (lower-extremity bypass or endarterectomy), and 766 underwent hybrid revascularization procedures (PVI and surgical revascularization on the same claim). The clinical settings were broken down into inpatient facility, outpatient facility, office-based clinic or ambulatory surgery center. 

The results of the study showed that while PVI rates decreased in inpatient hospital settings (210 in 2006 to 151.6 in 2011), the rate of PVI done in outpatient hospital settings (185 in 2006 to 229 in 2011) and office-based clinics (six in 2006 to 38 in 2011) increased significantly. Further, the rate of atherectomy in the same outpatient settings spiked from 39 in 2006 to 84 in 2011. In conjunction with these increases in outpatient practices after the Medicare modification in 2008, “Medicare payments for outpatient and office-based clinic atherectomies were the highest reimbursed procedures.”

The authors of the study note that their findings “shed light on possible unintended consequences of these payment decisions... The significant rise in atherectomy use during the study period in outpatient facilities and office-based clinics is likely related to higher reimbursement for [these] procedures.” The authors add that further site improvements in technology for use in PVI as another possible explanation for their results.

“A desire to be at the forefront of one’s specialty is part of the culture for most physicians, and being proficient in the latest technology is highly desirable for specialists,” remarked Paul Heidenreich, MD, FACC, in an accompanying editorial comment. “Physicians should not be expected to choose the most cost-effective treatment for society.”

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Ambulatory Surgical Procedures, Atherectomy, Endarterectomy, Fee-for-Service Plans, Health Care Costs, Inpatients, Medicare, Outpatients, Research Personnel, Specialization, Stents

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