Practice Patterns of Vascular Surgery's "1%".

Autor: Sheaffer WW; Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ. Electronic address: Sheaffer.william@mayo.edu., Davila VJ; Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ., Money SR; Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ., Soh IY; Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ., Breite MD; Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ., Stone WM; Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ., Meltzer AJ; Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ.
Jazyk: angličtina
Zdroj: Annals of vascular surgery [Ann Vasc Surg] 2021 Jan; Vol. 70, pp. 20-26. Date of Electronic Publication: 2020 Jul 29.
DOI: 10.1016/j.avsg.2020.07.010
Abstrakt: Background: 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.
Methods: 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).
Results: 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.
Conclusions: 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.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE