Hemodialysis Access Maintenance in the Medicare Population: An Analysis Over a Decade of Trends by Provider Specialty and Site of Service
| Autor: | Bulent Arslan, Ketan Patel, Michael Ginsburg, Rana Rabei, Bishir Clayton, Mikin V. Patel, Osman Ahmed |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Percutaneous medicine.medical_treatment 030232 urology & nephrology Specialty MEDLINE Psychological intervention 030204 cardiovascular system & hematology Medicare End stage renal disease 03 medical and health sciences Arteriovenous Shunt Surgical 0302 clinical medicine Renal Dialysis medicine Humans Radiology Nuclear Medicine and imaging Practice Patterns Physicians' Vascular Patency Thrombectomy Service (business) business.industry Angiography United States Emergency medicine Current Procedural Terminology Hemodialysis Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Vascular and Interventional Radiology. 29:159-169 |
| ISSN: | 1051-0443 |
| DOI: | 10.1016/j.jvir.2017.09.028 |
| Popis: | Purpose To evaluate annual national trends in hemodialysis access maintenance procedures in the Medicare population by specialty and setting. Methods Medicare Physician Supplier Procedure Summary Master Files between 2005 and 2015 were analyzed for procedure codes of hemodialysis access angiography and percutaneous thrombectomy. Using physician specialty codes, component procedure volume for endovascular services were queried for radiology, medicine, and surgery. Data entries were analyzed by provider specialty and place of service. Average submitted and allowed charges per intervention were extracted. Linear regression modeling was used to identify trends in number of and allowed charges by specialty and practice setting. Results Between 2005 and 2015, the frequency of dialysis access angiography for Medicare fee-for-service beneficiaries increased by a total of 74.71% (211,181 to 368,955). Specialty-specific analysis demonstrated volume increases of 220.21% (22,128 to 101,109) for surgery, 249.02% (32,690 to 114,094) for medicine, and 2.81% (135,564 to 139, 367) for radiology. By 2015, an increased trend from hospital-based to non-hospital-based procedures associated with significantly higher reimbursement rates to providers (+18,798 non-hospital-based cases/year, $46.95/year, P ≤ .001) was also observed, with medicine performing the highest volume of non-hospital-based procedures. In this period, there was also a modest total overall increase of percutaneous thrombectomy procedures by 7.75% (61,485 to 66,250). Conclusions The frequency of endovascular hemodialysis access maintenance procedures in the Medicare fee-for-service program has increased from 2005 to 2015, with the majority market share transitioning from radiologists to non-radiologists. Similarly, most access maintenance in this time period changed from hospital-based to non-hospital-based interventions. |
| Databáze: | OpenAIRE |
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