100 - Twelve Years of Peripheral Vascular Interventions (PVIs): An Analysis of Trends from 2011-2022

Peripheral Vascular Interventions (PVIs), including angioplasty, atherectomy, and stenting, of lower extremity vessels have been highly utilized techniques. This study aims to characterize trends in utilization of PVIs among different specialties: interventional radiologist (IR), interventional cardiologists (IC), vascular surgeons (VS), and other providers (OP), as well as place of service: Office-Based Labs (OBLs), Ambulatory Surgical Centers (ASCs), Outpatient Hospitals, and Inpatient Hospitals.

Materials and Methods:

Data was tabulated from the Centers of Medicare and Medicaid (CMS) Physician/Supplier Procedure Summary file from 2011-2022 in Microsoft Excel™. Findings were stratified by physician specialty, place of service, and anatomic location of intervention. Utilization was expressed as procedures performed per year per 100,000 Medicare beneficiaries.

Results:

Physician market share for IRs increased from 12.0% to 18.8%. VS increased from 46.6% to 50.1%, whilst IC declined from 39.8% to 28.3% in the same time period.  Overall PVI volume in the Outpatient and Inpatient Hospital settings decreased by 24.9% and 19.9% respectively since 2011. During this same period, OBLs and ASCs PVIs increased by 789.5% and 824.3% respectively. OBLs dominate the place of service market share with 53.5% of case volume while ASCs, Outpatient Hospitals, and Inpatient Hospitals hold 0.91%, 24.0%, and 21.6% of case volume respectively.

Conclusion:

The changes in physician market share reflect a greater prominence of IR in the PVI space, a welcome change as IRs begin to reclaim some of its lost dominance in the PVI space; this may be in part due to a large culture shift promoted at the national level for IRs to engage in heavy clinical practices. The growth of OBLs over the past 11 years likely reflects reimbursement changes that favor OBLs in effort to decrease hospital based procedures. However, despite their small market share, ASCs have the fastest rate of growth. This can be explained by proposed, but not enacted, reimbursement cuts to OBLs in 2014 and 2018. There were 116.2% and 103.2% yearly increases in ASC claims shortly following both proposals, which were relative outliers compared to other years. Perhaps the jumps in ASC PVIs reflect anticipation of long term changes in reimbursement. Overall, trends in PVIs reflect a complex dynamic of changing physicians with a shift away from hospital PVIs to the outpatient setting with the possibility of ASCs becoming a major player over the next few years, especially if proposed OBL reimbursement cuts come to pass.